Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county

Purpose

Health-related quality of life (HRQoL) studies in children and adolescents with disabilities tend to report lower self-reported health than in the typical population. However, reports are not always consistent and HRQoL appears to vary depending on diagnosis, cultural setting and clinical context. The aim of this study was to explore HRQoL in children and adolescents with various disabilities in Västerbotten County, Sweden.

Methods

A total of 175 children and adolescents [57 girls, 118 boys; mean age 11.7 years (range 7–17 years)] divided into four different diagnostic groups (intellectual disabilities, autism spectrum disorders, movement disorders and hearing disabilities) participated in the study. The EuroQol Five Dimensions Health Questionnaire, Youth version (EQ-5D-Y) was used as HRQoL measure.

Results

Significant differences in various EQ-5D-Y dimensions between the different diagnostic groups were found, but no differences in overall health status. HRQoL in children and adolescents with hearing disabilities was found similar to the typical child population in Sweden whereas children and adolescents with other diagnoses reported evidently more problems.

Conclusions

Findings suggest that there is an increased risk for children with functional disabilities other than hearing disabilities in northern Sweden to experience difficulties in various health domains and lowered general health.     

Impact of autism in adolescents on parental quality of life

Purpose

To study the impact of autism spectrum disorders (ASDs) on parental quality of life (QoL) at adolescence using the parental–developmental disorders-quality of life scale (Par–DD-QoL).

Methods

One hundred and fifty-two mothers of adolescents with ASD completed Par–DD-QoL. This scale assesses the following dimensions: emotional, daily disturbance and global QoL. This cross-sectional study uses a subset of data collected at the final time of a follow-up study (EpiTED cohort).

Results

A polytomic regression identified an increase in aberrant behavior scores as the major independent risk factor for parental QoL. The identified protective factors were the increase in daily living, communication and object cognition scores and a higher number of siblings.

Conclusions

Those results suggest that there is a negative effect of externalizing behaviors and a protective effect of adaptive skills, communication and object cognition on parental QoL. Study limitations and implications are discussed.     

Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity

Background

The relationship between relative metabolic disturbances and developmental disorders is an emerging research focus. This study compares the nutritional and metabolic status of children with autism with that of neurotypical children and investigates the possible association of autism severity with biomarkers.

Method

Participants were children ages 5-16 years in Arizona with Autistic Spectrum Disorder (n = 55) compared with non-sibling, neurotypical controls (n = 44) of similar age, gender and geographical distribution. Neither group had taken any vitamin/mineral supplements in the two months prior to sample collection. Autism severity was assessed using the Pervasive Development Disorder Behavior Inventory (PDD-BI), Autism Treatment Evaluation Checklist (ATEC), and Severity of Autism Scale (SAS). Study measurements included: vitamins, biomarkers of vitamin status, minerals, plasma amino acids, plasma glutathione, and biomarkers of oxidative stress, methylation, sulfation and energy production.

Results

Biomarkers of children with autism compared to those of controls using a t-test or Wilcoxon test found the following statistically significant differences (p < 0.001): Low levels of biotin, plasma glutathione, RBC SAM, plasma uridine, plasma ATP, RBC NADH, RBC NADPH, plasma sulfate (free and total), and plasma tryptophan; also high levels of oxidative stress markers and plasma glutamate. Levels of biomarkers for the neurotypical controls were in good agreement with accessed published reference ranges. In the Autism group, mean levels of vitamins, minerals, and most amino acids commonly measured in clinical care were within published reference ranges. A stepwise, multiple linear regression analysis demonstrated significant associations between several groups of biomarkers with all three autism severity scales, including vitamins (adjusted R² of 0.25-0.57), minerals (adj. R² of 0.22-0.38), and plasma amino acids (adj. R² of 0.22-0.39).

Conclusion

The autism group had many statistically significant differences in their nutritional and metabolic status, including biomarkers indicative of vitamin insufficiency, increased oxidative stress, reduced capacity for energy transport, sulfation and detoxification. Several of the biomarker groups were significantly associated with variations in the severity of autism. These nutritional and metabolic differences are generally in agreement with other published results and are likely amenable to nutritional supplementation. Research investigating treatment and its relationship to the co-morbidities and etiology of autism is warranted.     

Gender and racial/ethnic differences in the associations of urinary phthalate metabolites with markers of diabetes risk: national health and nutrition examination survey 2001–2008

Background

The environmental contribution to autism spectrum disorders (ASD) is largely unknown, but household pesticides are receiving increased attention. We examined associations between ASD and maternally-reported use of imidacloprid, a common flea and tick treatment for pets.

