Children's Health-related Quality Research Articles

A Prospective Study to Assess the Quality of Life in Children with Newly Diagnosed Asthma and Their Caregivers using the Pediatric Asthma Quality of Life Questionnaire.

Objectives:The study aims to assess the quality of life (QOL) in newly diagnosed asthmatic children and their caregivers before and after treatment using mini pediatric asthma quality of life questionnaire (PAQLQ) and pediatric asthma caregivers quality of life questionnaire (PACQLQ) and to compare their quality of life with ACS (asthma clinical severity score).Materials and Methods:This prospective study was done among 99 children and their caregivers, who were interviewed using mini PAQLQ and PACQLQ on 2 occasions: at the time of inclusion and 4 weeks after treatment. During their clinic visit, asthma clinical severity scoring was done, and children were treated according to GINA (Global Initiative for Asthma).Results:After 4 weeks of treatment, there was a significant change in all domains of mini PAQLQ (P < .001) and PACQLQ (P < .001). In children, the change in the emotional domain after treatment was minimal when compared to other domains. When ACS was compared with mini PAQLQ and PACQLQ, children with well-controlled asthma had a better quality of life than partially-controlled asthmatic children (P < .001) and there wasn’t a significant change in the quality of life of the caregivers after treatment (P = .321)Conclusion:During treatment, QOL of newly diagnosed asthmatic children and their caregivers showed significant improvement but children lagged in their emotional domain. Despite medical intervention, these children also require psychological support and counseling. Also, caregivers didn’t perceive a change in their QOL when compared with ACS and it indicates that parent’s and child health-related quality of life should be taken as independent dimensions.

Psychosocial functioning in children with phenylketonuria: Relationships between quality of life and parenting indicators.

This study aimed to assess the impact of phenylketonuria (PKU) and its treatment on parent and child health-related quality of life (HRQoL) and to identify the parenting-related correlates of parent and child HRQoL, as well as metabolic control. Eighteen mothers of 2- to 12-year-old children with PKU participated and completed a series of self-report questionnaires including the PKU Impact and Treatment Quality of Life Questionnaire (PKU-QOL). Mothers reported that the most significant impact of PKU on HRQoL was in relation to the impact of their child's anxiety during blood tests on their own HRQoL and guilt related to poor adherence to dietary restrictions and supplementation regimens. Higher reported intensity of child emotional and behavioural difficulties and parenting stress were associated with higher scores for PKU symptoms on the PKU-QOL, higher scores for emotional, social, and overall impact of PKU, and higher scores for the impact of dietary restriction. Where mothers reported greater use of overreactivity as a parenting strategy, children tended to have better lifetime phenylalanine levels; however, the overall impact of PKU and the impact of supplement administration on mothers' HRQoL were worse for these families. These findings have implications for a holistic family-centred approach to the care of children with PKU and their families.

Correction to: Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study.

The current sentence is in the discussion (sub-section The role of pre-conception maternal depression) and reads: "Pre-conception treatment of mental health issues is also associated with substantial savings in health care costs (Chojenta et al., 2018)."

Quality of Life in Pediatric Neurosurgery: Comparing Parent and Patient Perceptions

In the pediatric neurosurgical population, understanding how to mitigate the effects of disease on children's physical ability, social and psychological well-being, and education can have lasting effects on their development and family. Understanding parents' perceptions of their children's health-related quality of life (HRQoL) is crucial in proper counseling, management of expectations, establishment of a healthy patient/parent-physician relationship, and understanding the role and impact of health care. In this study we sought to examine the differences between patient and parent perceptions of HRQoL and the factors that influence these differences. A standardized survey (PedsQL Inventory) to assess physical, psychological, and social function and school performance was administered to both parents and patients in a general pediatric neurosurgery outpatient clinic from 2015-2018. 197 encounters with 179 patients occurred in the study period. There were 105 male and 92 female patients across various ethnic backgrounds. The most common diagnoses were tumor (23.4%) and vascular malformation (16.2%). Parent overall scores were lower than their children's (72.5 vs. 76.4, P < 0.01). Parent scores of physical function (74.3 vs. 78.7, P < 0.01) and overall psychosocial function (71.5 vs. 75.3, P < 0.01) were also lower. Parent scores in all domains of the PedsQL were correlated with overall score difference (P < 0.01), but only child scores of overall psychosocial (P < 0.03) and school function (P < 0.04) were correlated with overall score difference. Parents have more negative assessments of their children's HRQoL compared with their children in all domains assessed by the PedsQL. Further research is needed to identify factors that contribute to these discrepancies.

