[Evaluation of the quality of life in pediatrics: how to collect the point of view of children]

Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program

Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children’s family.

Impact of epilepsy surgery on quality of life and burden of caregivers in children and adolescents

OBJECTIVE

The objective of this study was to analyze the impact of pediatric epilepsy surgery on the quality of life (QOL), determining whether patients improve, worsen, or maintain their preoperative patterns, as it relates to the burden of caregivers, as well as evaluating potential related factors, from both the children and caregivers perspectives.

MATERIAL AND METHODS

This is a retrospective study of children and adolescents who underwent epilepsy surgery and were evaluated through clinical data, videoelectroencephalogram (V-EEG), neuroimaging findings, neuropsychological testing, and aspects of QOL. These assessments were performed prior to surgery and after six months and two years of follow-up. Quality of life was assessed with epilepsy-specialized questionnaires, namely Questionnaire health-related quality of life for children with epilepsy (QVCE-50), Autoquestionnaire Qualité de Vie Enfant Image Scale (AUQUEI), Quality of life in epilepsy inventory for adolescents (QOLEI-AD-48); and burden of caregivers with Burden Interview - ZARIT scale. Postoperative changes in QVCE-50 were quantified using measures of the analysis of variance (ANOVA MR) for comparison of the difference between the three times of the scale and domains.

RESULTS

Fifty patients were enrolled. Of these, 27 (54%) were male, with a mean age at surgery of 8.2 years (range: 1-18 years). Thirty-five patients (70%) were Engel I and one was Engel II (2%) at six months of follow-up, whereas 28 (56%) were Engel I and 32 (64%) were Engel I or II at two years of follow-up. Preoperatively, 21 (42%) presented with moderate or severe intellectual disability. Postoperative cognitive evaluations at the two-year follow-up showed 18 (36%) maintained similar deficits. The QVCE-50 showed postoperative improvement in the two-year follow-up period, but not at six months after surgery. Postoperative improvements were associated mainly with better seizure outcome. Autoperception evaluations were limited because of the clinical and cognitive severity of patients. The burden of caregivers was quoted as mild to moderate and remained unchanged postoperatively.

CONCLUSIONS

Children and adolescents with surgically treated epilepsy reach a good seizure outcome, stabilize in intellectual and adaptive functions, and have an increase in QOL, from the caregiver's perspective. Nevertheless, their burden remains unchanged. Seizure outcome is the main factor for improvement in the QOL. The upgrading of structured questionnaires and QOL instruments specific to pediatric epilepsy can be helpful to assess patient- and caregiver-reported surgical outcomes, allowing for better planning of therapeutic approaches.

Cognitive Mediators of School-Related Socio-Adaptive Behaviors in ASD and Intellectual Disability Pre- and Adolescents: A Pilot-Study in French Special Education Classrooms

The school inclusion of students with autism is still a challenge. To address the cognitive underpinnings of school-related adaptive behaviors, 27 students with autism and 18 students with intellectual and/or severe learning disability, aged from 11 to 17, were recruited. They underwent socio-emotional processing and executive functioning assessments, as well as school-related adaptive behavior and quality of life measurements. Both groups performed equally on socio-emotional and executive assessments, and they reported the same low quality of life. However, students with autism exhibited more limitations than the students with intellectual disabilities on complex school adaptive behaviors (socialization and autonomy) and problem behaviors, but both groups performed equally on more basic adaptive behaviors (school routines, communication). Multiple regression analyses highlighted between-group differences in terms of adaptive functioning profiles, which were linked with different cognitive predictors according to students’ medical conditions. The greater school-related limitations of students with autism were mostly explained by socio-emotional performance, while IQ (intellectual quotient) mostly explained the comparable between-group limitations. The low quality of life of both groups was slightly explained by executive performance. The role of both socio-emotional and executive functioning in students’ adaptive behaviors and quality of life suggests remediation targets for promoting the school inclusion of students with autism.

A Rights-Based Approach for Service Providers to Measure the Quality of Life of Children with a Disability

BACKGROUND

This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD).

