Health-related Quality Of Life In Children Research Articles

Family resources moderate the relationship between seizure control and health-related quality of life in children with drug-resistant epilepsy.

Pediatric drug-resistant epilepsy (DRE) is associated with poor health-related quality of life (HRQOL). Achieving seizure control, however, does not improve HRQOL in all children. This study sought to evaluate whether (1) baseline caregiver and family factors are associated with child HRQOL at 1-year follow-up over and above epilepsy characteristics, treatment, and seizure outcome; and (2) baseline family factors moderate the association between seizure outcome and child HRQOL at 1-year follow-up. This multicenter longitudinal cohort study recruited 152 children with DRE who were being evaluated for surgical candidacy. Child HRQOL was rated by caregivers using the Quality of Life in Childhood Epilepsy Questionnaire at baseline and 1-year follow-up. Additional data collected at baseline included child epilepsy characteristics, caregiver demographics, caregiver mood, and family environment. Seizure freedom was achieved in 68% and 28% of patients 1 year after surgery and medical treatment, respectively. Caregiver and family factors were not associated with higher child HRQOL at follow-up after accounting for epilepsy characteristics, treatment, seizure outcome, and baseline child HRQOL, F11, 131 =1.34, P=.21, ΔR2 =.04. Family resources moderated the association between seizure outcome and child HRQOL at follow-up (b=.41, 95% confidence interval [CI] = 0.09-0.74, P=.03); seizure freedom was strongly associated with higher HRQOL when family resources were high (b=13.50, 95% CI = 8.35-18.54, P<.001), relative to when family resources were low (b=5.17, 95% CI = -0.18 to 10.52, P=.06). Family relationships and demands did not moderate the relationship between seizure outcome and HRQOL. Achieving seizure freedom was associated with better HRQOL in children with DRE, but this association was reduced for those children who presented with limited family resources. These results highlight the importance of assessing the family environment during presurgical evaluation and implementing early family-based intervention and supports to promote better outcomes for children in the long term.

Quality of life in early age Spanish children treated for cleft lip and/or palate: a case-control study approach.

The objectives of this study were to evaluate health-related quality of life (HRQoL) in 4-7-year-old children treated for cleft lip and/or palate (CL/P) compared to healthy controls and to estimate a possible association with cleft type, gender, age, and surgical re-interventions. A total of 171 children with CL/P (mean age 5.7years) and 186 healthy controls (mean age 5.5years) were included in the study. Sixty-four (37.4%) children experienced both cleft lip and palate, 56 (32.8%) cleft lip only, and 51 (29.8%) cleft palate only. HRQoL in children was assessed by Kiddy-KINDL and COHIP-14 questionnaires and in parents by KINDL-p. Total score and dimensions of each questionnaire were compared between cleft children, their parents, and controls. The total scores and dimension scores of Kiddy-KINDL showed similar values between CL/P and control groups, except for "self-esteem" dimension (p= 0.036). The comparison of Kiddy-KINDL and KINDL-p showed a statistically significant total score (82.11 vs. 80.44, p= 0.047). The CL/P group presented significantly worse values with respect to controls in total score of COHIP-14 (10.53 vs 5.01, p< 0.001) and in all its dimensions. Children treated for CL/P had a negative impact on HRQoL at early age compared to controls. Significant differences were found in the psychological and functional dimensions related to lip and palatal affectation, respectively. Parents reported significantly worse scores than their children. HRQoL measurement provided valuable complementary information to better inform to parents and make clinical decisions in children with CL/P at early age. Our findings suggested that Spanish children between 4 and 7years of age with a history of surgically treated CL/P experienced a poorer HRQoL when compared with their non-cleft peers.

Health-related quality of life of children and their parents 2 years after critical illness: pre-planned follow-up of the PEPaNIC international, randomized, controlled trial

