Health related quality of life in Dutch young adults: psychometric properties of the PedsQL generic core scales young adult version

Evaluating outpatient transition clinics: a mixed-methods study protocol

INTRODUCTION

To support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC).

METHODS AND ANALYSIS

We propose a mixed-methods study with a retrospective controlled design consisting of semistructured interviews among healthcare professionals, observations of consultations with young people, chart reviews of young people transferred 2-4 years prior to data collection and questionnaires among the young people included in the chart reviews. Qualitative data will be analysed through thematic analysis and results will provide insights into structures and daily routines of TCs, and experienced barriers and facilitators in transitional care. Quantitatively, within-group differences on clinical outcomes and healthcare use will be studied over the four measurement moments. Subsequently, comparisons will be made between intervention and control groups on all outcomes at all measurement moments. Primary outcomes are 'no-show after transfer' (process outcome) and 'experiences and satisfaction with the transfer' (patient-reported outcome). Secondary outcomes consider clinical outcomes, healthcare usage, self-management outcomes and perceived quality of care.

ETHICS

The Medical Ethical Committee of the Erasmus Medical Centre approved the study protocol (MEC-2014-246).

DISSEMINATION

Study results will be disseminated through peer-reviewed journals and conferences. The study started in September 2014 and will continue until December 2016. The same study design will be used in a national study in 20 diabetes settings (2016-2018).

Short- and long-term psychosocial of a single episode of alcoholic intoxication: a cohort study among Dutch adolescents

The short- and long-term psychological consequences of a single episode of alcohol intoxication in adolescents are unknown. Twenty-four adolescents (12 M, 12 F), mean age 18.3 ± 1.1 years, who had been admitted to the pediatric ward with alcohol intoxication (mean age at admission 15.6 ± 1.1) and thirty-two parents were interviewed on the intoxication episode and the subsequent consequences. This interview took place 2-3 years after the alcohol intoxication. At the same time, all participants completed questionnaires, assessing general and demographic information, detailed information about current alcohol use, present-day health-related quality of life, and psychological well-being. We observed that short-term (<6 months) psychosocial consequences on family life, family rules, friendships, and school were retrospectively judged more neutral and even more positive than negative by adolescents and their parents. Eighty-six percent of all reported changes by adolescents and parents, directly after the intoxication, lasted 6 months or less. At follow-up present-day quality of life was comparable to the norm, social functioning was significantly better and their mental health proved to be within the normal range (no emotional and behavioral problems). Since the intoxication, none of the participants had dropped out of school and their present-day alcohol use was comparable to estimated averages for their age.

CONCLUSION

Short- and long-term psychosocial consequences of a single episode of alcohol intoxication were positively judged by adolescents and their parents.

WHAT IS KNOWN

• Alcohol abuse among adolescents is a growing concern both in society and pediatrics. What is new: • This manuscript describes short and long term psychological consequences of a single episode of alcohol intoxication in adolescents.

Assessment of Quality of Life in Young Patients with Single Ventricle after the Fontan Operation

OBJECTIVES

To assess self-reported quality of life (QOL) in a large multicenter cohort of adolescent and young adults surviving Fontan.

STUDY DESIGN

Cross-sectional. The Pediatric Quality of Life Inventory (PedsQL) was administered to 408 survivors of Fontan ages 13-25 years enrolled in the Pediatric Heart Network Fontan Follow-up Study. Subjects also completed either the Child Health Questionnaire (age <19 years) or Short Form Health Survey (age ≥ 19 years). PedsQL data were compared with matched controls without a chronic health condition. Correlations between the measures were examined.

RESULTS

Mean PedsQL scores for subjects receiving Fontan were significantly lower than those for the control group for physical and psychosocial QOL (P < .001). Overall, 45% of subjects receiving Fontan had scores in the clinically significant impaired range for physical QOL with 30% in the impaired range for psychosocial QOL. For each 1 year increase in age, the physical functioning score decreased by an average of 0.76 points (P = .004) and the emotional functioning score decreased by an average of 0.64 points (P = .03). Among subjects ≥19 years of age, the physical functioning score decreased by an average of 2 points for each year increase in age (P = .02). PedsQL scale scores were significantly correlated with conceptually related Child Health Questionnaire (P < .001) and Short Form Health Survey scores (P < .001).

CONCLUSIONS

Survivors of Fontan are at risk for significantly impaired QOL which may decline with advancing age. Routine assessment of QOL is essential to inform interventions to improve health outcomes. The PedsQL allowed QOL assessment from pediatrics to young adulthood.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00132782.