METHODS

This study reviewed systematic reviews to identify generic QoL instruments for children and adolescents, followed by an appraisal process using newly developed criteria. QoL instruments with a health status, functioning, and condition-specific focus were excluded.

RESULTS

Twenty generic QoL instruments for children were identified from existing systematic reviews to undergo further review. Only 2 of the 20 instruments were recommended for service providers to measure the QoL of children with a disability (KIDSCREEN and KINDL). Many pediatric QoL instruments (N = 9) focus on functioning and are not consistent with the CRPD, confounding a child's functioning with their feelings about their life. KIDSCREEN and KINDL have self-report and parent report versions, are applicable for childhood and adolescence, demonstrate adequate reliability and validity, involved children in their development, focus on wellbeing, are likely to be able to be completed by a child with a disability, and are low in cost.

CONCLUSIONS

Many instruments focus on functioning rather than wellbeing and thus may not capture the QoL of children with a disability. A child's functional limitations may not be consistent with their feelings about life. Two instruments that assess wellbeing and meet the criteria important for service providers now require further testing to explore their usefulness and validity for children with varying abilities.

Outcome measures in coeliac disease trials: the Tampere recommendations

OBJECTIVE

A gluten-free diet is the only treatment option of coeliac disease, but recently an increasing number of trials have begun to explore alternative treatment strategies. We aimed to review the literature on coeliac disease therapeutic trials and issue recommendations for outcome measures.

DESIGN

Based on a literature review of 10 062 references, we (17 researchers and 2 patient representatives from 10 countries) reviewed the use and suitability of both clinical and non-clinical outcome measures. We then made expert-based recommendations for use of these outcomes in coeliac disease trials and identified areas where research is needed.

RESULTS

We comment on the use of histology, serology, clinical outcome assessment (including patient-reported outcomes), quality of life and immunological tools including gluten immunogenic peptides for trials in coeliac disease.

CONCLUSION

Careful evaluation and reporting of outcome measures will increase transparency and comparability of coeliac disease therapeutic trials, and will benefit patients, healthcare and the pharmaceutical industry.

Measuring Outcomes of Psychological Well-Being within Paediatric Health Settings

There are many widely used, validated patient reported outcome measures for physical and mental health. However, capturing outcomes from young people living with chronic health conditions presents a challenge, needing to take the complex interplay of physical and mental health into consideration. The authors found that regularly used outcome measures for child and adolescent emotional well-being in paediatric settings largely fall into two groups: paediatric quality of life and child and adolescent mental health measures. The applicability and potential for use of these measures within this context is discussed. Whilst offering some utility, neither approach leaves sufficient space for young people’s individual experiences of illness and treatment. The scope of using alternative qualitative approaches that capture the rich stories and experiences of young people living with chronic illnesses is considered.

Psychometric properties of the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI) applied to children with cerebral palsy

BACKGROUND

Quality of life (QL) assessments of children with incapacitating diseases, such as cerebral palsy (CP), have often been conducted with the help of the representatives of a child, making QL assessment more subjective. The Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI) is a QL assessment designed for children to self-report-it uses images to facilitate the reporting process.

OBJECTIVE

evaluate the psychometric properties of AUQEI when responses are given by children with CP.

FINDINGS

Children aged 4 to 12 years (45 with CP and 45 healthy children) gave responses to the questionnaire. The data quality, reliability and validity were assessed. The data loss rate ranged from 8.8% to 46.7%, and was highest for the "autonomy" factor. No floor or ceiling effect was detected. The success rate for reliability of the internal consistency of the items was less than 80% for the "autonomy" factor. Cronbach's alpha coefficient was 0.71 for the instrument and less than 0.5 for the factors. All the factors had a success rate of greater than 80% for the discriminating validity of the items. The factors did not have correlations between each other, thus indicating adequate discriminating validity. Convergent validity was tested and a significant correlation was demonstrated only between the AUQEI "functioning" factor and the Child Health Questionnaire--50-Item (CHQ-PF50) physical summary score (r = 0.31, p = 0.042). The AUQEI scores did not have correlations with the gross motor function scores (p>0.05) as expected for divergent validity. Regarding construct validity, the total AUQEI score obtained by the CP group was lower (median: 47.3) than that of the healthy group (median: 51.0) (p<0.01).