Brushing RemInder 4 Good oral HealTh (BRIGHT) trial: does an SMS behaviour change programme with a classroom-based session improve the oral health of young people living in deprived areas? A study protocol of a randomised controlled trial

BackgroundAlmost one-half of 12–15 year olds living in deprived areas of the UK have dental caries (tooth decay) with few oral health promotion programmes aimed at children of this age. Mobile phone-based interventions such as short messaging service (SMS) interventions have been found effective at changing certain behaviours and improving health outcomes. This protocol describes the BRIGHT Trial, investigating the clinical and cost-effectiveness of a behaviour change intervention—classroom-based session (CBS) embedded in the curriculum and a series of SMS delivered to participants twice daily to remind them to brush their teeth, compared to usual curriculum and no SMS—to reduce the prevalence of dental caries in young people from deprived areas.ObjectivesTo investigate the clinical and cost-effectiveness of a complex intervention to improve the oral health of young people living in deprived areas.Methods/designThis is a school-based, assessor-blinded, two-arm cluster-randomised controlled trial with an internal pilot trial. Overall, the trial will involve approximately 5040 11–13 year olds in 42 schools with a 3-year follow-up. The trial will take place in secondary schools in England, Scotland and Wales. The primary outcome is the presence of carious lesions in permanent teeth at 3 years. Secondary outcomes are: number of carious teeth, frequency of twice-daily toothbrushing, plaque levels, gingivitis, child health-related quality of life and oral health-related quality of life. A cost-utility analysis will be conducted.DiscussionThe findings of the trial have implications for embedding oral health interventions into school curricula guidance produced by national bodies, including departments for education and dental public health and guideline-development organisations.Trial registrationISRCTN registry, ISRCTN12139369. Registered on 10 May 2017.

Development and evaluation of the Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS): assessment of parental concordance with guidelines for the prevention of child anxiety and depression.

BackgroundInvolving parents in the prevention of mental health problems in children is prudent given their fundamental role in supporting their child’s development. However, few measures encapsulate the range of risk and protective factors for child anxiety and depression that parents can potentially modify. The Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS) was developed as a criterion-referenced measure to assess parenting against a set of evidence-based parenting guidelines for the prevention of child anxiety and depressive disorders.MethodsIn Study 1, 355 parents of children 8–11 years old across Australia completed the PaRCADS and measures of parenting, general family functioning, child anxiety and depressive symptoms, and parent and child health-related quality of life. Their children completed measures of parenting, anxiety and depressive symptoms, and health-related quality of life. In Study 2, six subject-experts independently evaluated the PaRCADS items for item-objective congruence and item-relevance. Item analysis was conducted by examining item-total point-biserial correlation, difficulty index, B-index, and expert-rated content validity indices. Reliability (or dependability) was assessed by agreement coefficients for single administration. Construct validity was examined by correlational analyses with other measures.ResultsFour items were removed to yield a 79-item, 10-subscale PaRCADS. Reliability estimates for the subscale and total score range from .74 to .94. Convergent validity was indicated by moderate to strong correlations with other parenting and family functioning measures, and discriminant validity was supported by small to moderate correlations with a measure of parents’ health-related quality of life. Higher scores on the PaRCADS were associated with fewer anxiety and depressive symptoms and better health-related quality of life in the child. PaRCADS total score was associated with parental age, parent reported child’s history of mental health diagnosis and child’s current mental health problem.DiscussionResults showed that the PaRCADS demonstrates adequate psychometric properties that provide initial support for its use as a measure of parenting risk and protective factors for child anxiety and depression. The scale may be used for intervention and evaluative purposes in preventive programs and research.

