Health-related Quality of Life in Preschool Children with Wheezing and Dyspnea: Preliminary Results from a Random General Population Sample

Quality of life in children with diseases causing central airway obstruction: Reliability and validity of the TAPQOL questionnaire

INTRODUCTION

The aim of this study was to analyse the psychometric performance (reliability and validity) of the TAPQOL questionnaire in measuring the global quality of life in children with central airway obstruction (CAO), which encompasses pathologies with a low prevalence that have a common anatomical or functional affectation.

METHOD

The study population consisted of 109 patients with CAO attended in a national reference airway unitafter signing informed consent. The TAPQOL questionnaire was used to measure the global quality of life and its psychometric characteristics were analysed. The reliability was determined using Cronbach's α statistic and the validity was determined by means of a principal component analysis.

RESULTS

The mean age was 4.8 years and there was no predominant sex. The most frequent diagnosis was laryngomalacia (24.5%), followed bysubglotticstenosis (20.2%). The lowest score in the TAPQOL questionnaire was obtained for the scales of anxiety (66.2 ± 23.7), respiratory (67.9 ± 29.6), and conduct 68.2 ± 21.4). The Cronbach's α was above 0.7 in the majority of the scales and the validity study by principal component analysis with a total variance of 76.7% fits the original 12-component model.

CONCLUSIONS

TAPQOL is a valid tool to measure the health-related quality of life in patients with CAO. Measuring it in these patients indicates which fields are most affected, highlighting therapeutic needs that have not been resolved but which can be approached in normal clinical practice.

The impact of the family-centered empowerment model on the children's quality of life with chemical burns and their parent’s perceived stress

BACKGROUND AND AIM

Chemical burns are challenging for children and their families due to the unpleasant health consequences. Therefore, it is necessary to provide organized programs to support and educate families suffering child burns. This study aimed at determining the impact of the Family-Centered Empowerment Model (FCEM) on the quality of life of children with chemical burns and their parents' stress.

METHODS

This two-group pre-test-post-test experimental study was conducted on 50 children 1-12 years old with chemical burns along with their parents (n = 50) in three hospitals in Birjand, Iran. Eligible participants were selected by convenience randomized sampling method and then assigned to intervention and control groups. The questionnaires included: PedsQL for measuring the quality of life of children aged 6-12 years, TAPQOL for evaluating the quality of life of children aged 1-6 years, and PSS for exploring the perceived parental stress. The intervention group received the FCEM-based program consisting of four steps (perceived threat, self-efficacy, self-esteem, and evaluation) and the control group received the standard care. Perceived parental stress and children's quality of life were assessed before and after the intervention in both groups. The data were analyzed using SPSS statistical software V. 23.

RESULTS

The results showed that the mean scores of parental stress and children's quality of life (total and subscales) were not significantly different before the intervention. The independent t-test results exhibited a significant difference after the intervention between the mean scores of the variables of the two groups (P < 0.001), indicating an increase in the quality-of-life score and its subscales and a decrease in the parents' stress score. The paired t-test results revealed a significant difference between the means of scores before and after the intervention in the intervention group (P < 0.001).

CONCLUSION

FCEM is an effective approach to reducing parental stress and improving the children's quality of life aged 1-12 years old suffered chemical burns. Therefore, it is suggested to consider the model care plan for this population.

Role of montelukast in multitrigger wheezers attending chest clinic in Punjab, India

BACKGROUND

Wheeze is seen in 40% of preschool children, one-third of these may develop recurrent wheeze. Montelukast is an oral, once a day, easy to give therapy but there is no definite evidence to support its use in a recent meta-analysis. Present study was done to evaluate role of daily montelukast and various factors affecting the outcome after therapy in multitrigger wheeze (MTW).

