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Witt S, Bloemeke J, Bullinger M, Dörr HG, Silva N, Quitmann JH. Growth hormone treatment in children with short stature: impact of the diagnosis on parents. J Pediatr Endocrinol Metab 2024; 37:326-335. [PMID: 38421314 DOI: 10.1515/jpem-2023-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES This prospective multicenter study aimed (1) to examine changes in parent-reported health-related quality of life (HRQOL) of children with short stature and the effects of the children's condition on parents themselves within the first year of human growth hormone (hGH) treatment and (2) to predict effects on parents based on main and interaction effects of children's HRQOL and increase in height. METHODS A total of 110 parents of children aged 4-18 years, diagnosed with idiopathic growth hormone deficiency, small for gestational age, or idiopathic short stature, were recruited from 11 participating German pediatric endocrinologists and asked to fill out the short stature-specific Quality of Life in Short Stature Youth (QoLISSY) Questionnaire before hGH treatment was initiated and one year later. RESULTS Negative effects of the children's short stature on the parents decrease over time, independent of diagnosis and treatment status. Furthermore, treatment status and height increase moderated the links between children's improved HRQOL as perceived by their parents and decreased caregiving burden. CONCLUSIONS Based on the children's improved HRQOL and the parent's decrease in caregiving burden, patient-reported outcomes that consider parental and child's perspectives should be considered when deciding on hGH treatment for children.
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Affiliation(s)
- Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, 37734 University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Janika Bloemeke
- Department of Medical Psychology, Center for Psychosocial Medicine, 37734 University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Monika Bullinger
- Department of Medical Psychology, Center for Psychosocial Medicine, 37734 University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Helmuth-Günther Dörr
- Clinic for Children and Adolescents, 27168 Erlangen-Nürnberg Universtiy , Erlangen, Germany
| | - Neuza Silva
- Department of Medical Psychology, Center for Psychosocial Medicine, 37734 University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, 37734 University Medical Center Hamburg-Eppendorf , Hamburg, Germany
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Zang J, Witt S, Johannsen J, Weiss D, Denecke J, Dumitrascu C, Nießen A, Quitmann JH, Pflug C, Flügel T. DySMA - an Instrument to Monitor Swallowing Function in Children with Spinal Muscular Atrophy ages 0 to 24 Months: Development, Consensus, and Pilot Testing. J Neuromuscul Dis 2024; 11:473-483. [PMID: 38457144 PMCID: PMC10977442 DOI: 10.3233/jnd-230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 03/09/2024]
Abstract
Background The manifestation of bulbar symptoms, especially swallowing, is important for evaluating disease-modifying therapies for spinal muscular atrophy (SMA). Due to the lack of instruments, the topic is still underrepresented in research. Objective This study aimed to develop a tool to monitor swallowing development in children aged 0 to 24 months with SMA. Methods The method was guided by the COSMIN guidelines and followed a multi-stage Delphi process. The first step was a rapid review of swallowing outcomes in children with SMA younger than 24 months. In the second step, online group interviews with experts (n = 7) on dysphagia in infants were conducted, followed by an anonymous online survey among experts in infants with SMA (n = 19). A predefined consensus threshold for nominal scaled voting was set at≥75 % and for 5-point Likert scale voting at 1.25 of the interquartile range. The third step was the pilot test of the instrument, performed with three groups (healthy controls n = 8; pre-symptomatic n = 6, symptomatic n = 6). Results Based on the multi-level interprofessional consensus, the DySMA comprises two parts (history and examination), ten categories, with 36 items. Implementation and scoring are clearly articulated and easy to implement. The pilot test showed that swallowing development could be recorded in all groups. Conclusion The DySMA is well suited for monitoring swallowing development in pre-symptomatic and symptomatic treated infants with SMA. It can be performed in a time-efficient and interprofessional manner. The resulting score is comparable to results from other instruments measuring other domains, e.g., motor function.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deike Weiss
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Dumitrascu