CONCLUSION

The AUQEI was shown to be a reliable and valid instrument for assessing children with CP when the total score was used. Convergent validity should continue to be tested in future studies.

[The placement courses and the subjective quality of life of 6- to 11-year-old children living in child welfare institutions]

BACKGROUND

Besides diseases, the concept of quality of life is increasingly used to account for the consequences of other vulnerability situations that may be encountered by individuals, including young children. However, very few studies have examined children's perception of their quality of life in the context of child welfare and protection, and they yielded mixed results.

OBJECTIVES

The objectives of this study were (1) to compare the subjective quality of life of children placed in institution with that of children living in their families, by controlling for child sex, age, socioeconomic and familial status, and (2) to examine its relations with their placement course in the child welfare system.

METHOD

The sample of this study was composed of 56 children aged 6 to 11, 28 of which were placed in a child welfare institution. Information about the placement course of institutionalized children was given by their social workers and the quality of life of all participants was assessed with the AUQUEI questionnaire. This self-report, which is based on children's conception of their quality of life, allows assessment of four distinct dimensions in addition to the overall score: leisure, performances, relations and family life, and separation.

RESULTS

According to the results, the quality of life of children placed in institutions did not differ from that of children living in their families. However, its perception was closely related to the placement course of institutionalized children in the child welfare system. Whereas maltreated children obtained lower overall and performance scores than their neglected peers, children placed in foster families before institution had a poorer perception of their quality of life in the domains of family life and separations.

DISCUSSION

These results are interpreted in light of attachment research and theory. Indeed, the relations between children's quality of life and their placement course could be explained by their high level of attachment disorganization. Finally, the results of this study suggested that children were well aware of their difficulties and that they can easily be identified by directly assessing the children's quality of life.

A new self-report quality of life questionnaire for children with neuromuscular disorders: presentation of the instrument, rationale for its development, and some preliminary results

Improvement of quality of life in neuromuscular disorders is a primary objective, both in management of affected children and in the context of therapeutic trials. Quality of life is a subjective concept and it is crucial to gather information directly from patients. We created the SOLE Questionnaire for NMDs, a new instrument designed to investigate quality of life in children with neuromuscular disorders, and tested it in a study population of 78 patients and in 81 healthy children aged 5 to 13 years. The SOLE Questionnaire, characterized by a visual and neutral approach, was well received, practical, rapid to administer, and able to discriminate between patients and controls. We also confirmed the presence of disagreement about children's quality of life between children and their parents. We suggest that our new approach could help to improve understanding of quality of life in children with neuromuscular disorders.

Health-related quality of life in children and adolescents with autism spectrum disorder

OBJECTIVE

This study evaluates self- and proxy-reported health-related quality of life (HRQOL) in children and adolescents with autism spectrum disorders (ASD). The study also compares HRQOL in ASD patients with a healthy control sample and a psychiatric reference sample.

METHOD

42 children and adolescents (39 male, mean age: 12.7 ± 2.6 years, mean IQ: 100.5 ± 20.7) with the diagnosis of autism spectrum disorder (ASD) and their parents completed the Inventory for the Assessment of Quality of Life in Children and Adolescents (ILK).

RESULTS

Mean ILK LQ 0-28 scores were 20.6 (± 4.6) (self-report version) and 18.2 (± 4.0) (proxy version). Compared to a reference sample, mean ILK scores from the ASD sample were at the 47th percentile (self-report) and the 33rd percentile (proxy). Compared to children and adolescents with psychiatric disorders, self-reported ILK scores correlated with the 69th percentile, and proxy-reported ILK scores correlated with the 67th percentile. Self-reported HRQOL was significantly higher than proxy-reported HRQOL. No significant correlation was found between HRQOL and age, IQ, or autistic symptoms.

CONCLUSIONS

HRQOL in children and adolescents with ASD seems to be better than in other psychiatric disorders, but lower than in healthy controls.