BackgroundPediatric intensive care unit (PICU) survivors are at risk for prolonged morbidities interfering with daily life. The current study examined parent-reported health-related quality of life (HRQoL) in former critically ill children and parents themselves and aimed to determine whether withholding parenteral nutrition (PN) in the first week of critical illness affected children’s and parents’ HRQoL 2 years later.MethodsChildren who participated in the pediatric early versus late parenteral nutrition in critical illness (PEPaNIC) trial and who were testable 2 years later (n = 1158) were included. Their HRQoL outcomes were compared with 405 matched healthy controls. At PICU admission, children had been randomly assigned to early-PN or late-PN. In the early-PN group, PN was initiated within 24 h after PICU admission. In the late-PN group, PN was withheld for up to 1 week in the PICU. Parents completed the Infant Toddler Quality of Life Questionnaire (ITQOL; age 2–3 years) or the Child Health Questionnaire-Parent Form 50 (CHQ-PF50; age 4–18 years). Besides, they completed the Health Utility Index (HUI) and the Short Form Health Survey (SF-12) regarding their child’s and their own HRQoL, respectively.ResultsFor the total age group of 786 post-PICU survivors, parents reported lower scores for almost all HRQoL scales compared to healthy children. Age-specifically, younger critically ill children (2.5 to 3 years old) scored worse for growth and development and older children (4–18 years old) scored worse for role functioning and mental health. Parents’ own mental and physical HRQoL was comparable to that of healthy control parents. No HRQoL differences were found between children in the late-PN and those in the early-PN group.ConclusionsParent-reported HRQoL of children 2 years after critical illness was impaired compared with healthy controls. In relation to their child’s HRQoL, parents reported impairments in emotions, personal time, and family activities; however, their own HRQoL was not impaired. Withholding PN in the first week during critical illness had no impact on longer-term HRQoL of the child.Trial registrationClinical trials, NCT01536275. Registered 22 February 2012

Associations of Abdominal Pain and Psychosocial Distress Measures With Health-Related Quality-of-Life in Pediatric Healthy Controls and Irritable Bowel Syndrome.

Children with irritable bowel syndrome (IBS) have lower health-related quality-of-life (HRQOL) than healthy controls (HC). Abdominal pain and psychosocial distress are negatively associated with HRQOL, although their relative effect is unclear. The aim of this study was to compare the relative associations of abdominal pain and psychosocial distress with HRQOL in HC and IBS. Baseline abdominal pain, psychosocial distress, and HRQOL measures were obtained from HC and IBS pediatric clinical trial participants. Regression assessed which measures were most strongly associated with Physical and Psychosocial HRQOL separately by group. Interaction analyses examined group differences in the associations of abdominal pain and psychosocial distress with HRQOL. Eight-five HC and 213 children with IBS participated. Somatization was most strongly associated with Physical HRQOL in HC, and functional disability was most strongly related in IBS. With respect to Psychosocial HRQOL, somatization was most strongly associated for both HC and IBS; depression was also significantly associated in HC. The strength of association between somatization and Physical HRQOL differed between groups; the negative association was less pronounced for IBS than HC. The association between functional disability and both Physical and Psychosocial HRQOL differed significantly between groups; the negative associations were more pronounced for IBS than HC. Multiple psychosocial distress measures, including somatization, were associated with HRQOL in children with IBS; HRQOL in HC was driven consistently by somatization, to the exclusion of other psychosocial concerns. The associations of somatization and functional disability with HRQOL are distinctly different between HC and IBS. This knowledge supports utilization of psychosocial interventions to improve overall well-being for children with IBS.

Health-related quality of life in patients with bronchiolitis obliterans.

Bronchiolitis obliterans (BO) is mainly caused by infections and hematopoietic stem cell transplantation (HSCT). This study aimed to investigate the health-related quality of life (HRQOL) of children with BO compared to the healthy children and also to assess the HRQOL according to the etiology. Postinfectious (group 1) and post-HSCT BO (group 2) patients and healthy children were included in the study. HRQOL was assessed by the Short Form-36 (SF-36) and St George's Respiratory Questionnaire (SGRQ). Correlations between demographic and clinical characteristics, pulmonary function tests, high-resolution chest tomography scores, and HRQOL were assessed. Thirty-seven postinfectious and post-HSCT BO patients and 34 healthy children were included in the study. Mean age was 13.8 ± 0.7 years. Mean forced vital capacity and forced expiratory volume1 were 60.7 ± 2.7% predicted, and 49.8 ± 3.1% predicted, respectively. The SF-36 scores were lower in BO patients compared to healthy children (P < .01). Patients with better lung functions had higher SF-36 scores, but lower SGRQ. The number of inhaled therapies, acute exacerbations, hospitalizations were inversely correlated with SF-36. A positive correlation was found between these parameters and total SGRQ scores (r = .507, P = .02; r = .409, P = .12; r = .326, P = .049, respectively). SF-36 scores were better in group 1 for subscales of physical role functioning and social role functioning compared to group 2. (P = .01, P = .01, respectively). The HRQOL of patients with BO measured by SF-36 was low compared to healthy children. SF-36 scores were more affected in post-HSCT BO patients. HRQOL of children with chronic lung disease should be taken into consideration in the management of these patients.

Trajectories of quality of life 10 years following a diagnosis of epilepsy in childhood.