METHODS

A prospective study conducted in Pediatric chest clinic over 18 months at DMCH, Ludhiana. Children from 6 months to 5 years, diagnosed cases of MTW were started on montelukast. Diagnosis based on symptoms of recurrent wheeze triggered by various allergens/precipitants was made by pediatrician in charge of chest clinic. Children were followed up at 1 and 3 months. They were labeled as controlled, partially controlled, or uncontrolled as per global initiative for asthma guidelines. Data were used to compare the outcome related to various factors.

RESULTS

Total 139 out of 150 children came for regular follow-up. At the end of 3 months, 94 (67.7%) were controlled, 8 (5.7%) partially controlled, and 37 (26.6%) children remained uncontrolled on montelukast. Factors associated with poor control were onset of symptoms at younger age (<6 months of age), family history of allergies, prior multiple visits or hospitalizations due to MTW, use of MDI in the past. No significant side effects were reported by parents.

CONCLUSION

Symptomatically two-third of children became better after starting montelukast. There were few factors which resulted in poorer control in subset of patients.

Relation of Asthma Control with Quality of Life among a Sample of Egyptian Asthmatic School Children

BACKGROUND

Asthma is considered a chronic health illness that not only resulted in physical symptoms but also emotional effects. It is; therefore, so important to assess the quality of life of asthmatic patients besides their level of disease control.

AIM

To determine the correlation of asthma control with the health-related quality of life (HRQOL) of asthmatic children in Egypt.

METHODS

One hundred and twenty-eight asthmatic Egyptian children were enrolled in the study. They were subjected to asthma severity grading, asthma control questionnaire (ACQ) and pediatric asthma quality of life questionnaire (PAQLQ). Studied cases were taken from 6 primary and preparatory schools, Giza governorate.

RESULTS

The mean child control score was significantly higher in not well-controlled asthmatics compared to well-controlled asthmatics (p < 0.005). The not well controlled asthmatic children showed significantly lower activity limitation score, symptoms score, and overall asthmatic score compared to controlled asthmatic children (p < 0.05). The severity of asthma shows significant positive correlation with symptoms score, emotional function score and overall asthmatic score (p < 0.05).

CONCLUSION

The quality of life for the asthmatic children is strongly correlated with the level of asthma control and severity.

Vitamin D for secondary prevention of acute wheeze attacks in preschool and school-age children

INTRODUCTION

Vitamin D is best known for its role in bone health; however, the discovery of the vitamin D receptor and the expression of the gene encoding the vitamin D 1α-hydroxylase (CYP27B1) enzyme in a wide variety of tissues including immune cells and respiratory epithelium has led to the discovery of potential roles for vitamin D in the prevention of acute wheeze.

METHODS

We review here the literature concerning the relationships between circulating 25-hydroxyvitamin D (25(OH)D) concentration and secondary prevention of acute wheeze attacks in preschool and school-age children.

RESULTS

Epidemiological data suggest that vitamin D insufficiency (25(OH)D <75 nmol/L) is highly prevalent in preschool and school-age children with wheeze. Preschool age children with a history of wheeze attacks and circulating 25(OH)D <75 nmol/L are at increased risk and frequency of future acute wheeze. However, no consistent association between low vitamin D status and risk of acute wheeze is reported in school-age children. Seven randomised controlled trials (RCTs) with relatively small sample sizes (30-430) and variable quality showed inconsistent results regarding the effect of oral vitamin D supplementation during childhood on the risk of asthma attacks, asthma symptom control, inhaled corticosteroid requirements, spirometry and unscheduled healthcare attendances for wheeze. A RCT showed that vitamin D supplementation had no effect on the frequency of unplanned healthcare attendances due to acute wheeze in 22 preschool children.

DISCUSSION

An evidence-based recommendation for the use of vitamin D as a preventive therapy for wheeze attacks cannot be made until results of further trials are available. The assessment of circulating 25(OH)D concentration and the optimisation of vitamin D status to prevent acute respiratory tract infections, and to maintain skeletal and general health in preschool and school-age children with acute wheeze is worthwhile in its own right, but whether this will reduce the risk of acute wheeze attacks is unclear.