Evaluation of the quality of life of children with celiac disease and their parents: a case-control study

PURPOSE

The purpose of the present study was to evaluate the quality of life (QoL) of children with CD and of their parents and to compare it with that of children without CD and of their parents.

METHODS

A case-control study was conducted to evaluate the quality of life of children (5-12 years) with CD and one of their parents, compared to the QoL of children without CD (and their parents as their caregivers ). The QoL was assessed by applying the following questionnaires: AUQUEI (children) and WHOQOL-BREF (parents).

RESULTS

QoL was evaluated in 33 children with CD, 63 children without CD, and of their respective parents as their parent caregivers (96 adults). QoL total scores were similar between the groups of children with and without CD. However, in the Leisure dimension, the scores of children with CD were significantly lower than those of the controls (P = 0.029). Similarly, when assessing the QoL of the parents, we found scores significantly lower in the social dimension (P = 0.0196) for parents of children with CD compared to parents of children without CD. Family income presented an impact on the QoL in adults, but did not affect children. In CD group, children of mothers who had lower educational levels presented better scores in the function dimension, regarding self-care and autonomy.

CONCLUSIONS

There is an impairment of the QoL of children with CD and of their parents, with regard to social life, particularly in the leisure (children) and social (adults) dimensions.

Self-reported quality of life has no correlation with functional status in children and adolescents with spinal muscular atrophy

BACKGROUND

Spinal muscular atrophy is one of the most common neuromuscular disorders in children. Associated with progressive muscular weakness, it may assume a chronic course. In chronic disorders it is of utmost importance to determine the quality of life level.

OBJECTIVE

To determine the level of quality of life in a cohort of SMA children and adolescents, and study its relation to motor ability.

METHODS

From the children and adolescents with confirmed SMA diagnosis (presence of deletion) followed at a University Hospital, we selected those that were 4 years or older. They were classified as SMA type II or III according to their best motor ability, evaluated according to the modified Hammersmith functional score, and undertook the AUQEI Portuguese version to determine quality of life. This is an Institutional Review Board approved study and consent was given by all those included.

RESULTS

Thirty-three children and adolescent with a mean age of 10.28 (± 4.71) took part of the study. The fourteen SMA type II had a mean Hammersmith score of 11 (± 9.50) and AUQEI of 55.85 (± 7.16), while the nineteen SMA type III scored 31.10 (± 12.30) and 52.94 (± 4.85). No significant difference was found when quality of life scores was compared among those groups.

CONCLUSION

On a self-reported scale it seems that regardless the functional status an SMA child and adolescent has a perception of good quality of life.

Quality of life in children with epilepsy and cognitive impairment: a review and a pilot study

Various methods have recently been proposed to assess the physical, psychological or social dimensions of quality of life (QoL) in children with epilepsy (CwE) and their families. Some methods are based exclusively on parental report and others emphasize the importance of an interview with the patient himself. In children with epilepsy and severe cognitive deficit only parental report is possible in practice; however, some parental based methods to evaluate QoL in CwE have excluded children with cognitive deficit. The present pilot study explores which items are suitable for a parental-based QoL evaluation in CwE and special educational needs, and the most frequently reported parental concerns in this special population of children.

Quality of life among adolescents with cerebral palsy: what does the literature tell us?

This review describes trends in quality of life (QOL) and health-related quality of life (HRQOL) among adolescents with cerebral palsy (CP). Twenty original articles were identified by a structured search of multiple databases and grouped by design. Categories included descriptive cross-sectional studies (n=8), measurement validation studies (n=9), and exploratory qualitative studies (n=3). Several trends were apparent. First, individuals with CP are reported to have decreased QOL and HRQOL compared with a normative population in some but not all areas of well-being. Second, functional status measures such as the Gross Motor Function Classification System are reliable indicators of variations in physical function, but do not correlate consistently with psychosocial well-being. Third, although adolescents with CP have different life issues than adults or children, limited research on factors associated with QOL and HRQOL has been described for this age range. We recommend that clinicians and researchers interested in assessing well-being among adolescents with CP include participants from across the spectrum of motor impairment, allow adolescents to self-report whenever possible, and assess adolescents independently, rather than including them with individuals from other age groups or clinical populations.

