Socio-economic differentials in the health-related quality of life of Australian children: results of a national study

OBJECTIVE: To examine differences in health-related quality of life (HRQL) of children living in different socio-economic contexts in Australia. METHODS: Parental reports describing the HRQL and socio-economic status of a random national sample of 3,597 school-age children were obtained using the Child Health Questionnaire (CHQ) and a standardised socio-economic interview. Response rate was 70%. RESULTS: Children in families of higher income, whose parents had more years of schooling and were employed and children who lived in two-parent, original families had significantly higher HRQL across a range of domains assessed by the CHQ. CONCLUSION: Children from lower socio-economic backgrounds in Australia have a significantly more negative experience of health and wellness. Such differences may well increase unless deliberate political attention is given to addressing the widening differences in relative wealth in Australia.     

Health-related quality-of-life measures for long-term follow-up in children after major trauma

OBJECTIVE: Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning using the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO). METHODS: The Medline and EMBASE databases were searched in all years up to October 2007 for generic HRQL measures suitable for children aged 5-18 years old and validated in English or Dutch. Measures were reviewed with respect to the age range for which the measure was suitable and reliability, validity, and content related to the ICF. RESULTS: The search resulted in 1,235 hits and 21 related articles. Seventy-nine papers met the inclusion criteria, describing in total 14 measures: Child Health and Illness Profile Adolescent and Child Edition (CHIP-AE/CE), Child Health Questionnaire Child and Parent Forms (CHQ-CF87/PF50/PF28), DISABKIDS, Functional Status II (FS II)(R), Health Utilities Index Mark 2 (HUI 2), KIDSCREEN 52/27, KINDL, Pediatric Quality of Life Inventory (PedsQL), TNO Institute of Prevention and Health and the Leiden University Hospital (TNO-AZL), TNO-AZL Children's Quality Of Life (TACQOL), and Youth Quality of Life Instrument--Research Version (YQOL-R). Measures that were suitable for a large age range were CHQ-PF50/PF28, DISABKIDS, FS II(R), HUI 2, KIDSCREEN, PedsQL, and TACQOL. All measures had moderate to good psychometric properties, except for CHQ-PF50/PF28, KINDL, and TACQOL, which had either low internal consistency or bad test-retest reliability. The measures that covered more than six chapters of the ICF domains were CHIP-AE/CE, CHQ-CF87/PF50, DISABKIDS, KIDSCREEN-52, PedsQL, and TACQOL. CONCLUSIONS: DISABKIDS, KIDSCREEN 52, and PedsQL are suitable for long-term follow-up measurement of HRQL in children after major trauma. They cover a large age range, have good psychometric properties, and cover the ICF substantially.     

The Relationship between Asthma Severity,Family Functioning and the Health-Related Quality of Life of Children with Asthma

This study compared the health-related quality of life (HRQL) of 236 children with mild or moderate/severe asthma with that of a large representative sample of children in the general community. The study also examined the relationship between the HRQL of children with asthma and their demographic characteristics, asthma severity and family functioning. Children with asthma had a significantly poorer HRQL than other children in the community. Amongst the children with asthma, parents reported that children living in single-parent families had poorer physical health, mental health and social functioning than children in two-parent families. There was a significant relationship between the mental health of children with asthma and family functioning but no significant relationship between their physical health and family functioning. These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. A better understanding of these relationships will facilitate the development of new interventions to help children with asthma. This revised version was published online in June 2006 with corrections to the Cover Date.     

Preliminary psychometric evaluation of the Child Health Ratings Inventory (CHRIs) and Disease-Specific Impairment Inventory-Hematopoietic Stem Cell Transplantation (DSII-HSCT) in parents and children