Methods

Bayesian logistic models were used to estimate the association between ASD and imidacloprid and to correct for potential differential exposure misclassification due to recall in a case control study of ASD.

Results

Our analytic dataset included complete information for 262 typically developing controls and 407 children with ASD. Compared with exposure among controls, the odds of prenatal imidacloprid exposure among children with ASD were slightly higher, with an odds ratio (OR) of 1.3 (95% Credible Interval [CrI] 0.78, 2.2). A susceptibility window analysis yielded higher ORs for exposures during pregnancy than for early life exposures, whereas limiting to frequent users of imidacloprid, the OR increased to 2.0 (95% CI 1.0, 3.9).

Conclusions

Within plausible estimates of sensitivity and specificity, the association could result from exposure misclassification alone. The association between imidacloprid exposure and ASD warrants further investigation, and this work highlights the need for validation studies regarding prenatal exposures in ASD.     

Lehrer als Trainer von Pr?ventionsprogrammen für sozial benachteiligte Jugendliche

Background

Emotional disorders often begin during adolescence and constitute a major problem. To counter this problem the focus lies on prevention programmes, which operate in everyday life, in this case the school, without selection of persons. Integrating teachers as group leaders is important in order to integrate these programmes into the normal environment of adolescents. In this article the universal prevention programme??LARS?&?LISA?? is characterized, which is designed for deprived students and can be successfully implemented by teachers at school.

Sample and Methods

Vocational track students in grade 8 from the southwest of Germany participated either in a school-based universal prevention programme or in regular classes as a control group.

Results

The programme is extensively evaluated in three studies and has shown positive effects on the participants?? social network, symptoms of depression and aggressive behaviour compared to teaching as usual.

Conclusions

We have demonstrated that the programme can be successfully delivered to students in a higher vocational track of school by teachers. With LARS?&?LISA we provide a prevention strategy that can be successfully delivered to a school-based population and integrated into the classroom curriculum.     

Functional impairment but not metabolic syndrome is associated with depression in older Taiwanese: Results from the social environment and biomarkers of Aging study

Objectives

This study examined the association of metabolic syndrome, metabolic disorders and functional impairment with depression in older (??54 years) adults.

Design

A cross-sectional study. Setting: Data of this study were from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan (2000).

Participants

A national representative sample of persons 54 years of age or older in Taiwan (N = 1023).

Results

Results showed that the presence of any number of metabolic disorders without functional impairment was not associated with depression. However, the presence of functional impairment regardless of the number of metabolic disorder was associated with a significantly higher risk of depression after adjusting for confounding factors (OR = 5.13, 95% CI = 2.13?C12.36) (p<0.05). The presence of a basic Activities of Daily Living (ADL) dependency was significantly associated with a 1.45 times higher likelihood of depression (OR = 1.45, 95% CI = 1.17?C1.79) (p<0.05).

Conclusions

Results suggest that functional impairment, but not metabolic syndrome or metabolic disorders, is associated with depression in older adults. Metabolic syndrome/disorders do not necessarily affect patient??s psychological health unless it is accompanied with functional impairment.     

Gef?hrdungsbeurteilung bei Verkaufspersonal

Background

An occupational health risk assessment for selling personnel ??T?tigkeitsanalyse distributiver Dienstleistungen?? (TA-DD) was created. The purpose of this study was to investigate the correlations between job characteristics and indicators of well-being, job satisfaction and turnover intentions.

Sample and methods

The random sample includes 48 salespersons. The job characteristics were captured by work studies with simultaneous interviews using the TA-DD, and the psychological outcome variables (short- and midterm strain, job satisfaction and turnover intentions) were measured by a questionnaire survey. Correlation analyses were performed.

Results

The job characteristics captured by the TA-DD correlate with psychological outcome variables.

Conclusion

The TA-DD can be used to identify and assess risk factors and educe interventions in the field of distributive services.     

Pressure pain sensitivity maps, self-reported musculoskeletal disorders and sickness absence among cleaners

Background

Pressure pain threshold mapping is a valuable method for the identification of distinct zones of mechanical pain sensitivity. Such approach was applied for the first time in relation to self-reported musculoskeletal disorders and long-term sickness absence (LTSA) within the last 12?months among cleaners.

Methods

About 29 cleaners filled out a self-administered questionnaire regarding health, work-related measures and musculoskeletal disorders. Subsequently, PPTs were measured at (1) tibialis anterior (control location, 1 point), (2) the neck-shoulder (48 points) and (3) the low back regions (27 points). LTSA was defined as ten or more consecutive workdays with sick leave.