[Quality of life in HIV-infected children and adolescents under highly active antiretroviral therapy: change over time, effects of age and familial context]

OBJECTIVE

To evaluate Quality of life (QoL) of HIV-infected children under highly active antiretroviral therapies, and its change over 18 months.

MATERIALS AND METHODS

QoL was evaluated by self-administred questionnaires (french versions of AUQUEI, OK-ado, and compilation of both) in 23 young living with HIV/AIDS (6-15 yrs), under antiretroviral multitherapies, and re-evaluated 18 months later in 19 of them.

RESULTS

At baseline, QoL in HIV-infected children-adolescents was relatively good. The answers given to each items and the mean score from infected children were similar to those obtained in uninfected healthy children. Moreover, infected adolescents distinguished definitly from healthy adolescents, describing higher QoL. The mean satisfaction score from the whole group decreased between M0 and M18 (mainly in the youngests), and mainly concerned 3 fields (self-esteem, health and school) while their somatic health remained stable or improved. An effect of the familial context was also observed for these 3 fields.

CONCLUSION

The progressive decline of QoL in HIV-infected children, and the surprising high and steady level of satisfaction over-time provided by the adolescents, underlined the frailty of this population and the need for a psychologic management associated to the medical follow-up. Such a multidisciplinary approach should take into account the preoccupations and difficulties of each age-class, those linked to the diagnosis itself, and to the familial or scolar contexts, in order to preserve QoL of this pediatric population, as far as possible, in a long term.

Satisfaction in different life domains in children receiving home parenteral nutrition and their families

OBJECTIVE

To assess the quality-of-life (QOL) of children receiving home parenteral nutrition (HPN).

STUDY DESIGN

A national multicenter study of 72 patients (median age 4 years) presenting with a digestive disease requiring HPN, and 90 siblings, 67 fathers, and 69 mothers of these children. Median duration of HPN was 2 years (3 months-18 years). QOL was measured using validated, nondisease-specific questionnaires appropriate to the children's ages.

RESULTS

The QOL scores were high in patients of all ages and were not significantly different from scores in a reference population of healthy children and adolescents. Lower QOL scores were recorded in the domains related to hospital, health, doctors, medications, and obligations. The QOL was not affected in siblings but was significantly impaired in parents, especially in mothers, who showed a lower level of satisfaction than did fathers for items related to work, inner life, and freedom. Presence of an ileostomy was the only factor that influenced QOL, especially of adolescents.

CONCLUSIONS

QOL of HPN-dependent children and siblings is not different from that of healthy children, suggesting that these children actively use effective coping strategies. In contrast, the QOL of parents of HPN-dependent children is low.

Reliability and validity of the VSP-A, a health-related quality of life instrument for ill and healthy adolescents

PURPOSE

To report the preliminary validation results of a generic self-administered measure for adolescents the VSP-A (Vecu et Sante Percue de l'Adolescent).

METHODS

The validation survey of the 37-item VSP-A involved 1938 adolescents: 1758 adolescents attending school (90.7%) and 180 inpatient youths (9.3%) with medical, surgical, or psychiatric conditions; mean age was 14.8 years (SD = 2.1; range = 10-17) and 1018 (52.5%) were girls. Ten dimensions scores were computed: psychological well-being, body image, physical well-being, vitality, friends, parents, teachers, school performance, medical staff, and a global HRQL index. Construct validity was tested using inter-item correlations, item-dimension correlations, and principal component analysis. The unidimensionality of the scales was studied using Rasch rating scale model and the internal consistency of the scales using Cronbach alpha. Known group comparisons were performed and effect sizes computed to assess the clinical validity and sensitivity of the instrument.

RESULTS

VSP-A, completed in less than 15 minutes, is consistent (Cronbach alpha = 0.74-0.91). Content and construct validity are good. Factorial validity, item-internal consistency, item-discriminant validity, and inter-dimension correlations support the item grouping in 10 dimensions. The results of the comparison of the VSP-A scores according to external criteria (sociodemographics, health status) show they are in accordance with the literature and previous works.