Purpose: To describe the initial results of the Child Health Ratings Inventory (CHRIs), 20-item generic health-related quality of life (HRQL) instrument and the 10-item disease-specific (DS) module, the Disease Specific Impairment Inventory-Hematopoietic Stem Cell Transplantation (DSII-HSCT), for children and adolescents, ages 5–18 years and their parents following HSCT. Study design: Using cross sectional design, 122 children with a median age of 11 years (range 5.0–18 years) completed the questionnaire (CHRIs +DSII-HSCT) with research assistance. Seventy-four parents independently completed a parallel version of the questionnaire; health care providers assigned a global clinical severity rating. Results: The generic core includes four domains: physical, role, and emotional functioning, and energy. The DS module has three domains: worry, hassles, and body image. The Cronbach’s alpha for parents and for older children (8 years and over) exceeded 0.70 for all generic and DS domains. While the range of alpha coefficients was lower for younger children, ages 5–7 year, only the alpha coefficient for one domain (energy) was less than 0.70. The instrument satisfactorily discriminated between clinically important groups: those early in the transplant process (<6 months) versus those later (>12 months) and by provider-assigned clinical severity ratings. Conclusion: results suggest that the CHRIs generic core and its DSII-HSCT module is a promising measure of HRQL after pediatric HSCT. Although parent and child reports were moderately correlated and revealed complementary results, the unique perspectives of both raters provide a more complete picture of HRQL. Longitudinal application is underway to further characterize the measurement properties of the CHRIs and to determine the instrument’s responsiveness and sensitivity to change over time in this vulnerable population.     

A two-year prospective study of the health-related quality of life of children with chronic illness – the parents’ perspective

The aim of this study was to assess prospectively changes in the health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF). One hundred and twenty-two parents of children aged 10–16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Parents described their childrens HRQL using the Child Health Questionnaire (PF98) at baseline, 6, 12, 18 and 24 months post-baseline. They reported that the general health of children with CF was significantly worse than that of children with asthma and diabetes at baseline. In other domains there were few differences between the HRQL of children in the three groups. In several domains, the HRQL of children with asthma or diabetes improved over the 2years of the study. This improvement was less evident for children with CF.     

Maternal Mental Health and Pediatric Health Care Use Among a National Sample of Medicaid- and SCHIP-Insured Children

While the literature has shown that health care use is associated with mental health status, little is known about the relationship between a mother’s mental health status and her children’s health care use. This study examined the association of maternal mental health status and pediatric health care for their children in a nationally representative sample of 17,830 women parenting children ages 0–17 insured through Medicaid or a State Children’s Health Insurance Program (SCHIP). Mothers with a mental health problem were significantly more likely to be poorer, single parents, with lower levels of education, fewer parenting supports, and greater difficulty coping with parenting than mothers without a mental health problem; however, they reported comparable receipt of pediatric health care for their children, indicating their resilience as caretakers. The findings also suggest that all Medicaid- or SCHIP-eligible families could benefit from targeted engagement strategies linking them with consistent and appropriate sources of pediatric health care.     

Gradients in the Health Status and Developmental Risks of Young Children: The Combined Influences of Multiple Social Risk Factors

Objectives: To analyze child vulnerability as a profile of multiple risk factors for poorer health based on race/ethnicity, social class (maternal education and family poverty status), child health insurance coverage, and maternal mental health. Profiles are examined in relation to disparities in the health status and developmental risks of young children. Data Sources: Cross-sectional data on 2,068 children ages 4–35 months from the 2000 National Survey of Early Childhood Health. Study Design: Multiple logistic regression models are used to examine risk profiles in relation to child health status and developmental risk (based on parent concerns about development). The profiles are also examined in relation to three measures of basic access to health care: telephone contact with a physician, well-child visit in the past year, and missed or delayed needed care. Principal Findings: About one-third of (or 3.1 million) young children in the United States have two or more risk factors (RF) for poor health. Controlling for other family factors, having more RFs is associated with poorer health status (i.e., percent reported “good/fair/poor” vs. “excellent/very good”) and being higher risk for developmental delays. For example, the likelihood of having either poorer health or higher developmental risk increases with each RF (vs. zero): 1 RF (OR = 1.70, CI: 1.20–2.38), 2 RFs (OR = 3.28, CI: 2.27–4.73), 3 RFs (OR = 4.69, CI: 2.84–7.73), 4 RFs (OR = 14.58, CI: 4.98–42.64). Higher RFs were also associated with poorer health care access. Conclusions: This study demonstrates a dose–response relationship of higher risk profiles with poorer child health status and higher developmental risk. Because children with higher profiles of risk are also more likely to lack access to care, this suggests that children who most need care have the greatest difficulty obtaining it. Addressing health gradients for vulnerable children will require explicit attention to these multiple, overlapping risk factors.     