Results

The PPT maps revealed the spatial heterogeneity in mechanical sensitivity among cleaners. The level of pain in the neck and dominant shoulder and upper back within the last 7?days correlated negatively with most PPT measurements. The group of cleaners with LTSA had significantly lower levels of PPT (large effects) in the neck-shoulder region than the cleaners with no LTSA (P?2?=?0.19 in average).

Conclusions

The present study investigated pressure pain topographical maps from the neck-shoulder and low back region in cleaners. Cleaners with LTSA the last year exhibited mechanical hyperalgesia as depicted by lower PPT in the neck-shoulder compared with cleaners without LTSA. More studies assessing the relation between PPT maps, self-reported musculoskeletal disorders and sickness absence are warranted.     

Betriebliches Eingliederungsmanagement von Mitarbeitern mit psychischen St?rungen

Background

Reintegration programs at the workplace are conducted in order to secure the employees?? working ability and employability after terms of longer illness. The study deals with the question which demands companies have to cope with and which support they wish.

Methods

An online survey was performed in which 130 companies as well as 25 external experts participated. A panel of experts discussed the results and made comments.

Results

Though reintegration programs at the workplace are an issue there still is a big deficit of information and action at small and smallest companies. And the success of the measures is seen critically, primarily because of the absence of suitable workplaces. Furthermore the reintegration of employees with mental disorders is quoted as ??difficult??. The companies report a low acceptance of reintegration measures in such cases by executives as well as by employees.

Conclusion

Two thirds of the responding enterprises see a demand for improvement. Stronger support from external experts could be helpful. The importance of a closer cooperation is underlined by the appraisal of one third of the companies: they believe that they will not be able to cope successfully with an encreasing number of employees with mental disorders in future.     

Psychohygiene in der ?Palliative Care“

Background

The mental strain for nursing staff in palliative care has been sufficiently described in recent years. However, in a nursing home, employees from other professional guilds are also active in the same context and often have intensive contact with the residents as well as with their relatives. It could already be shown that their mental strain does not differ from those of the nursing staff in several constructs. However, the special demands of palliative care were not considered in the past studies.

Aims

The present study tries to assess the effects of palliative settings on mental hygiene and compare nursing to non-nursing staff.

Methods

In the nursing home Mattenhof-Irchelpark, which belongs to the City of Zurich Nursing Homes, an enquiry by questionnaires was carried out among nursing and non-nursing staff. A total of 72 employees participated in this study. We examined the constructs ??contact with relatives?? and ??mental hygiene?? with a 7-point Likert scale.

Results

Employees from non-nursing divisions estimated their competence in ??contact with relatives?? to be significantly lower (p=0.005) and they felt equally burdened as the nursing staff. Analysis of the scale ??mental hygiene?? yielded significantly higher values of stress for the non-nursing staff in comparison to the nursing staff (p=0.022).

Conclusion

In summary, it can be stated that not only the nursing staff feels confronted with psychic challenges in the context of palliative care. Also employees from non-nursing areas perceive these challenges at least equally.     

Bewegungsfreundlichkeit von Wohnumgebungen messen

Background

Internationally most studies analyzing residential environments for friendliness toward physical activity have used the ??Neighborhood Environment Walkability Scale?? (NEWS). As a German version was missing the objective of this study was to establish NEWS-Germany (NEWS-G).

Methods

The NEWS was culturally adapted and tested by cognitive debriefings (n=6) before (n=179) young adults (mean age 25.2 years) completed a computer-assisted version of NEWS-G and of a physical activity measure. Psychometric characteristics for the whole sample and intraclass correlations (ICC) based on a test-retest inquiry on NEWS-G (n=66) were calculated. Bivariate correlations of NEWS-G and physical activity were used to evaluate validity.

Results

All subscales (and most items) of NEWS-G showed acceptable psychometric characteristics and good stability (0.74??ICC??0.94) but internal consistency was low for two subscales. Some scales and items of NEWS-G showed significant correlation with physical activity.

Conclusions

The NEWS-G will be used to analyze residential environments for friendliness toward physical activity in Germany and to compare future data with available international findings. All in all more representative studies are essential to finally evaluate the reliability and validity of NEWS-G.     

Supplementation of highly concentrated β-cryptoxanthin in a satsuma mandarin beverage improves adipocytokine profiles in obese Japanese women

Background

Serum ??-cryptoxanthin levels are lower in overweight subjects than in normal subjects. Abnormalities of adipocytokine profiles in obesity subjects have been reported. There are several reports that serum ??-cryptoxanthin levels in them were relatively lower than normal subjects.