CONCLUSIONS

These preliminary results support the reliability and validity of the VSP-A as a multidimensional adolescent report of HRQL in healthy and patient populations. The next phase of the research consists of testing the sensitivity to changes of the VSP-A.

Quality of life after kidney and pancreas transplantation: a review

There is an increasing amount of data on quality of life (QOL) in most chronic illnesses; some of the instruments used are generic, but recently, there is a tendency to use disease-specific instruments. We propose that recipients of organ transplants be assessed routinely for QOL by means of the 36-Item Short-Form Health Survey or a disease-specific instrument; for compliance, by means of the Long-Term Medication Behavior Self-Efficacy Scale; and for psychological status, by means of the Beck Depression Inventory Brief Symptom Inventory or the Symptom Checklist. The widespread use of QOL data in recipients of organ transplants will increase accountability of service providers and eventually increase patient satisfaction because these instruments are patient reported.

Quality of life of children and adolescents after kidney or liver transplantation: child, parents and caregiver's point of view

A cross-sectional study was performed to assess quality of life (QoL) after kidney or liver transplantation during childhood. Self-questionnaires explored children, adolescent and parent QoL. Seventy-five transplant children, 36 transplant adolescents, 67 mothers, 34 fathers and 67 caregivers filled out the questionnaires; they were compared with a reference population. Children reported a rather good QoL, but their extra-family involvement appeared not as satisfactory as that of the reference population children. Adolescents reported a very high QoL when completing the structured format scale; however, their responses to open-ended questions showed qualitative differences compared with those of a reference population: they expressed concern about their body or health, less pleasure than ordinary adolescents to manage by themselves, and a poor relationship with peers. Mothers indicated a deep impact of the child's illness on their own QoL, and the need for psychological support. In conclusion, a rather good QoL is a long-lasting feature of kidney and liver transplantation in children. Such an assessment is mandatory to identify remaining impairments in some selected areas, either in the recipient or family.

Renal transplant recipient attitudes toward steroid use and steroid withdrawal

Although steroid avoidance and withdrawal in renal transplant recipients (RTR) are actively being evaluated by physicians, the attitudes of recipients toward steroid use have not been systematically studied in the modern era. We conducted a confidential written survey of single-organ adult RTR pertaining to prednisone-related side-effects. Recipients were asked which drug they felt maximized graft life, which drug they wished to avoid if graft life was unaffected, and which drug they had most compliant with. They also rated 16 common immunosuppressive-related side-effects on a Likert scale with 1 meaning complete disagreement and 10 complete agreement with their own prednisone-attributed experience. A comparison of responses based on RTR demographic characteristics was made by ANOVA or chi-square analysis with Bonferroni correction. The questionnaire was completed by 223 recipients, of whom 93% were primary recipients, 57% were cadaveric organ recipients, and 69% were white people, 7% black people, and 23% Asian people. Age at transplant, age at survey and time since transplant were 41.5 +/- 11, 47.5 +/- 11 and 6.0 +/- 5 yr, respectively. For the entire group, overall side-effect profile for prednisone was rated as 6.1 +/- 3 on the Likert scale, while efficacy was rated as 7.3 +/- 3. If offered monotherapy, 67% preferred a calcineurin-inhibitor (CI), 23% mycophenolate mofetil (MMF)/azathioprine (AZA), and 10% prednisone. When asked which drug they would like to discontinue, 19% chose CI, 16% MMF/AZA, and 65% prednisone. Most recipients felt that CI was the most efficacious drug (80%), followed by MMF/AZA (12%), and prednisone (8%). The side-effects reported as most common were unacceptable weight gain (5.8 +/- 3) and bone/joint disease (5.3 +/- 3). The least common side-effects were blood disorders (2.2 +/- 2) and cancer (2.3 +/- 2). Black people were more likely than non-black people to report developing diabetes (p = 0.02), blood disorders (p = 0.003) and headaches (p = 0.003) as a result of prednisone use. Males reported more liver damage (p = 0.01) while females reported more body fat (p = 0.01) and fluid retention (p = 0.006). RTR >5 yr post-transplant reported more infections (p = 0.008), skin/hair problems (p = 0.02), gastrointestinal irritation (p = 0.02), and bone disease (p = 0.02) compared with RTR <1 yr. Donor source and recipient age did not determine any responses. If given a 'risk-free' choice, the majority of recipients prefer withdrawal of steroids over other agents. Demographic data may be used to predict prednisone-related side-effects and guide steroid use in this population. Study designs related to steroid withdrawal should account for patient preferences in this context.