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rautmann L, Witt S, Theiding C, Odenwald B, Nennstiel-Ratzel U, Dörr HG, Quitmann JH. Caring for a Child with Congenital Adrenal Hyperplasia Diagnosed by Newborn Screening: Parental Health-Related Quality of Life, Coping Patterns, and Needs. Int J Environ Res Public Health 2023; 20:4493. [PMID: 36901502 PMCID: PMC10002056 DOI: 10.3390/ijerph20054493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Diagnosing a child by newborn screening with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) causes multiple challenges for the affected parents and the whole family. We aimed to examine the health-related Quality of Life (HrQoL), coping, and needs of parents caring for a child with CAH to develop demand-responsive interventions for improving the psychosocial situation of affected families. In a retrospective cross-sectional design, we assessed HrQoL, coping patterns, and the needs of parents caring for a CAH-diagnosed child using specific questionnaires. Data of 59 families with at least one child diagnosed with CAH were analyzed. The results show that mothers and fathers in this study reached significantly higher HrQoL scores compared to reference cohorts. Decisive for the above-average parental HrQoL were effective coping behaviors and the parental needs being met. These findings verify the importance of helpful coping patterns and rapid fulfillment of parental needs for maintaining a good and stable HrQoL of parents with a child diagnosed with CAH. It is crucial to strengthen the parental HrQoL to build a reasonable basis for a healthy upbringing and improve the medical care of CAH-diagnosed children.
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Affiliation(s)
- Laura Rautmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W26, 20246 Hamburg, Germany
| | - Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W26, 20246 Hamburg, Germany
| | - Christoph Theiding
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W26, 20246 Hamburg, Germany
| | - Birgit Odenwald
- Bavarian Screening Center, Bavarian State Office for Health and Food Safety, Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Uta Nennstiel-Ratzel
- Bavarian Screening Center, Bavarian State Office for Health and Food Safety, Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Helmuth-Günther Dörr
- Department of Pediatric Endocrinology, University Children’s Hospital Erlangen, Loschgestr. 15, 91054 Erlangen, Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W26, 20246 Hamburg, Germany
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Witt S, Kristensen K, Blömeke J, Hebestreit H, Wocker M, Pfister L, Bullinger M, Tüscher O, Deckert J, Graessner H, Lapstich AM, Zwaan MD, Mundlos C, Quitmann JH. [Quality of Life and Experienced Distress of Patients Suspected of having a Rare (Chronic) Health Condition - Initial Findings from the ZSE-DUO Study]. Psychother Psychosom Med Psychol 2023; 73:9-15. [PMID: 35793670 DOI: 10.1055/a-1814-3998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Patients suspected of having a rare (chronic) health condition have often gone a long way within the healthcare system. To date, little is known about the health-related quality of life of this group of patients. The study aims to describe the health-related quality of life and the perceived distress of patients suspected of having a rare (chronic) health condition and compare the results with standard values of the German population. METHODS Eighty patients suspected of having a rare (chronic) health condition were recruited in the nationwide intervention study "ZSE-DUO" and reported their health-related quality of life and perceived distress using the SF-8 and the Distress-Thermometer. RESULTS The patients rated all eight dimensions of quality of life as well as the physical and mental component scores of the SF-8 significantly lower than the general population. On average, the perceived distress was rated significantly higher. More than 90% of the sample indicated distress in the clinical range. Exhaustion, pain, limited mobility as well as worries and fears were mentioned most frequently as concrete problems, with percentages ranging from 73% to 90% of the total sample. DISCUSSION In comparison to German reference data, patients suspected of having a rare (chronic) health condition report a massive impairment of their quality of life and a high burden, which is especially characterized by physical and emotional problems. The lack of a diagnosis could explain the high proportion of emotional problems, as it can create a form of legitimation of one's own disease experience. CONCLUSION The present results underline the need for research on the psychosocial impact of the possible presence of a rare (chronic) health condition. The high distress and the impact on the physical and psychological quality of life domains also highlight the need for care in this patient group.