Objective

We hypothesize that supplementation of highly concentrated ??-cryptoxanthin improves serum adipocytokine profiles in obese subjects. This study tested the association between ??-cryptoxanthin intake and serum adipocytokine levels.

Methods

An intervention study consisted of a 3-week long before-and-after controlled trial, where ??-cryptoxanthin (4.7?mg/day) was given to 17 moderately obese postmenopausal women.

Results

The results indicated no significant changes in body weight or body mass index (BMI). Serum ??-cryptoxanthin levels increased significantly by 4-fold. Serum high molecular weight (HMW)-adiponectin levels increased significantly, while serum plasminogen activator inhibitor (PAI)-1 levels decreased.

Conclusions

We concluded that increasing the intake of ??-cryptoxanthin to approximately 4?mg per day for 3?weeks may have beneficial effects on the serum adipocytokine status and consequently alleviate progression of metabolic syndrome.     

Dietary habits and ageing in a sample of Italian older people

Objectives

To analyse dietary habits and explore the role of socioeconomic status in a sample of elderly Italians.

Study design

Observational.

Participants and setting

306 elderly subjects aged 65 and over living in the Marche Region (Italy).

Measurements

Assessment of dietary habits and life-style characteristics using a ??Life-style questionnaire??. Nutritional data collected by means of a 53-item ??Frequency food questionnaire??.

Results

The study revealed differences in dietary patterns and food consumption. Age was negatively related to all food categories. Some socio-economic characteristics (level of education and economic status) were correlated with consumption of many foods, such ad Fish, Red Meat and Diary products. Between-the-sexes differences were also documented.

Conclusion

Our findings showed that the nutritional and dietary habits varied greatly within the sample investigated. The mapping of these dietary and nutritional patterns may be of value for future research in elderly populations, particularly those with low educational status and poor economic means. Conclusively, greater promotion of healthy dietary habits should be targeted towards elderly populations.     

Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers

Purpose

We sought to identify indicators associated with the quality of life (QoL) of stroke patients and caregivers.

Methods

The cross-sectional study was conducted at nine Dutch stroke service facilities involving 251 stroke patients and their caregivers. We used the EuroQol (EQ-5D) and Satisfaction with Stroke Care questionnaires, and included the variables (1) disability at hospital admission, (2) length of hospital stay, (3) demographic data, and (4) caregivers?? relationship with stroke patients. The Actor?CPartner (patient?Ccaregiver) Interdependence Model (APIM) was used to examine dependence between patients?? and caregivers?? QoL scores through dyad membership.

Results

Patients?? age was significantly related to their QoL, and caregivers?? age and educational level were significantly related to their QoL. Patients?? disability on hospital admission and length of stay were associated with patients?? QoL, and their disability on admission was related to caregivers?? QoL. No relationship was found between length of stay and caregivers?? QoL. Satisfaction with care was associated with both patients?? and caregivers?? QoL.

Conclusions

The APIM distinguished the different roles of patients and caregivers while acknowledging the interdependence of their QoL scores. Satisfaction with care was identified as important indicator of stroke patients?? and caregivers?? QoL.     

Gef?hrdungsbeurteilung bei psychischen Belastungen in Deutschland

Background

Risk assessment including psychosocial risks is among employers?? obligations as stipulated by the German labour protection law.

Methods

This contribution reviews current studies on the prevalence of psychosocial risk assessment in the workplace, considering also drivers and barriers for the implementation of psychosocial risk assessment.

Results and Conclusions

These studies clearly demonstrate that only a small proportion of companies which carry out risk assessment do it in a comprehensive way including also psychosocial risks. On the basis of these results, recommendations for practical implementation are developed.     

The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services

Purpose

Previous studies showed that older persons with vision loss generally reported low levels of health-related quality of life, although study outcomes with respect to feelings of anxiety and social support were inconsistent. The objective of this study was to examine the impact of low vision on health-related quality of life, including feelings of anxiety and social support, among community-living older adults seeking vision rehabilitation services.

Methods

Differences of activities of daily living (Groningen Activity Restriction Scale??GARS), symptoms of depression and feelings of anxiety (Hospital Anxiety and Depression Scales??HADS) and social support (Social Support Scale Interactions??SSL12-I) between 148 older persons ??57?years with low vision and a reference population (N?=?4,792) including eight patient groups with different chronic conditions were tested with Student??s t tests.