Cross-cultural adaptation and validation of the Malay language version of the TZO-AZL Preschool Children Quality of Life questionnaire: A health-related quality of life instrument for preschool children

The aim of this study is to evaluate the psychometric properties of the translated Malay language version of TZO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire in preschool children. Preterm children and term children aged between two and five years were enrolled into the study. The Malay language version of TAPQOL and a set of questions regarding the child's health status were answered by the caregivers. The internal consistency, Spearman's correlation coefficients and principal component analysis (PCA) with Varimax rotation and Mann-Whitney U test for group comparison were employed to evaluate the psychometric properties of this instrument. A total of 258 children (120 preterm children and 138 term children) were recruited to this study with a response rate of 94%. All (sub)domains except one had Cronbach's α coefficients of more than .7. The Spearman's correlation coefficients between 12 subdomains were generally low. PCA supported the structural unidimensionality of the items in the instrument. Preterm children had lower quality of life scores than that of term children. Malay version of TAPQOL has multidimensional construct. It is a reliable and valid instrument for preschool children, with almost similar psychometric properties to the original version.

Health-related quality of life of infants from ethnic minority groups: the Generation R Study

Purpose

To assess whether the health-related quality of life of infants from ethnic minority groups differs from the health-related quality of life of native Dutch infants and to evaluate whether infant health and family characteristics explain the potential differences.

Methods

We included 4,506 infants participating in the Generation R Study, a longitudinal birth cohort. When the child was 12 months, parents completed the Infant Toddler Quality of Life Questionnaire (ITQOL); ITQOL scale scores in each ethnic subgroup were compared with scores in the Dutch reference population. Influence of infant health and family characteristics on ITQOL scale scores were evaluated using multivariate regression models.

Results

Infants from ethnic minority groups presented significantly lower ITQOL scale scores compared to the Dutch subgroup (e.g., Temperament and Moods scale: median score of Turkish subgroup, 70.8 (IQR, 15.3); median score of Dutch subgroup, 80.6 (IQR, 13.9; P < 0.001)). Infant health and family characteristics mediated an important part of the association between the ethnic minority status and infant health-related quality of life. However, these factors could not fully explain all the differences in the ITQOL scale scores.

Conclusions

Parent-reported health-related quality of life is lower in infants from ethnic minority groups compared to native Dutch infants, which could partly be explained by infant health and by family characteristics.

Asthma-like symptoms in the first year of life and health-related quality of life at age 12 months: the Generation R study

PURPOSE

This study compares HRQOL among subgroups of infants with asthma-like symptoms to a subgroup without such symptoms and examines independent associations between asthma-like symptoms during the first year of life and HRQOL at age 12 months.

METHODS

Our study sample included 5,000 infants participating in the Generation R study. Their parents completed structured questionnaires to obtain information on asthma-like symptoms, HRQOL, infants', and maternal characteristics. Asthma-like symptoms were defined according to the number of positive answers to 12 items on lower respiratory symptoms. HRQOL was measured using the ITQOL. Higher scores indicated better HRQOL.

RESULTS

Infants with asthma-like symptoms had significantly lower HRQOL scores for all ITQOL scales. Among the subgroup with severe symptoms (4% of the infants), relevant deficits in HRQOL were observed for most ITQOL scales, particularly for General Health, Bodily Pain, and Family Activities (effect sizes ≥ 0.8). In multivariate linear models, asthma-like symptoms were independently associated with 6 ITQOL scales. The population attributable risks were especially high for Family Activities, General Health, Parental Emotional, and Parental Time.

CONCLUSIONS

Asthma-like symptoms during the first year of life are associated with impaired quality of life at age 12 months. At population level, asthma-like symptoms were associated with lower HRQOL, regardless of symptom severity.

Reliability and validity of the Spanish version of the TAPQOL: a health-related quality of life (HRQOL) instrument for 1- to 5-year-old children

OBJECTIVES

To evaluate the reliability, and construct validity of the Spanish version of the TNO-AZL preschool children quality of life (TAPQOL).