儿童心理问题对生活质量的影响分析

目的探讨心理问题对儿童生活质量的影响,为儿童心理问题干预提供依据。方法以杭州市某小学三~六年级学生370名为调查对象,利用儿少主观生活质量问卷、Rutter儿童行为问卷、儿童焦虑性情绪障碍筛查表和儿童抑郁障碍自评量表作为评估工具进行调查。结果父母报告有行为问题和本人报告有抑郁障碍或焦虑障碍儿童的主观生活质量各个维度都明显低于正常组儿童(P值均<0.01)。A行为对主观生活质量的各个维度都有明显的负面影响(P<0.05),而N行为对家庭生活与自我认识维度无明显影响(P=0.190,0.898)。结论儿童各种心理问题对主观生活质量各方面都会产生不良影响,应予以高度关注。     

A longitudinal analysis of mental health mobility in Britain

This paper is concerned with quantifying the level of mental health mobility in the British Household Panel Survey (BHPS). We investigate whether the extent of intertemporal fluctuations in mental health is different across categories of socio-economic group such as income quintiles, educational attainment and social class. Our measure of mental health is the 12-item version of the General Health Questionnaire (GHQ) that serves as a self-administered screening test aimed at detecting psychiatric disorders. Using 11 waves of the BHPS and a variety of methods we show there is much mobility in mental health from one wave to the next. Further the extent of mobility varies across socio-economic categories with greatest persistence observed in more disadvantaged groups. In general, these groups suffer poorer mental health and experience more periods of ill-health. Our results have implications for the design of appropriate prevention policies targeting mental illness within different risk groups, and also for the measurement of long-term inequalities in mental health across socioeconomic groups.     

Parental Nativity Affects Children’s Health and Access to Care

Objective To examine the effect of parental nativity on child health and access to health care. Data Source The 2002 National Survey of America’s Families. Results Among US children, 14% have foreign-born parents; 5% have one foreign- and one native-born parent (“mixed-nativity”). In multivariate logistic regression analyses, children with foreign-born parents were less likely than children with US-born parents to be perceived in “very good” or “excellent health” [OR = 0.68; 95% CI (0.56–0.82)] and to have a usual health care site [OR = 0.52 (0.38–0.69)]; having mixed-nativity parents is associated with better perceived child health. These effects persisted for minority, but not white, children. Regardless of race and ethnicity, non-citizen children have worse access to care. Conclusion Efforts to improve children of immigrants’ health and access to care should focus on families in which both parents are immigrants, particularly those who are ethnic or racial minorities. Efforts to increase use of health services should focus on non-citizen children.     

Psychometric validation of the child health questionnaire (CHQ) in a sample of children and adolescents with attention-deficit/hyperactivity disorder

Measuring health-related quality of life (HRQL) in children with attention-deficit/hyperactivity disorder (ADHD) in clinical trials can complement efficacy measures, offering a complete picture of the impact of disease and treatment on overall well-being. The purpose of the current study was to psychometrically validate a multidimensional, generic HRQL instrument completed by parents of children with ADHD. A total of 921 children and adolescents with ADHD participated in a clinical study of atomoxetine. Subjects parents completed the 50-item Child Health Questionnaire-Parent Version (CHQ-PF50) at baseline and week 10. ADHD symptoms and behavioral problems were assessed using parent and clinician rating scales. Internal consistency reliability at baseline was 0.88 for the CHQ-PF50 Psychosocial Summary Score, ranging from 0.53 to 0.91 for subscale scores. Construct validity was supported by statistically significant correlations between CHQ-PF50 psychosocial scores and parent and clinician symptom ratings. Several methods were used to determine clinically meaningful differences in patient outcomes: inter- and intra-patient mean CHQ-PF50 change scores were tested and standard error of measurement (SEM) and effect sizes were calculated. Study results indicate the CHQ-PF50 is reliable, valid, and responsive to change in ADHD symptoms, suggesting it may provide a means of assessing HRQL outcomes associated with treatments for ADHD.     

Health-related quality of life of children and adolescents with chronic illness – a two year prospective study

The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.     