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Affiliation(s)
- Stefanie Witt
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kaja Kristensen
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Janika Blömeke
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Hebestreit
- Zentrum für Seltene Erkrankungen - Referenzzentrum Nordbayern, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maximilian Wocker
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Pfister
- Zentrum für Seltene Erkrankungen - Referenzzentrum Nordbayern, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Monika Bullinger
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Tüscher
- Zentrum für Seltene Erkrankungen, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Jürgen Deckert
- Zentrum für Seltene Erkrankungen - Referenzzentrum Nordbayern, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Holm Graessner
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Anne-Marie Lapstich
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
| | - Martina de Zwaan
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christine Mundlos
- Allianz Chronischer Seltener Erkrankungen (ACHSE) e.V., Berlin, Germany
| | - Julia Hannah Quitmann
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Lackner L, Quitmann JH, Witt S. Caregiving burden and special needs of parents in the care of their short-statured children - a qualitative approach. Front Endocrinol (Lausanne) 2023; 14:1093983. [PMID: 37008922 PMCID: PMC10064859 DOI: 10.3389/fendo.2023.1093983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE To explore caregiving burden, health-related quality of life (HRQOL), stress, and individual resources of parents in the care of children with isolated growth hormone deficiency (IGHD) or idiopathic short stature (ISS). METHODS Focused interview analysis of previously, within the Quality of Life in Short Stature Youth (QoLISSY) project, conducted structured focus group discussions (n=7) with parents (n=33) of children with IGHD/ISS aged 4 to 18 years were performed. RESULTS 26 out of the 33 parents reported mental stress due to their child's growth disorder. Social pressure and stigmatization were also mentioned as being demanding. Some parents reported having trouble with human growth hormone (hGH) treatment. Several parents wished for parent support groups with other like-minded parents of short-statured children. CONCLUSION For physicians, it is essential to understand the parents' caregiving burden, stress, and individual resources in caring for IGHD/ISS children. If an impaired HRQOL is detected, psychological intervention for these parents may be scheduled, and coping mechanisms may be discussed. Furthermore, it seems essential for parents to be educated by their healthcare provider about the possible side effects of hGH treatment or to know where to find evidence-based information about it.
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Uecker M, Ure B, Quitmann JH, Dingemann J. Need for transition medicine in pediatric surgery – health related quality of life in adolescents and young adults with congenital malformations. Innov Surg Sci 2022; 6:151-160. [PMID: 35937850 PMCID: PMC9294337 DOI: 10.1515/iss-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Survival rates of patients with visceral congenital malformations have increased considerably. However, long-term morbidity in these patients is high. In the last decades, these circumstances have led to a shift in goals of caretakers and researchers with a new focus on patients’ perspectives and long-term morbidity. Health-related quality of life (HrQoL) is the most commonly used patient-reported outcome measure to assess the impact of chronic symptoms on patients’ everyday lives. Most pediatric surgical conditions can cause a significantly decreased HrQoL in affected patients compared to the healthy population. In order to guarantee life-long care and to minimize the impact on HrQoL a regular interdisciplinary follow-up is obligatory. The period of transition from child-centered to adult-oriented medicine represents a critical phase in the long-term care of these complex patients. This scoping review aims to summarize relevant pediatric surgical conditions focusing on long-term-morbidity and HrQoL assessment in order to demonstrate the necessity for a well-structured and standardized transition for pediatric surgical patients.