METHODS

A consecutive sample of children (3 months to 5 years old) was recruited from primary care centers and two teaching hospitals in Spain. The TAPQOL and a set of questions related to their child's health status were administered to parents. Clinical diagnoses were collected from clinical records. Principal component analysis (PCA) with varimax rotation was used to analyze the instrument's structure. Effect size (ES) and analysis of variance (ANOVA) were used to analyze differences between subgroups known to be in poor health compared to the healthy subgroup.

RESULTS

A total of 228 children participated in the study (response rate=95%). Ten of the 12 scales showed more than 30% ceiling effect. All dimensions except one had Cronbach's alpha coefficients greater than 0.7. PCA explained 75% of the variance. Healthy children in general had better scores than the other subgroups. Children at risk of poor health outcomes and those with respiratory problems scored lower in several scales than the healthy subgroup.

CONCLUSIONS

Although the Spanish TAPQOL shows a non-negligible ceiling effect, it seems to be a reliable and valid instrument for Spanish infants and toddlers, and with similar psychometric characteristics to the original version. Future studies should try to improve questionnaire's structure and assess its sensitivity to change.

Prevalence and risk factors of wheeze in Dutch infants in their first year of life

Factors operating in the first year of life are critical in determining the onset and persistence of wheezing in preschool children. This study was designed to examine the prevalence and risk factors of wheeze in the first year of life in Dutch infants. This was a population-based survey of 13-month-old infants visiting well baby clinics for a scheduled immunization. Parents/caregivers completed a standardized validated questionnaire on respiratory symptoms in the first year of life and putative risk factors. The independent influence of these factors for wheeze was assessed by multiple logistic regression analysis. A total of 1,115 questionnaires were completed. Wheeze ever (with a prevalence in the first year of life of 28.5%) was independently associated with male gender, eczema, sibs with asthma, any allergic disease in the family, day care, damp housing, and asphyxia. Recurrent wheeze (prevalence 14.5%) showed independent associations with eczema, sibs with asthma, and day care. In addition to these factors, severe wheeze (prevalence 15.4%) was also associated with premature rupture of membranes during birth, and with damp housing. Wheeze is common during the first year of life, and places a major burden on families and the health care system. Factors associated with wheeze are mainly related to markers of atopic susceptibility, and to exposure to infections. The strongest modifiable risk factor for wheeze in the first year of life is home dampness. Interventions to reduce home dampness to reduce wheeze in infancy should be examined.

[Spanish version of the TNO-AZL preschool children quality of life questionnaire (TAPQOL)]

OBJECTIVES

To obtain a Spanish version of the TNO-AZL Preschool Children Quality of Life Questionnaire (TAPQOL) that would be both semantically and culturally equivalent to the original.

MATERIAL AND METHODS

The TAPQOL questionnaire was designed to measure health-related quality of life in children aged 3 months to 5 years and contains 43 questions distributed in 12 subdimensions. The Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. Cognitive debriefing interviews were carried out with the parents of healthy children and with those of children with respiratory disease.

RESULTS

During the adaptation phase, four items were modified after input from the authors of the original version to retain the meaning of the original. At the end of the adaptation process, 37 of the 43 items were classified as A, i.e. without difficulty in the adaptation. Four mothers and two fathers participated in the cognitive debriefing interviews. Four had secondary level education, and two had university level education. Their children were aged between 16 and 60 months. The average time taken to complete the questionnaire was 13.5 minutes. No comprehension problems regarding the questionnaire's content were found, and no items were modified after this phase of the study. The mothers of children with respiratory disease considered the questions related to their children's symptoms to be appropriate.

CONCLUSIONS

The Spanish version of the TAPQOL has proven to be acceptable and culturally equivalent to the original version. Future studies should investigate the psychometric properties of this questionnaire and compare them with those of the original version.