[Quality of life of a population of 54 ambulatory children with cerebral palsy. A cross-sectional study]

To evaluate the impact of handicap on quality of life in children with cerebral palsy and living in family.

METHOD

A descriptive study by investigation was conducted in children with cerebral palsy, with the ability to walk, from 4 to 12 years of age, and in their family. Quality of life was evaluated with the AUQUEI questionnaire. Another questionnaire was given to the parents to collect the different variables, which could influence quality of life of the child.

RESULTS

The mean age was 9 years. Associations between the studied variables and the quality of life were observed for motor function, number of siblings and the quantity of hours of reeducation given by the family. Parents evaluated their quality of life on the visual scale at 72.23 mm (95CI: 51.60-92.84). There was no correlation between the assessment of quality of life of parents and children.

DISCUSSION-CONCLUSION

The better the child's motor function the less satisfied he was. This result shows the poor correlation between quality of life and general condition, impairment or disability. The greater the number of children in the family the less satisfied the child was within the family and the more satisfied the child was at school. A handicapped child has perhaps a more difficult place in the close family and an easier time in a school where the environment is more neutral. The more time that is devoted by the family to reeducation the less the child is satisfied. Quality of life seems to be influenced negatively by the demands of physical therapy, which do not correspond to the reality of the abilities of the child.

Health-related quality of life reported by French adolescents: a predictive approach of health status?

PURPOSE

To examine the relevance of a self-administered multidimensional instrument to the discrimination of illness and health among adolescents in South-eastern France.

METHODS

We show the results of a self-reported HRQL assessment by the Vécu et Santé Perçue de l'Adolescent (VSP-A) multidimensional questionnaire, conducted on a population of 3061 adolescents. The VSP-A produces a score for each of the seven dimensions (relationships with friends, relationships with parents, school life, inaction, psychological distress, future, and energy/vitality) and a global score. The result is compared with the answers of the parents to the same multidimensional HRQL questionnaire reworded for them (VSP-P) and to the perceived health self-reported by the adolescents on a visual analogue scale (VAS). The adolescents filled both the VSP-A and VAS questionnaires twice at a 1-month interval.

RESULTS

A total of 2941 adolescents completed the questionnaire correctly, and 1760 VSP-P questionnaires were filled out by their parents. The global HRQL score as well as the dimension scores from the parents' assessment were significantly different from those of the adolescents. At the inception, using three approaches (self-reported VAS, VSP-A, and VSP-P), it was possible to discriminate between ill and healthy adolescents. Nevertheless, the VSP-A completed at the inception is the only of the three approaches that can point out the adolescents who will become ill during the following month. Furthermore, the results reported by VSP-A largely agree with literature.

CONCLUSION

The VSP-A could provide a comprehensive approach of HRQL of young people in both health prevention and the health care system.

[Family socioeconomic deprivation and vulnerability in the pediatric emergency room: evaluation and management]

OBJECTIVE

The aim of this study was to evaluate the importance of socioeconomic deprivation and other forms of vulnerability in families attending the pediatric emergency unit (PEU). It was based on a five-level classification of family types and an analysis of responses provided by the French healthcare system.

METHOD

The prospective study involved 150 families admitted to the PEU on the basis of open-response interviews that analyzed demographic and socio-economic characteristics, motivations for consultation, the child's quality of life, family problems experienced by the parents, and their support network.