Results

Older persons with vision loss reported poorer levels of functioning with respect to activities of daily living, symptoms of depression and feelings of anxiety as compared to the general older population as well as compared to older patients with different chronic conditions. In contrast, older persons with vision loss reported higher levels of social support.

Conclusions

Vision loss has a substantial impact on activities of daily living, symptoms of depression and feelings of anxiety. Professionals working at vision rehabilitation services may improve their quality of care as they take such information into account in their intervention work.     

Longitudinal changes in social functioning in mildly disabled patients with relapsing–remitting multiple sclerosis receiving subcutaneous interferon β-1a: results from the COGIMUS (COGnitive Impairment in MUltiple Sclerosis) study (II)

Purpose

To report longitudinal changes in and explore the influence of cognition on social functioning in mildly disabled patients with relapsing?Cremitting multiple sclerosis (RRMS).

Methods

Italian patients (18?C50?years) with RRMS and Expanded Disability Status Scale (EDSS) score ??4.0 were assigned to interferon ??-1a, 44 or 22???g subcutaneously three times weekly, and underwent annual assessments for social functioning (Environmental Status Scale [ESS]) over 3?years.

Results

Baseline total ESS score did not differ between patients with and without cognitive impairment (P?=?0.505). Total ESS score remained low (<2.0) and stable over 3?years in the whole study population, but worsened slightly when assessed by assigned treatment or treatment and baseline cognitive status (both P?=?0.004), driven mostly by changes in the ??transportation?? and ??financial/economic status?? subscales. The strongest independent predictor of worsening ESS score was baseline EDSS score. Test?Cretest analyses confirmed that total ESS score and most subscales changed little over 3?years.

Conclusion

ESS scores remained low and changed minimally over 3?years, reflecting the mild physical disability and good cognitive performance in this patient population. Determining the influence of cognitive function and treatment on longitudinal changes in social functioning requires further studies.     

Patterns of dietary supplement use among older men and women in the UK: Findings from the Hertfordshire Cohort Study

Objectives

To determine patterns of supplement use in a UK community-dwelling older population, and to investigate the extent to which supplement user groups differ, in terms of their sociodemographic and lifestyle characteristics, diet and morbidity.

Design

Cross-sectional cohort study.

Setting

Home interview and clinic visit. Participants: 3217 Hertfordshire Cohort Study participants, aged 59 to 73.

Measurements

Information was obtained on the participant??s social and medical history by a trained research nurse. Diet over the preceding 3 months was assessed by Food Frequency Questionnaire; compliance with ??healthy?? eating recommendations was defined using individual scores for a ??prudent?? dietary pattern, identified using principal components analysis. Details of all dietary supplements taken in the preceding 3 months were recorded. Individual supplements were allocated to one of 10 types based on their nutrient composition. Cluster analysis was used to define groups of supplement users.

Results

45.4% of men and 57.5% of women reported taking at least one dietary supplement in the previous 3 month period. There were 5 distinct clusters of supplement users; these were common to men and women. They were labelled according to the principal supplement taken; oils, glucosamine, single vitamins, vitamins and minerals, and herbal products. These groups differed in their social class and prudent diet score, but few other characteristics. With the exception of a difference in diagnosis of diabetes among the women, there were no differences in morbidity between the supplement groups in either men or women.

Conclusions

Dietary supplement use is high in this population. There are distinct patterns of supplement use, which are related to sociodemographic and lifestyle characteristics including diet, though there were few clear differences in morbidity.     

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.     

‘All the burden on all the carers’: exploring quality of life with family caregivers of Huntington’s disease patients

Background

Existing research suggests that family caregivers of persons with Huntington??s disease face a unique series of problems, linked to the complex nature of the disease. There is little research that explicitly investigates the impact of HD on the quality of life (QoL) of the family caregiver. The purpose of this study was to explore the quality of life issues for family carers of Huntington??s disease patients in a focus group setting.

Methods

Participants were recruited via a Huntington??s Disease Association (HDA) family conference day. Six semi-directed focus groups (n?=?47) explored disease-specific aspects of QoL that were deemed important to family carers of this carer group. Data were analysed using Interpretative Phenomenological Analysis (IPA).

Results

Analysis of the focus group data identified four superordinate themes: ??Levels of Support??, ??Dissatisfaction with Caregiving Role??, ??Practical Aspects of Caring?? and ??Feelings and Emotional Well-being??.

Conclusions

These data provide evidence that QoL is compromised in many ways for HD family carers. The carers in this study often negated their own needs as their caregiving role overwhelmed them and ??took over?? their lives.