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Affiliation(s)
- Marie Uecker
- Center of Pediatric Surgery , Hannover Medical School and Bult Children’s Hospital , Hannover , Germany
| | - Benno Ure
- Center of Pediatric Surgery , Hannover Medical School and Bult Children’s Hospital , Hannover , Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jens Dingemann
- Center of Pediatric Surgery , Hannover Medical School and Bult Children’s Hospital , Hannover , Germany
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Witt S, Dellenmark-Blom M, Kuckuck S, Dingemann J, Abrahamsson K, Dingemann C, Chaplin JE, Ure B, Bullinger M, Gatzinsky V, Jönsson L, Quitmann JH. Parent-child-agreement on health-related quality of life and its determinants in patients born with Esophageal Atresia: a Swedish-German cross-sectional study. Orphanet J Rare Dis 2021; 16:120. [PMID: 33676542 PMCID: PMC7937291 DOI: 10.1186/s13023-021-01748-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim was to compare parent and child-reported health-related quality of life (HRQOL) of children born with esophageal atresia (EA) and determine factors that affect the level of parent-child agreement. METHODS We included 63 parent-child dyads of children born with EA aged 8-18 from Germany and Sweden. The generic PedsQL 4.0™ questionnaire and the condition-specific EA QOL questionnaire were used to assess children's HRQOL from parents' and children's perspectives. The PedsQL™ Family Impact Module was used to assess parental HRQOL and Family Functioning. RESULTS On an individual level, intra-class correlation coefficients indicated strong levels of parent-child agreement (.61-.97). At the group level, the analyses showed no significant differences between the responses of parents and children. When a disagreement occurred, parents were more likely to rate generic HRQOL lower than the children (19-35%) and condition-specific HRQOL higher than the children (17-33%). Findings of the binary logistic regression analyzes showed that the child's age, gender, and country (Germany vs. Sweden) were significant predictors of parent-child agreement in condition-specific HRQOL. We did not identify any significant variables that explain agreement for the generic HRQOL. CONCLUSION The parent-child agreement is mostly good, suggesting that parent-reports are a reliable source of information. However, discrepancies may occur and can be explained by the child's age, gender, and country (Sweden vs. Germany). Both perspectives are essential sources for treating EA patients and should not be considered right or wrong. Instead, this information broadens the perspective on pediatric EA patients.
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Affiliation(s)
- Stefanie Witt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 - W26, 20246, Hamburg, Germany.
| | - Michaela Dellenmark-Blom
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Drottning Silvias Barn O Ungdomsjukh, Rondvägen 10, 41685, Göteborg, Sweden
| | - Susanne Kuckuck
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 - W26, 20246, Hamburg, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School and Auf der Bult Children's Hospital, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kate Abrahamsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Drottning Silvias Barn O Ungdomsjukh, Rondvägen 10, 41685, Göteborg, Sweden.,Institute of Clinical Sciences, Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, 41686, Gothenburg, Sweden
| | - Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School and Auf der Bult Children's Hospital, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - John Eric Chaplin
- Institute of Clinical Sciences, Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, 41686, Gothenburg, Sweden
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School and Auf der Bult Children's Hospital, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 - W26, 20246, Hamburg, Germany
| | - Vladimir Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Drottning Silvias Barn O Ungdomsjukh, Rondvägen 10, 41685, Göteborg, Sweden
| | - Linus Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Drottning Silvias Barn O Ungdomsjukh, Rondvägen 10, 41685, Göteborg, Sweden
| | - Julia Hannah Quitmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 - W26, 20246, Hamburg, Germany
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Dellenmark-Blom M, Chaplin JE, Quitmann JH, Jönsson L, Gatzinsky V, Dingemann J, Abrahamsson K. The prevalence and role of coping strategies in the nutritional intake of children born with esophageal atresia: a condition-specific approach. Dis Esophagus 2019; 32:5393321. [PMID: 30888393 DOI: 10.1093/dote/doz004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study describes results of a condition-specific approach to the assessment of coping strategies in nutritional intake situations used by children with esophageal atresia. One hundred three families of children 2-17 years old with esophageal atresia participated (94% response rate). Following standardized focus groups with 30 families, nine coping items were developed, reflecting nine different coping strategies in nutritional intake situations. The coping items were pilot tested by 73 new families and