An Examination of Factors Affecting Quality of Life for Children With Asthma and Their Caregivers in Southeastern Georgia

IntroductionDespite effective treatments and interventions, asthma continues to affect children's health-related quality of life (QOL). This study explored factors affecting QOL of children with asthma and their caregivers. MethodsA mixed-model design was used. Children (7–17 years) completed the Paediatric Asthma Quality of Life Questionnaire, and parents/caregivers completed the Paediatric Asthma Caregiver's Quality of Life Questionnaire. These surveys focused on activity limitations, emotional function, and child symptoms. ResultsThe sample included 104 children and 104 caregivers. Analysis showed emergency department (ED) visits as a significant predictor of QOL for children in the domains of Physical Activity, Emotional, and Symptoms. Increased ED visits and reliever medication use predicted lower emotional QOL and physical QOL for parents, whereas increased use of controller medications predicated improved physical QOL. DiscussionFactors contributing to QOL, along with characteristics of those with the lowest QOL indicators, have been determined. Identification of interventions to reduce ED visits warrants further investigation.

Micronutrient deficiencies and health-related quality of life: the case of children with vitamin D deficiency.

To explore the extent to which micronutrient deficiencies (MND) affect children's health-related quality of life (HRQoL), using vitamin D deficiency (VDD) as a case study. Proxy valuation study to estimate the impact of VDD on the HRQoL of younger (0-4 years) and older (>4 years) children. We used the Child Health Utility 9 Dimension (CHU9D) questionnaire to estimate HRQoL for children within six VDD-related health states: 'hypocalcaemic cardiomyopathy', 'hypocalcaemic seizures', 'active rickets', 'bone deformities', 'pain and muscle weakness' and 'subclinical VDD'. Sampling was not restricted to any particular setting and worldwide experts were recruited. Respondents were paediatric bone experts recruited through network sampling. Thirty-eight experts completed the survey. The health state with the largest detrimental impact (mean score (se)) on children's HRQoL was hypocalcaemic cardiomyopathy (0·47 (0·02)), followed by hypocalcaemic seizures (0·50 (0·02)) and active rickets (0·62 (0·02) in young children; 0·57 (0·02) in older children). Asymptomatic VDD had a modest but noticeable negative impact on HRQoL, attributed mostly to tiredness in both age groups and pain in the older paediatric population. Elicitation of HRQoL from clinical experts suggests a negative impact of VDD on HRQoL, even if there is no recognizable clinical manifestation. HRQoL data from populations of patients with MND will inform public health policy decisions. In some settings, routine collection of HRQoL data alongside national nutrition surveys may help capture the full burden of MND and prioritize resources towards effective prevention.

Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study.

Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health were asked to be part of the Mothers and their Children's Health study and to complete surveys on the health of their three youngest children under 13years. The current study includes children aged 0-12years (N = 5532, M = 6.99years, SD = 3.22years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0-4years (unstandardized regression coefficient (B) = - 0.26, 95%CI - 0.38, - 0.13) and children aged 5-12years (B = - 0.25, 95%CI - 0.34, - 0.16), and by post-birth maternal stress (B = - 0.04, 95%CI - 0.08, - 0.01), and parenting (B = - 0.03, 95%CI - 0.04, - 0.02) in children aged 5-12years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline.

Predictors of parental distress during acute phase of pediatric hematopoietic stem cell transplantation in Japan: A multicenter prospective study.

The purposes of this study were (1) to describe the levels of anxiety and depressive symptoms in parents of children undergoing hematopoietic stem cell transplantation (HSCT) before (Time 1 [T1]) and one month after transplantation (Time 2 [T2]), and (2) to identify the pre-HSCT factors that predict anxiety and depressive symptoms in fathers and mothers one month after transplantation. A prospective quantitative study was conducted at four children's hospitals between June 2015 and September 2016 using self-administered questionnaires and medical records. Parents from 23 families, including 19 fathers and 23 mothers, completed the Hospital Anxiety and Depression Scale (cutoff score: 8) and provided information regarding their stress appraisal, coping strategies, family functioning, demographic characteristics, and children's health-related quality of life. Hierarchical multiple regression analysis was performed to identify the variables that predicted T2 paternal and maternal anxiety and depressive symptoms. Among the parents, 15 fathers (79%) and 11 mothers (48%) reported anxiety symptoms, and 13 fathers (68%) and 9 mothers (39%) reported depressive symptoms above the cutoff level for clinical relevance at T1. Similarly, 11 fathers (58%) and 6 mothers (26%) reported anxiety symptoms, and 10 fathers (53%) and 9 mothers (39%) reported depressive symptoms above the cutoff level at T2. Overall, parents' anxiety and depressive symptoms did not differ significantly between T1 and T2. For fathers, both T1 depressive symptoms and the understanding of their children's medical situation through communication with other parents and consultation with medical staff predicted T2 paternal depressive symptoms. For mothers, T1 maternal anxiety symptoms and marital satisfaction predicted T2 anxiety symptoms. The medical staff should understand that parents of children undergoing HSCT experience considerable psychological distress throughout the treatment process, and therefore, they should adopt unique approaches to reduce such distress.