This study estimated trajectories of health-related quality of life (HRQOL) over a 10-year period among children newly diagnosed with epilepsy. We also modeled the characteristics of children, parents, and families associated with each identified trajectory. Data came from the HERQULES (Health-Related Quality of Life in Children With Epilepsy Study), a Canada-wide prospective cohort study of children (aged 4-12years) with newly diagnosed epilepsy. Parents reported on their children's HRQOL at diagnosis, and at 0.5-, 1-, 2-, 8-, and 10-year follow-ups using the Quality of Life in Childhood Epilepsy Questionnaire-55. Trajectories of HRQOL were identified using latent class growth models. Characteristics of children, parents, and families at the time of diagnosis that were associated with each trajectory were identified using multinomial logistic regression. A total of 367 children were included. Four unique HRQOL trajectories were identified; 11% of the cohort was characterized by low and stable scores, 18% by intermediate and stable scores, 35% by intermediate scores that increased then plateaued, and 43% by high scores that increased then plateaued. Absence of comorbidities, less severe epilepsy, and better family environment (greater satisfaction with family relationships and fewer family demands) at the time of diagnosis were associated with better long-term HRQOL trajectories. Although the analyses used estimates for missing values and accounted for any nonrandom attrition, the proportion of children with poorer HRQOL trajectories may be underestimated. Children with new onset epilepsy are heterogenous and follow unique HRQOL trajectories over the long term. Overall, HRQOL improves for the majority in the first 2 years after diagnosis, with these improvements sustained over the long term.

Prenusinersen economic and health-related quality of life burden of spinal muscular atrophy.

To quantify the economic and health-related quality of life (HRQoL) burden incurred by households with a child affected by spinal muscular atrophy (SMA). Hospital records, insurance claims, and detailed resource use questionnaires completed by caregivers were used to capture the direct and indirect costs to households of 40 children affected by SMA I, II, and III in Australia between 2016 and 2017. Prevalence costing methods were used and reported in 2017 US dollar (USD) purchasing power parity (PPP). The HRQoL for patients and primary caregivers was quantified with the youth version of the EQ-5D and CareQoL multiattribute utility instruments and Australian utility weights. The average total annual cost of SMA per household was $143,705 USD PPP for all SMA types (SMA I $229,346, SMA II $150,909, SMA III $94,948). Direct costs accounted for 56% of total costs. The average total indirect health care costs for all SMA types were $63,145 per annum and were highest in families affected by SMA II. Loss of income and unpaid informal care made up 24.2% and 19.8% respectively, of annual SMA costs. Three of 4 (78%) caregivers stated that they experienced financial problems because of care tasks. The loss in HRQoL of children affected by SMA and caregivers was substantial, with average caregiver and patient scores of 0.708 and 0.115, respectively (reference range 0 = death and 1 = full health). Our results demonstrate the substantial and far-ranging economic and quality of life burden on households and society of SMA and are essential to fully understanding the health benefits and cost-effectiveness associated with emerging disease-modifying therapies for SMA.

Health-Related Quality of Life in Biliary Atresia Patients with Native Liver or Transplantation.

We aimed to assess health-related quality of life (HrQoL) in biliary atresia (BA) patients, based on original data and a literature review, and to determine factors associated with their HrQoL. We reviewed available studies describing HrQoL in BA patients. We assessed HrQoL in Dutch BA patients (6-16 years) using the validated Child Health Questionnaire. We compared HrQoL scores in BA patients with healthy peers and with children who had undergone major surgery in infancy or children with chronic conditions. We determined the relationship between specific patient-related factors and HrQoL. Literature data indicated that HrQoL in children with BA is lower than in healthy peers. In Dutch BA patients (n = 38; age 10 ± 3 years), parent-proxy physical HrQoL (48 ± 11) was significantly lower compared with two reference groups of healthy peers (59 ± 4 and 56 ± 6, respectively, each p < 0.001), and lower than in children with attention deficit hyperactivity disorder (60 ± 5), asthma (54 ± 6), attending a cardiology clinic (52 ± n/r), congenital diaphragmatic hernia (53 ± 7) or D-transposition of the great arteries (54 ± 6; all p < 0.05). Psychosocial HrQoL (50 ± 9) was lower than in healthy peers (54 ± 6, p = 0.02, and 53 ± 6, p = 0.07) and children with asthma (54 ± 6, p = 0.02), and largely comparable to children with other chronic conditions. Parent-proxy physical HrQoL was adversely related to adverse medical event in the past year, special education, and motor impairments; psychosocial HrQoL was adversely related to behavioral problems. Children with BA are at risk of impaired HrQoL. Special attention is warranted for children with adverse medical events and special education.

Health related quality of life in children with congenital heart disease that undergo cardiac surgery during their first year of life.