evaluated for feasibility, validity, and reliability. The families also completed a validated condition-specific quality-of-life questionnaire for children with esophageal atresia, which included the scale Eating-Quality-of-life. Data were analyzed using descriptives, between-group analysis, and Spearman's rho (P < 0.05). Altogether, the coping items were feasible, valid, and reliable. Items reflecting problem-focused strategies revealed that 89% of 2-17 years old 'recognized their responsibility' and managed nutritional intake problems on their own, 79% 'tried to solve their feeding problems' testing different solutions, 79% took a 'confronting approach' to do what peers did in eating situations, and 54% 'sought other people's support'. Items reflecting emotion-focused strategies showed that 86% of the children 'accepted' their feeding difficulties, 68% 'reappraised feeding difficulties into positive outcomes' such as to eat only when food tasted good. Moreover, 63% of the children 'avoided' nutritional intake situations, 29% 'expressed worry or fear' when faced with these situations, while 25% 'distanced' themselves from eating problems by hiding or throwing away food. The children's use of coping strategies were mostly related to the existence of digestive symptoms (P < 0.05). Positive and negative coping strategies were identified. Of particular note was a correlation cluster of the so-called disengagement strategies 'avoidance', 'expression of emotional concerns' and 'distancing'. These strategies were negatively correlated with Eating-Quality-of-Life. Conversely, taking a 'confronting approach' correlated positively with Eating-Quality-of-life (P < 0.05). Hence, most children with esophageal atresia employ various coping strategies in nutritional intake situations. A good Eating-Quality-of-life may be positively affected by treating digestive morbidity and encouraging children to take an active approach to their eating problems rather than using disengagement coping.
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Affiliation(s)
- M Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - J E Chaplin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - J H Quitmann
- Institute of Medical Psychology, University of Hamburg-Eppendorf, Hamburg
| | - L Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - V Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - J Dingemann
- Centre of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - K Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
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Witt S, Dellenmark-Blom M, Flieder S, Dingemann J, Abrahamsson K, Jönsson L, Gatzinsky V, Chaplin JE, Ure B, Dingemann C, Bullinger M, Sommer R, Quitmann JH. Health-related quality of life experiences in children and adolescents born with esophageal atresia: A Swedish-German focus group study. Child Care Health Dev 2019; 45:79-88. [PMID: 30221367 DOI: 10.1111/cch.12619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 07/20/2018] [Accepted: 07/21/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Esophageal atresia (EA) is a rare malformation of the esophagus, which needs surgical treatment. Survival rates have reached 95%, but esophageal and respiratory morbidity during childhood is frequent. Child and parent perspectives and cultural and age-specific approaches are fundamental in understanding children's health-related quality of life (HRQoL) and when developing a pediatric HRQoL questionnaire. We aimed to increase the conceptual and cross-cultural understanding of condition-specific HRQoL experiences among EA children from Sweden and Germany and investigate content validity for an EA-specific HRQoL questionnaire. METHODS Eighteen standardized focus groups (FGs) with 51 families of EA children aged 2-17 years in Sweden (n = 30 families) and Germany (n = 21 families) were used to explore HRQoL experiences, which were content analyzed into HRQoL domains. The Swedish HRQoL domains were analyzed first and used as framework to evaluate HRQoL content reported in the German FGs. HRQoL experiences were then categorized as physical, social, and emotional HRQoL burden or resource. RESULTS One thousand nine hundred eight HRQoL statements were recorded. All nine EA-specific HRQoL domains identified in the Swedish FGs (eating, social relationships, general life issues, communication, body issues, bothersome symptoms, confidence, impact of medical treatment, and additional difficulties due to concomitant anomalies) were recognized in the FGs held in Germany, and no additional EA-specific HRQoL domain was found. The HRQoL dimensions referenced physical burden (n = 655, 34.5%), social burden (n = 497, 26.0%), social resources (n = 303, 15.9%), emotional burden (n = 210, 11.0%), physical resources (n = 158, 8.3%), and emotional resources (n = 85, 4.5%). CONCLUSION This first international FG study to obtain the EA child and his or her parents' perspective on HRQoL suggests Swedish-German qualitative comparability of the HRQoL domains and content validity for a cross-cultural EA-specific HRQoL questionnaire. EA children make positive and negative HRQoL experiences, but prominently related to physical and social burden, which underlines appropriate follow-up care and future research.