Evaluation of a generic patient education program in children with different chronic conditions.

For frequent pediatric chronic conditions, especially less common chronic conditions patient education programs are missing. A recently developed modular patient education approach (ModuS) combines disease-specific modules with generic psychosocial topics. ModuS was associated with increased disease-specific knowledge and improvements in families' well-being in children with asthma. In this study we tested if new developed ModuS programs for seven, mostly less common, chronic conditions show comparable program-associated effects. ModuS education programs were offered to the affected child and its parents. Disease-specific knowledge, children's health-related quality of life, life satisfaction and condition-specific burden were measured before, directly following and 6 weeks after participation in the program. The results were compared with families who received a ModuS asthma program. One hundred and sixty-eight children participated. Families were highly satisfied with the programs. Program participation was associated with increased families' knowledge, children`s self-reported health-related quality of life and reduced condition-specific burden. The results were comparable with the results of 230 families who participated in a ModuS asthma program. The ModuS approach allowed the development of patient education programs for children with a variety of chronic conditions. Therefore, ModuS closed an important healthcare gap.

Living with Severe Bronchopulmonary Dysplasia—Parental Views of Their Child's Quality of Life

To assess parents' views of their children's health-related quality of life (HRQoL) and the association between neonatal morbidities and HRQoL in children with severe bronchopulmonary dysplasia (BPD) who survived to 18-36 months of corrected age. Study population included infants born <32 weeks of gestational age with severe BPD. At 18-36 months of corrected age, parents of children with severe BPD completed age appropriate validated Pediatric Quality of Life Inventory assessing parental views of their child's physical (PHY-QoL) and psychosocial HRQoL (PS-QoL). Ten neonatal morbidities provided a composite morbidity score between 0 and 10. Linear regression evaluated associations between PHY-QoL and PS-QoL with composite morbidity score, adjusting for gestational age, sex, corrected age at assessment. Seventy children (67% male, gestational age 26.1 ± 2.0 weeks, and birth weight 797 ± 318g) were enrolled at 27.1 ± 5.8 months of corrected age. Mean PHY-QoL and PS-QoL were 78.0 ± 21.9 and 75.3 ± 17.9, respectively, both significantly lower than reported means for term and preterm cohorts, with the exception of emotional QoL. Adjusted postnatal composite morbidity score was cumulatively associated with poorer PHY-QoL (P = .002) and poorer PS-QoL (P = .015). Presence of each additional neonatal morbidity was associated with a 4.4-point decrease in PHY-QoL and 2.8-point decrease in PS-QoL. In this cohort, parental perceived HRQoL for their child with severe BPD was lower than expected for term and preterm populations. Neonatal morbidities had an additive association with poorer parental assessment of PHY-QoL and PS-QoL. These findings may aid in care of children with severe BPD and their families, both in the intensive care nursery and postdischarge.

Health-related quality of life experiences in children and adolescents born with esophageal atresia: A Swedish-German focus group study.

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. Eighteen standardized focus groups (FGs) with 51 families of EA children aged 2-17years 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. 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%). 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.

A Healthy Life for a Child With Medical Complexity: 10 Domains for Conceptualizing Health.

Defining and measuring health for children with medical complexity (CMC) is poorly understood. We engaged a diverse national sample of stakeholder experts to generate and then synthesize a comprehensive list of health outcomes for CMC. With national snowball sampling of CMC caregiver, advocate, provider, researcher, and policy or health systems experts, we identified 182 invitees for group concept mapping (GCM), a rigorous mixed-methods approach. Respondents (n = 125) first completed Internet-based idea generation by providing unlimited short, free-text responses to the focus prompt, "A healthy life for a child or youth with medical complexity includes: ___." The resulting 707 statements were reduced to 77 unique ideas. Participants sorted the ideas into clusters based on conceptual similarity and rated items on perceived importance and measurement feasibility. Responses were analyzed and mapped via GCM software. The cluster map best fitting the data had 10 outcome domains: (1) basic needs, (2) inclusive education, (3) child social integration, (4) current child health-related quality of life, (5) long-term child and family self-sufficiency, (6) family social integration, (7) community system supports, (8) health care system supports, (9) a high-quality patient-centered medical home, and (10) family-centered care. Seventeen outcomes representing 8 of the 10 domains were rated as both important and feasible to measure ("go zone"). GCM identified a rich set of CMC outcome domains. Go-zone items provide an opportunity to test and implement measures that align with a broad view of health for CMC and potentially all children.