Validity, reliability and acceptability of the Japanese version of the General Well-Being Schedule (GWBS)

The General Well-Being Schedule (GWBS) is a widely used, self-administered questionnaire to measure subjective well-being. It contains 18 items and was originally hypothesized to have six domains; however, the following studies suggest other factorial models. We devised the schedule's Japanese edition following the standard procedure and tested its psychometric properties considering Japanese cultural characteristics. Subjects were 1224 middle-aged participants undergoing health checkups in Adachi, Tokyo. The reliability of the original version was high: alpha coefficient, 0.90; test–retest Pearson's correlation coefficient, 0.81; and intra-class correlation coefficient, 0.85. Confirmatory factor analyses supported the structural validity of the 6-factor, the following 3-factor and 4-factor models (goodness of fit index: 0.932, 0.946 and 0.937, respectively). A new 3-factor model developed after the exclusion of item 11, which had no correlation with the other variables, was proved to have a higher fitness index (0.958) than the other models. This 17-item version showed adequate reliability (α coefficient, 0.91; test–retest Pearson's correlation coefficient, 0.81; and intra-class correlation coefficient, 0.85) and concurrent validity compared with the General Health Questionnaire, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale, Self-rating Depression Scale and Profile Of Mood State (correlation coefficients: −0.75 to −0.53). The median time required to complete the schedule was five minutes. Completing this instrument was easy for 80% of the subjects. These findings attest to the adequacy of the 17-item Japanese GWBS for the comprehensive assessment of individual inner state. This revised version was published online in June 2006 with corrections to the Cover Date.     

Health related quality of life in 10-year-old schoolchildren

Objective  The purpose of this study was to investigate the health related quality of life (HRQL) in a total cohort of general school children. Methods  The study population consisted of the children starting 4th grade (age 9–10) in Finnish primary schools in autumn 2004 (n = 1,346) and their parents in a city of 175,000 inhabitants. Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0) was used for assessment of HRQL. The response rate was 81% for the children (n = 1,091). Most children had parents who participated (n = 999). Results  The children reported highest HRQL mean values in physical (85.00, SD 10.95) and social (84.71, SD 14.28), and lowest in school (78.89, SD 14.53) and emotional (75.43, SD 15.67), functioning scales. Girls reported significantly lower emotional (t = −2.43, P = 0.02) functioning than boys. Child self reports show lower social (t = −2.57, P = 0.01) and school (t = −3.44, P = 0.0006) functioning, and higher emotional (t = 5.82, P < 0.0001) and physical (t = 4.79, P < 0.0001) functioning than their parent-proxy assessments. Conclusions  Interventions aiming at supporting the emotional and school functioning of the school children are recommended. Parents may overestimate the social and school functioning and underestimate the physical and emotional functioning compared to their children’s own perceptions.     

Meeting Children's Mental and Physical Health Needs in Child Welfare: The Importance of Caregivers

Caregivers in the child welfare system are an important element in ensuring that mental and pediatric health services for their children are utilized appropriately. The high prevalence of mental and physical health problems of children in the child welfare system along with the inadequate utilization of health services make the role of caregivers essential for improving health outcomes. This article explores the barriers to meeting the health needs of this vulnerable population of children and how different types of caregivers (unrelated foster, kinship foster, and birth parents) utilize mental and pediatric health services. Child welfare caseworkers need to increase their communication with caregivers, assess adherence to health care recommendations, and help alleviate barriers to care.     

Preparing Child Care Health Consultants to Address Childhood Overweight: A Randomized Controlled Trial Comparing Web to In-Person Training

Objectives Child care centers have recently become targets for overweight prevention efforts directed at young children. Child Care Health Consultants (CCHCs), who provide consultation to these centers, receive little training on the basic nutrition and physical activity principles important for the promotion of child healthy weight. Traditional approaches, such as in-person training, are limited in their ability to disseminate health information to a geographically diverse population of health professionals. The purpose of this study was to determine if web-based training is as effective as in-person training. Methods A randomized controlled trial was conducted between August 2005 and June 2006 with 50 CCHCs. Web-based and in-person trained CCHCs were compared to each other and to controls. The main outcome of this study was performance on a test of nutrition knowledge related to childhood overweight measured by a 28-item multiple choice test administered pre- and post-training. Results Results from the ANCOVA model suggest that web trained CCHCs performed similarly to in-person trained CCHCs on the knowledge test (P < .0001). Additionally, both training groups improved significantly compared to controls (P < .0001 for each group). Conclusions This study found no significant differences in post-training knowledge between in-person and web trained Child Care Health Consultants. Scores on the post-training knowledge test were within 0.5 points for the in-person and web trained groups. These results demonstrate that web-based instruction is as effective as in-person training on improving basic nutrition and physical activity knowledge for promoting healthy weight in preschool children.     