RESULTS

Five categories of families were defined as follows: complete destitution necessitating immediate social measures (0.7%); acknowledged and well-managed economic deprivation (13.3%), unacknowledged and/or complex economic deprivation with a significant deterioration in the quality of life (22.2%), familial psychological vulnerability without economic deprivation (30.4%), and families without any apparent problems (33.7%). Consultation at the PEU appears to be a multifactorial phenomenon motivated by socioeconomic, psychological and cultural factors. This phenomenon is connected with the present-day imbalance in the healthcare system, which does not adequately respond to the needs of vulnerable families.

CONCLUSION

This survey contributes to the current reflection on the integration of psychosocial factors in child healthcare at both the hospital and local community level. The method described herein has determined the factors of vulnerability and the risks of economic deprivation. It can contribute to the development of improved communication and cooperation between practitioners, the hospital and local social workers.

Validation of a French health-related quality of life instrument for adolescents: the VSP-A

The French Health Ministry, stating the limits of traditional indicators to take into account the different aspects of adolescent health, declared adolescent health status assessment as a priority. Thus a French health-related quality of life (HRQL) generic self-administered indicator was developed on the adolescent's viewpoint for healthy and ill adolescents of 11-17: the VSP-A, Vécu et Santé Perçue de l'Adolescent, intended to be used as a discriminative, predictive and evaluative instrument. This paper reports the validation study of the 40-item VSP-A including 2941 adolescents. Six dimension scores were computed: psychological well-being, energy, friends, parents, leisure, school, as well as an index. Content and construct validity were confirmed. Factorial validity was shown. As expected, scale scores were significantly associated with a one-item global well-being visual analogue scale (r = 0.53; p < 0.001) and with a self-esteem score (r = 0.62; p < 0.001). On the VSP-A index, girls and older adolescents were found to have the lowest scores. The VSP-A is reliable in terms of internal consistency (Cronbach's alpha = 0.83) and test-retest results (r = 0.69; p < 0.001). The ability of VSP-A, filled in less than 15 min, was shown to discriminate between ill and healthy adolescents, and to predict an impairment of their health status. The next phase of the research involves testing in various populations and more specifically in populations with diverse acute and chronical health conditions, so as to refine the content of the instrument and to add much to what is known about the sensitivity to changes of the VSP-A scores in patients who are under treatment.

[Evaluation of the quality of life of infants and very young children: validation of a questionnaire. Multicenter European study]

In the last few years, evaluating quality of life in children has become possible using specific instruments; nevertheless, there is still an unsolved issue concerning the earliest ages, when the child is not able to give his/her own opinion. QUALIN, a new instrument designed to assess an infant's quality of life (between the ages of three months and three years) was developed from the study of spontaneous criteria used by parents or caregivers (paediatricians or nurses) when they think about the quality of life of a baby (preliminary survey including 800 open-ended questionnaires).

PATIENTS AND METHODS

One thousand four hundred and twelve children under the age of three were included in this validation study. QUALIN questionnaire is a 34-item scale and can be completed by parents or caregivers. Two forms are available: one form is designed for children under the age of one and the other is designed for children between the ages of one and three. The QUALIN questionnaire was translated into English, Italian and Spanish, and a European multicentric validation study was conducted in Belgium, France, Italy, Luxembourg, Spain and Switzerland. Data were collected with QUALIN questionnaires from children's parents and paediatricians.

RESULTS

The psychometric properties of the scale are satisfactory (acceptability 90%, Cronbach's coefficient alpha over 0.75, correlations between two raters over 0.50, construct validity with principal component analysis showed emerging factors in agreement with the hypotheses linked to the questionnaire construction). The results are interesting, showing significant differences according to the health status of the children and their country of origin.

CONCLUSION

The QUALIN questionnaire can be used for studies concerning the quality of life of children less than three years of age.

[Infant quality of life: criteria of parents and professionals. Development of an evaluation instrument]

A survey was performed using open-ended questionnaires to be completed by parents or care-givers dealing with very young children (less than 3 years old) in order to study their opinions concerning the child's quality of life. About 800 questionnaires were analyzed with a content-analysis method. Nine categories and about 40 elementary criteria were distinguished. Some criteria were widely quoted. Others appeared useful to discriminate between care givers and parents, between different situations encountered by the child, and his/her age. This information will be used to develop a young child's quality of life scale.