Children's propensity to consume sugar and fat predicts regular alcohol consumption in adolescence.

The present study investigated the association between sugar and fat intake in childhood in relation to alcohol use in adolescence. We hypothesized that early exposure to diets high in fat and sugar may affect ingestive behaviours later in life, including alcohol use.Design/Setting/SubjectsChildren from the European IDEFICS/I.Family cohort study were examined at ages 5-9 years and followed up at ages 11-16 years. FFQ were completed by parents on behalf of children, and later by adolescents themselves. Complete data were available in 2263 participants. Children's propensities to consume foods high in fat and sugar were calculated and dichotomized at median values. Adolescents' use of alcohol was classified as at least weekly v. less frequent use. Log-binomial regression linked sugar and fat consumption in childhood to risk of alcohol use in adolescence, adjusted for relevant covariates. Five per cent of adolescents reported weekly alcohol consumption. Children with high propensity to consume sugar and fat were at greater risk of later alcohol use, compared with children with low fat and low sugar propensity (relative risk=2·46; 95 % CI 1·47, 4·12), independent of age, sex and survey country. The association was not explained by parental income and education, strict parenting style or child's health-related quality of life and was only partly mediated by sustained consumption of sugar and fat into adolescence. Frequent consumption of foods high in fat and sugar in childhood predicted regular use of alcohol in adolescence.

Parent-Child Agreement on Health-Related Quality of Life in Congenital Glaucoma.

PurposeWe assess parent-child agreement regarding child's health-related quality of life (HRQoL) in children operated for congenital glaucoma (CG).MethodsA total of 121 children aged 8 to 18 years (mean age, 11.8 years) operated for CG (mean duration since surgery, 10.2 years) and their parents (mean age, 36.5 years) completed the child and parent versions of the Kidscreen-27 questionnaire, respectively. Psychometric properties of Kidscreen-27 were assessed using Rasch analysis, and child–parent agreement regarding child's HRQoL was investigated using the Bland-Altman limits of agreement (LoA) method.ResultsMinor modifications in the rating scale and deletion of few misfitting items resulted in a psychometrically robust Kidscreen-23 questionnaire. Average parental HRQoL score was higher than the child's own ratings, with a significant difference between their scores (mean ± standard deviation [SD] difference = 0.53 ± 2.58 logits, P = 0.02; lower LoA [95% CI], −4.52 [−5.31 to −3.72] and upper LoA [95% CI], 5.58 [4.79–6.38]). The range of child–parent agreement was wide and bidirectional, with parents tending to underestimate and overestimate their child's HRQoL. Younger children and girls showed greater discordance in their HRQoL with parental reports than adolescents and boys, respectively.ConclusionsDiscordance between CG child's self-report of HRQoL and parent's report indicate that both groups perceive the broader impact of living with CG very differently.Translational RelevanceThe HRQoL as reported by the child with CG and by his/her parent should be viewed as being complementary, rather than interchangeable. Both assessments should be taken into account in clinical practice and research studies.

Children and Nature: Linking Accessibility of Natural Environments and Children's Health-Related Quality of Life.

A growing body of research suggests that increasing children’s nature interactions can have positive benefits for their health-related quality of life (HRQOL); however, researchers have yet to examine how geographical context influences this relationship. The purpose of this study was to examine individual-level and environmental factors that are associated with HRQOL of children from different geographical contexts. Data were collected for 851 children from 34 elementary schools in Ontario, Canada. The natural environments around each child’s home were computed using geospatial analyses in a geographic information system. Natural environment measures were combined with HRQOL and the demographics from child surveys to be used in a series of step-wise linear regression models. These models explored the relationship between children’s HRQOL and the natural environment in urban/suburban and rural populations. In addition to important individual-level determinants, the findings revealed that characteristics of the natural environment, including the amount of greenness, park, and water, show significant relationships in the urban/suburban population. Interpersonal variables were the key predictors of HRQOL in the rural population. Where children live influences relationships between nature and HRQOL. These findings have implications for policymakers, health practitioners, educators, and parents in the design and the promotion of nature for children’s HRQOL.