[Epidemiology of allergic respiratory disorders in infants]

INTRODUCTION

Allergic disorders of the respiratory tract have been the subject of many epidemiological studies, especially during infancy which is known to be a critical period for development of the immune system. This paper aims to describe the prevalence of allergic respiratory disorders in children below three years of age in the general population, despite the lack of shared definition of asthma and allergic rhinitis among studies.

STATE OF ART

Doctor-diagnosed asthma occurs in 5% of children below two years of age. One third of children below three years of age experience wheeze during a lower respiratory tract infection, but only 7% of children wheeze apart from a respiratory infection. Asthma-like cough and bronchial obstruction symptoms are reported in respectively 15% and 9% of children below two years of age. Depending on the definition of allergic rhinitis used, its prevalence varies from 1 to 30% among two years old children.

PERSPECTIVES

Definitions of allergic respiratory tract disorders in infants become more elaborate involving parental and personal history of allergy and medication; epidemiological research now attempts to identify, using biological evidence of atopy, infants at risk of persistent allergic disorders.

CONCLUSIONS

A better definition of allergic respiratory disorders in infants may help epidemiological research and early care management.

Determinants of health care utilization for respiratory symptoms in the first year of life

OBJECTIVE

Health care utilization for respiratory symptoms is very common in infancy. Little is known about the determinants of visiting a physician for such complaints in infants. We investigated which factors determine the likelihood of visiting a physician for respiratory symptoms in the first year of life of their offspring.

PATIENTS AND METHODS

Infants were participants of the ongoing Wheezing Illnesses Study Leidsche Rijn (WHISTLER), a prospective birth cohort study on respiratory illnesses. Parental reports on respiratory symptoms and possible risk factors were assessed by daily questionnaires. Physician diagnosed respiratory symptoms were classified in medical records using the International Classification of Primary Care. Outcome was defined as a having a child visit a general practitioner for respiratory symptoms in the first year of life. Logistic regression was used to study the likelihood of outcome (yes/no) as a function of putative predictors.

RESULTS

Forty-seven percent of the infants visited a physician for respiratory symptoms in the first year of life. Every extra week of respiratory symptoms was associated with a 4.3% higher chance (odds ratio [OR], 1.043; 95% confidence interval [CI], 1.022-1.065) of visiting a physician. Furthermore, the chance was higher in boys (OR, 1.5; 95% CI, 1.1-2.1), children attending day care (OR, 1.9; 95% CI, 1.2-3.0), children with nonwhite mothers (OR, 1.9; 95% CI, 1.1-3.2), and children whose mother had supplementary health care insurance (OR, 1.7; 95% CI, 1.1-2.7). Findings were similar within the subgroup of children with serious respiratory symptoms (>median: 46 d/yr), but in that group parental age over 30 also determined physician visits (OR, 3.8; 95% CI, 1.6-8.9).

CONCLUSIONS

Child and parent characteristics, besides complaints per se, play an important role in health care utilization for respiratory illnesses in infancy.

Adequacy of health-related quality of life measures in children under 5 years old: systematic review

AIM

This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old.

BACKGROUND

Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services.

METHODS

A methodological systematic review was carried out for the period 1980-2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded.

RESULTS

Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0-8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age.

CONCLUSION

There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children.

Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample

OBJECTIVE

To evaluate feasibility, internal consistency, test-retest reliability, and concurrent and discriminative validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) for parents of pre-school children with 12 scales (103-items) covering physical and psychosocial domains and impact of child health on parents, in comparison with the TNO-AZL Pre-school Children Quality of Life Questionnaire (TAPQOL).

METHODS

Parents of children from a random general population sample (2 months-4 years old; n = 500) and of an outpatient clinic sample of children with respiratory disease (5 months-[Formula: see text] years old; n = 217) were mailed ITQOL and TAPQOL questionnaires; a retest was sent after two weeks.