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Affiliation(s)
- Stefanie Witt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michaela Dellenmark-Blom
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sofie Flieder
- Department of Pediatric Surgery, Hannover Medical School, Auf der Bult Children's Hospital, Hannover, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Auf der Bult Children's Hospital, Hannover, Germany
| | - Kate Abrahamsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Linus Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vladimir Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Eric Chaplin
- Institute of Clinical Sciences, Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Auf der Bult Children's Hospital, Hannover, Germany
| | - Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Auf der Bult Children's Hospital, Hannover, Germany
| | - Monika Bullinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rachel Sommer
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Dellenmark-Blom M, Abrahamsson K, Quitmann JH, Sommer R, Witt S, Dingemann J, Flieder S, Jönsson L, Gatzinsky V, Bullinger M, Ure BM, Dingemann C, Chaplin JE. Development and pilot-testing of a condition-specific instrument to assess the quality-of-life in children and adolescents born with esophageal atresia. Dis Esophagus 2017; 30:1-9. [PMID: 28475726 DOI: 10.1093/dote/dox017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/10/2017] [Indexed: 12/11/2022]
Abstract
The survival rate of children with esophageal atresia has today reached 95%. However, children are at risk of chronic morbidity related to esophageal and respiratory dysfunction, and associated anomalies. This study describes the pilot testing of a condition-specific health-related quality-of-life instrument for children with esophageal atresia in Sweden and Germany, using a patient-derived development approach consistent with international guidelines. Following a literature review, standardized focus groups were conducted with 30 Swedish families of children with esophageal atresia aged 2-17 years. The results were used for item generation of two age-specific pilot questionnaire versions. These were then translated from Swedish into German with considerations of linguistic and semantical perspectives. The 30-item pilot questionnaire for children aged 2-7 years was completed by 34 families (parent report), and the 50-item pilot questionnaire for children aged 8-17 years was completed by 52 families (51 child report, 52 parent report), with an overall response rate of 96% in the total sample. Based on predefined psychometric criteria, poorly performing items were removed, resulting in an 18-item version with three domains (Eating, Physical health and treatment, Social isolation and stress,) for children aged 2-7 years and a 26-item version with four domains (Eating, Social relationships, Body perception, and Health and well-being) for children aged 8-17 years. Both versions demonstrated good internal consistency reliability and acceptable convergent and known-groups validity for the total scores. The study identified specific health-related quality-of-life domains for pediatric patients with esophageal atresia, highlighting issues that are important for follow-up care. After field testing in a larger patient sample, this instrument can be used to enhance the evaluation of pediatric surgical care.