Health-related quality of life in children with obstetrical brachial plexus palsy

Purpose

We aimed to determine the health-related quality of life (HRQL) of children with obstetrical brachial plexus palsy (OBPP) and examine its association with gender, age, injury level, injured side, and functional status.

Methods

We conducted a controlled, cross-sectional study including 70 children with OBPP. Fifty-two age-matched children without any health problems were included as controls. HRQL was assessed with the short parent form of the Child Health Questionnaire (CHQ-PF28), and functional status was measured using the active movement scale (AMS).

Results

Children with OBPP scored significantly lower on most of the CHQ-PF28 subscales than the healthy controls (p < 0.05). Gender or age did not significantly affect scores in any domain (p > 0.05). CHQ-PF28 scores showed that there were significant differences according to the side of injury between groups, especially in the “parental impact-time” and “family activities” domains (p < 0.05). There were no statistically significant differences in CHQ-PF28 scores between groups that had an upper trunk involvement and total injury groups (p > 0.05), except in the “bodily pain/discomfort” domain (p < 0.05). The AMS score was weakly to moderately correlated with the “mental health” and “parental impact-time” and “general health perceptions” domains.

Conclusion

The study demonstrated that children with OBPP have a poorer HRQL than their healthy peers. Side of injury, limitations in shoulder flexion, shoulder internal rotation, elbow flexion, elbow extension, and forearm supination were important factors affecting the HRQL of the children. The health concepts and factors discussed in the study can guide clinicians aiming to improve QoL of children with OBPP.     

Pediatric mental health problems and associated burden on families

Approximately 20% of children in the United States have mental health problems. The factors associated with childhood mental health problems and the associated burdens on families are not well understood. Therefore, our goals were to profile mental health problems in children to identify disparities, and to quantify and identify correlates of family burden. We used the National Survey of Children's Health, 2003 (n?=?85,116 children aged 3–17 years) for this analysis. The prevalence, unadjusted and adjusted odds ratios (AOR) of mental health problems and family burden were calculated for children by child-, family- and health systems-level characteristics. The prevalence of mental health problems among children aged 3–17 years was 18%. The odds of mental health problems were higher for boys, older children, children living in or near relative poverty, those covered by public insurance, children of mothers with fair or poor mental health, children living in homes without two parents, children without a personal doctor or nurse and children with unmet health care needs. Among families with children with mental health problems, 28% reported family burden. Correlates of family burden included white race, severity, older age, higher income, non-two-parent family structure and having a mother with mental health problems. In conclusion, childhood mental health problems are common, and disproportionally affect children with fewer family and health care resources. Families frequently report burden, especially if the mental health problem is moderate to severe, but the correlates of family burden are not the same correlates associated with mental health problems. Understanding those highest at risk for mental health problems and family burden will help assist clinicians and policy makers to ensure appropriate support systems for children and families.     

AIDS in the family and community: The impact on child health in Malawi

Pediatric HIV infections jeopardize children’s health and survival. Much less is known about how the experiences of being orphaned, living with chronically ill parents, or living in a severely affected community impact child health. Our study responds by examining which HIV/AIDS-related experiences place children at greatest risk for poor health. Data from the 2004–2005 Malawi Integrated Household Survey were analyzed using logistic multilevel modeling to examine whether HIV/AIDS-related experiences within the family and community predicted reported health status among children age 6–17 years. We found higher burdens of acute and chronic morbidity for children whose parents have an AIDS-related illness. No other AIDS-related exposure, including orphanhood and recent household deaths, demonstrated a clear relationship with health status. Children living with sick parents may be at increased risk due to the spread of infectious disease and receiving limited adult care. Community home-based care programs are best situated to identify children in these difficult circumstances and to mitigate their disadvantage.