RESULTS

Feasibility: The response was >or=80% with few missing and non-unique ITQOL-answers (<2%) in both study populations. Some ITQOL-scales (3-4 scales) showed a ceiling effect (>25% at maximum score). Internal consistency: All Cronbach's alpha >0.70. Test-retest Intraclass Correlation Coefficients (ICCs) were moderate or adequate (>or=0.50; p < 0.01) for 10 ITQOL-scales.

VALIDITY

ITQOL-scales, with a few exceptions, correlated better with predefined parallel TAPQOL scales than with non-parallel scales. Five to eight ITQOL-scales discriminated clearly between children with few and with many parent-reported chronic conditions, between children with and without doctor-diagnosed respiratory disease and with a low and a high parent-reported medical consumption (p < 0.05).

CONCLUSIONS

This study supported the evidence that the ITQOL is a feasible instrument with adequate psychometric properties. The study provided reference ITQOL scores for gender/age subgroups. We recommend repeated evaluations of the ITQOL in varied populations, especially among very young children, including repeated assessments of test-retest characteristics and evaluations of responsiveness to change. We recommend developing and evaluating a shortened ITQOL version.

Respiratory symptoms in the first 7 years of life and birth weight at term: the PIAMA Birth Cohort

RATIONALE

The relation between birth weight and respiratory symptoms and asthma in children remains unclear. Previous studies focused on a relation at separate ages. A longitudinal analysis may lead to a better understanding.

OBJECTIVES

To estimate the effect of birth weight on the development and course of respiratory symptoms and asthma in the first 7 years of life.

METHODS

In a prospective birth cohort study, 3,628 children with a gestational age 37 weeks or more were monitored for 7 years. Parental questionnaires were used to assess respiratory health yearly. Associations of birth weight with respiratory symptoms (wheezing, coughing, respiratory infections) and doctor's diagnosis of asthma were assessed in a repeated-event analysis.

MEASUREMENTS AND MAIN RESULTS

Lower birth weight was associated with more respiratory symptoms (odds ratio [OR] per kg decrease in birth weight, 1.21; 95% confidence interval [CI], 1.09-1.34). The effect of birth weight increased from age 1 to 5, but decreased thereafter and was no longer significant at the age of 7. The effect of birth weight on respiratory symptoms was significantly greater among children exposed to tobacco smoke in their home than among nonexposed children (OR at 5 yr: 1.21 [95% CI, 1.02-1.44] and 1.52 [95% CI, 1.23-1.87], respectively). Birth weight and a doctor's diagnosis of asthma were not related (OR, 1.06; 95% CI, 0.82-1.37).

CONCLUSIONS

A lower birth weight in children born at term is associated with a transiently increased risk of respiratory symptoms. This effect is enhanced by environmental tobacco smoke exposure.

Pediatric health-related quality of life questionnaires in clinical trials

PURPOSE OF REVIEW

This review summarizes recent studies on the feasibility, reliability and validity of pediatric health-related quality of life questionnaires and gives an overview of recent applications of these measures in pediatrics.

RECENT FINDINGS

The often-applied short form of the Child Health Questionnaire (CHQ-PF28) provides reliable physical and psychosocial summary measures, but reliable estimates for each scale require the longer version (CHQ-PF50). In addition to this questionnaire, the Pediatric Quality of Life Inventory is another reliable and valid measure. The TNO-AZL Preschool Children Quality of Life questionnaire is a feasible and reliable measure for preschool children. Generally, generic questionnaires are less sensitive to the impact of specific diseases than are disease-specific questionnaires. Parent and self-reports provide different outlooks on quality of life, which complement each other.

SUMMARY

There are several feasible, reliable and validated pediatric quality of life questionnaires that can be used in clinical trials. These include generic and disease-specific questionnaires and health profile measures, as well as preference-based measures in pediatric settings. Generally, a combination of these types of questionnaires would be the most appropriate approach. Moreover, a combination of parent and self-reports should be applied. Appropriate selection of outcome measures will enhance the quality of pediatric studies and the ability to assess treatment effects in clinical trials.