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Affiliation(s)
- M Dellenmark-Blom
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - K Abrahamsson
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - J H Quitmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Sommer
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Witt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Dingemann
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - S Flieder
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - L Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - V Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - M Bullinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B M Ure
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - C Dingemann
- Center of Pediatric Surgery, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - J E Chaplin
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
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11
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Dellenmark-Blom M, Chaplin JE, Jönsson L, Gatzinsky V, Quitmann JH, Abrahamsson K. Coping strategies used by children and adolescents born with esophageal atresia - a focus group study obtaining the child and parent perspective. Child Care Health Dev 2016; 42:759-67. [PMID: 27469614 DOI: 10.1111/cch.12372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 06/05/2016] [Accepted: 06/11/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a rare malformation, which requires surgical treatment. Survival rates today reach 95%, but EA remains a significant cause of chronic morbidity with increased risk of psychosocial problems and impaired health-related quality of life (HRQOL). No study of coping strategies of children with EA has been reported in the literature to date, but increased knowledge could lead to improved outcomes and better HRQOL. METHODS Standardized focus groups with children with EA and their parents were conducted to identify issues related to health care needs and HRQOL, with group members relating their coping experiences. Identified coping statements were content analysed using a card sorting procedure and descriptive statistics. RESULTS Thirty families (18 children 8-17 years; 32 parents of children with EA 2-17 years) participated in 10 focus groups. A total of 590 coping statements were recorded. Nine coping strategies were identified: problem solving (n = 116), avoidance (n = 95), recognizing responsibility (n = 71), confronting (n = 70), seeking social support (n = 63), positive reappraisal (n = 58), emotional expression (n = 46), acceptance (n = 40) and distancing (n = 31). Nine situational contexts were identified: nutritional intake (n = 227), communication of one's health condition (n = 78), self-perception when experiencing troublesome symptoms (n = 59), appearance of body or scar(s) (n = 57), physical activities like sport and play (n = 43), sleep (n = 34), hospital care (n = 33), stigmatization and social exclusion (n = 30) and medication intake (n = 29). CONCLUSIONS Focus group methodology contributed to an increased understanding of disease-specific coping processes among children and adolescence with EA. Findings illustrate that they use several coping strategies, some of which they seem to adopt at early age and use in disease-related contexts of physical, social and emotional character. Such coping may influence health and HRQOL in children with EA. In view of the importance of establishing good coping strategies early in life, health care professionals should integrate coping aspects into care management. Future studies are warranted.
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Affiliation(s)
- M Dellenmark-Blom
- Institute of Clinical Sciences Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - J E Chaplin
- Institute of Clinical Sciences Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - L Jönsson
- Department of Pediatric Surgery Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - V Gatzinsky
- Department of Pediatric Surgery Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J H Quitmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Abrahamsson
- Institute of Clinical Sciences Department of Pediatrics, Gothenburg University, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatric Surgery Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Quitmann JH, Bullinger M, Sommer R, Rohenkohl AC, Bernardino Da Silva NM. Associations between Psychological Problems and Quality of Life in Pediatric Short Stature from Patients' and Parents' Perspectives. PLoS One 2016; 11:e0153953. [PMID: 27097033 PMCID: PMC4838264 DOI: 10.1371/journal.pone.0153953] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022] Open
Abstract
Short stature has been associated with psychosocial impairments, but whether treatments and achieved height impact on health-related quality of life (HrQoL) and psychological functioning of children/adolescents is still controversial. This study aimed to examine the effects of height deviation and treatment status on psychosocial adaptation outcomes and to identify clinical and psychosocial determinants of internalizing/externalizing problems in a large cohort of short statured children/adolescents from seven European countries. Participants were 345 children aged 8–18 years with a clinical diagnosis of short stature and 421 parents of 4–18 year-old patients. Children and parents reported on psychological problems (Strengths and Difficulties Questionnaire), generic (KIDSCREEN) and condition-specific HrQoL (QoLISSY). According to analyses of covariance, children/adolescents with current short stature presented more parent-reported internalizing problems and lower self- and parent-reported condition-specific HrQoL, compared to patients with an achieved height above -2SD. Treated children self-reported better HrQoL than the untreated group. Hierarchical regression analysis showed that, rather than height–related clinical variables, children’s sex, younger age and poorer HrQoL were the best predictors of psychological problems, explaining 39% of the variance in patient- and 42% in parent-reported internalizing problems, and 22% of the variance in patient- and 24% in parent-reported externalizing problems. Treatment status also moderated the negative links between patient-reported HrQoL and internalizing problems, explaining 2% of additional variance. These results suggest that children with current short stature are at greater risk for internalizing problems. Routine assessment of HrQoL in pediatric healthcare may help identify children for referral to specialized psychological assessment and intervention.