Spillover Effects of Maternal Chronic Disease on Children's Quality of Life and Behaviors Among Low-Income Families.

Mothers with chronic diseases may have spillover effects on their children. The aim of this study was to estimate the spillover effects of mothers with chronic disease on their children's health-related quality of life (HRQOL) and behavior. A cross-sectional study was conducted on 255 mother-child pairs (130 boys and 125 girls, mean age 8.4years) from low-income Chinese families. We asked the mothers to self-report any doctor-diagnosed chronic diseases, and evaluate their children's HRQOL and behaviors with the Child Health Questionnaire-Parent Form-50 (CHQ-PF50) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Multiple linear regression analysis was conducted to assess the independent spillover effect of maternal chronic disease on children's HRQOL and behaviors, with adjustment for confounders. The differential impact of maternal physical and mental diseases was also investigated. Over one-third of mothers (n = 88, 34.5%) reported one or more doctor-diagnosed chronic diseases. Multiple linear regression analysis showed that children of mothers with chronic diseases had significantly lower CHQ-PF50 scores in the parental impact-time, parental impact-emotional, and family activities subscales and psychosocial summary scores, as well as more hyperactive and inattentive problems measured by SDQ after adjustment for confounders. Maternal mental and physical disease showed a differential impact on children's HRQOL and behavior. Chronic disease in mothers might exert adverse effects on their children's HRQOL and behaviors. The effects could differ by maternal physical or mental disease status. Special attention and support should be paid to children of mothers with chronic disease as these children are at an increased risk of poor HRQOL and problematic behaviors.

Student's perception of school bullying and its impact on academic performance: A longitudinal look.

Bullying among peers has immediate and long-term consequences, as it affects children's health-related quality of life. The aim was to examine the association between the frequency, type and dynamics of children's involvement in bullying situations and their academic performance over the school year. Longitudinal study conducted in 2015 in 9 to 12 year-olds in schools of Bahía Blanca, Argentina. Outcome measures: children's involvement in bullying situations, frequency of participation in bullying and academic performance. Bullying categories were obtained through the Preconceptions of Bullying and Intimidation Among Peers (PRECONCIMEI) questionnaire and academic performance as reflected by each child's school grades. The survey included 375 children, of which 22.1% (83/375) were repeatedly involved and 30.12% (113/375) were occasionally involved in bullying situations (20.27% [76/375] reported having participated by the year end but not at the beginning, and 9.85% [37/375] showed the opposite behavior). No statistically significant differences were found, regardless of the course subject analyzed. Grades were found to have improved by school year-end, in all groups assessed. No association was found between bullying and academic performance.

Human development index, children's health-related quality of life and movement behaviors: a compositional data analysis.

Health-related quality of life has been related to physical activity, sedentary behavior, and sleep among children from developed nations. These relationships have rarely been assessed in developing nations, nor have behaviors been considered in their true context, as mutually exclusive and exhaustive parts of the movement behavior composition. This study aimed to explore whether children's health-related quality of life is related to their movement behavior composition and if the relationship differs according to human development index. Children aged 9-11 years (n = 5855), from the 12-nation cross-sectional observational International Study of Childhood Obesity, Lifestyle and the Environment 2011-2013, self-reported their health-related quality of life (KIDSCREEN-10). Daily movement behaviors were from 24-h, 7-day accelerometry. Isometric log-ratio mixed-effect linear models were used to calculate estimates for difference in health-related quality of life for the reallocation of time between daily movement behaviors. Children from countries of higher human development index reported stronger positive relationships between health-related quality of life and moderate-to-vigorous physical activity, relative to the remaining behaviors (r = 0.75, p = 0.005) than those from lower human development index countries. In the very high human development index strata alone, health-related quality of life was significantly related to the movement behavior composition (p = 0.005), with moderate-to-vigorous physical activity (relative to remaining behaviors) being positively associated with health-related quality of life. The relationship between children's health-related quality of life and their movement behaviors is moderated by their country's human development index. This should be considered when 24-h movement behavior guidelines are developed for children around the world.