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Affiliation(s)
- Julia Hannah Quitmann
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- * E-mail:
| | - Monika Bullinger
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Rachel Sommer
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | | | - Neuza Maria Bernardino Da Silva
- University Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
- University of Coimbra, Cognitive and Behavioral Center for Research and Intervention, Coimbra, Portugal
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13
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Rohenkohl AC, Sommer R, Kahrs S, Bullinger M, Klingebiel KH, Quitmann JH. [Evaluation of a Self-Help Supported Counseling Concept for Children and Adolescents with Disproportional Short Stature]. Klin Padiatr 2015; 228:17-23. [PMID: 26466200 DOI: 10.1055/s-0035-1564106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Disproportionate short stature may impair the quality of life (QoL) of patients and their families. This study aimed to evaluate a self-help supported counseling concept to increase the QoL of the participants. METHODS QoL data from 58 children/adolescents (8-17 years) with a diagnosis of achondroplasia was collected at 2 measurement points during one year using the the QoLISSY questionnaire (self-/parental report). Differences before and after participation vs. non-participation in the intervention were evaluated using a linear mixed model. RESULTS The longitudinal results show a greater increase of QoL in the active intervention group compared to a passive control group (p=0,005). The increase in the self-reported QoL of affected patients was significantly higher than for the parent-report (p=0,048). CONCLUSIONS The study shows that patients with achondroplasia benefit from a self-help supported counseling concept. However, this should be tested in a randomized trial.
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Affiliation(s)
- A C Rohenkohl
- Department of Medical Psychology, University Medical Center Hamburg - Eppendorf, Hamburg
| | - R Sommer
- Department of Medical Psychology, University Medical Center Hamburg - Eppendorf, Hamburg
| | - S Kahrs
- German Association for People of Short Stature and their Families, Bremen
| | - M Bullinger
- Department of Medical Psychology, University Medical Center Hamburg - Eppendorf, Hamburg
| | - K-H Klingebiel
- German Association for People of Short Stature and their Families, Bremen
| | - J H Quitmann
- Department of Medical Psychology, University Medical Center Hamburg - Eppendorf, Hamburg
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14
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Quitmann JH, Rohenkohl AC, Kammerer U, Schöfl C, Bullinger M, Dörr HG. [Quality of life of young adults after a growth hormone therapy with childhood onset]. Dtsch Med Wochenschr 2014; 139:2335-8. [PMID: 25369043 DOI: 10.1055/s-0034-1387314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Little is known about the health-related quality of life of young adults with childhood onset idiopathic growth hormone deficiency or neurosecretory dysfunction of growth hormone secretion, who have been treated with recombinant human growth hormone (GH). METHODS Patients were diagnosed and treated with human growth hormone at the University Children´s Hospital in Erlangen (n=85). The data of both groups were merged for analysis, because no difference between idiopathic growth hormone deficiency and neurosecretory dysfunction of growth hormone secretion in auxological. Data were found. Health-related quality of life was cross- sectionally assessed after the end of growth hormone therapy with the Short Form-36 Health Survey and the Nottingham Health Profiles for which population based norm data are available. RESULTS At the time of the survey, the patients (53 m, 32 f) were 23.5 ± 4.6 years old. At start of GH therapy, age was 10.5 ± 2.8 and at the end 16.3 ± 1,4 years. At start, height SDS was -3.20 ± 1.06. GH dose was 0,026 ± 0,012 mg/kg/d (daily s. c.-injections). The increase in height SDS after the end of GH therapy was 1.69 ± 1.22. Compared to the reference population, patients reported significantly lower scores on the scales energy level, vitality, social functioning, indicating a greater social isolation, a stronger emotional reaction, an increased loss of mobility and a worse psychological state. CONCLUSION Young adults report specific impairments after completion of GH therapy.
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Affiliation(s)
- J H Quitmann
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - A C Rohenkohl
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - U Kammerer
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
| | - C Schöfl
- Endokrinologie und Diabetologie, Medizinische Klinik 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - M Bullinger
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - H-G Dörr
- Pädiatrische Endokrinologie und Diabetologie, Kinder- und Jugendklinik, Universitätsklinikum Erlangen
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