Advances in diagnostic methods, surgical techniques and postoperative intensive care have significantly increased the survival rates for children with congenital heart disease. In this context, long term sequelae acquired greater relevance. Health-related quality of life (HRQOL) is a concept that helps to measure the impact of chronic diseases. The purpose of the current study was to describe HRQOL in children with congenital heart disease that undergo cardiac surgery during their first year of life. A cross-sectional observational study was conducted between August 2017 and December 2018 at a University General Hospital. PedsQL 4.0 Generic Core Scales were used. Children with congenital heart disease between 2 and 4 years old who had cardiac surgery during their first year of life and healthy children were included. Scores were compared with T-test or Wilcoxon according to the observed distribution. p value < 0.05 was considered significant. A total of 31 children with congenital heart disease (26 % with a single ventricle) and 62 healthy children were enrolled. The first surgery was in the neonatal period in 61.3 %. Our study showed no statistical differences (p = 0.10) between HRQOL Total Scale Score of children with congenital heart disease compared to healthy children. However, lower scores were observed with statistically significant differences in social (p = 0.0092) and school (p = 0.0001) scales. Our cohort of children diagnosed with congenital heart disease has a global quality of life comparable with healthy children except in social and school functioning scales.

Long-Term Health-Related Quality of Life in Survivors of Congenital Diaphragmatic Hernia.

The health-related quality of life (HRQoL) of survivors of congenital diaphragmatic hernia (CDH) is presently unknown. Literature prior to 2015 suggests that CDH survivors have worse HRQoL compared with the general population. However, due to changes in the diagnosis, management, and follow-up of CDH patients, this may no longer be true. The objective of this review was to determine what recent literature suggests regarding the HRQoL of CDH survivors. We reviewed all studies published between April 9, 2015, and April 6, 2020, that described the HRQoL of CDH survivors. Studies were identified using PubMed, and the references of the identified papers were searched for additional studies eligible for inclusion. Seven studies describing HRQoL in CDH survivors using validated measures of HRQoL for children, PedsQL (Pediatric Quality of Life Inventory), KIDSCREEN-52, and Comprehensive Quality of Life Scale - School Version were examined. The findings were disparate. One study suggested that CDH survivors had better than average HRQoL scores, three studies found patients and controls had equivalent scores, and two studies reported poor outcomes for CDH patients. The final study found no effect of disease severity on HRQoL, as determined by prenatal ultrasound. Evidence published between 2015 and 2020 suggests that CDH patients have an HRQoL equivalent to the general population.

Effectiveness of a family intervention on health-related quality of life\u2013a healthy generation, a controlled pilot trial

BackgroundPhysical activity is associated with better health, but knowledge about health promoting interventions, including physical activity for families in disadvantaged areas and the impact on health-related quality of life (HRQOL) is sparse. The aim of this study was to assess HRQOL in children and their parents after participation in the programme “A Healthy Generation”.MethodsThe programme is delivered in socioeconomically disadvantaged areas in Sweden and offers physical activity and a healthy meal or fruit twice a week from August to May to families with children in grade 2. Children (n = 67), aged 8–9 years, and their parents (n = 90) participated in this controlled study conducted in four schools, two control and two intervention schools. HRQOL of children and adults was assessed at baseline and follow-up after the intervention with the Pediatric Quality of Life Inventory (PedsQL) 4.0 and the Gothenburg Quality of Life scale, respectively. Analyses of covariance (ANCOVAs), linear regression and Pearson’s correlation were conducted.ResultsThere were no significant differences between intervention and control in HRQOL among children or adults after the intervention. However, in a subgroup of children (n = 20) and adults (n = 29) with initial low HRQOL scores at baseline, there was a significant difference between the intervention group and control group after the intervention (children (total score): p = 0.02; adults (social domain) p = 0.04). Furthermore, within the intervention group, there was a significant relationship between level of participation in “A Healthy Generation” and the physical domain of HRQOL among girls (r = 0.44, p = 0.01), but not boys (r = − 0.07, p = 0.58).ConclusionParticipation in the programme “A Healthy Generation” did not show a significant intervention effect on HRQOL in general. However, the findings suggest that HRQOL may be increased for children and adults with low HRQOL in disadvantaged areas. This knowledge can contribute to the development of health promoting interventions in such areas, and to more equitable health.Trial registrationISRCTN ISRCTN11660938. Retrospectively registered 23 September 2019.

0990 Evaluating Components Of Sleep Quality And The Sleep-Quality Of Life Relationship For Children With Acute Lymphoblastic Leukemia

Abstract Introduction Poor sleep quality is associated with reduced health-related quality of life (HRQL) for children with Acute Lymphoblastic Leukemia (ALL). Research has yet to evaluate how components of child sleep quality uniquely contribute to HRQL beyond demographic characteristics. This study evaluates features of sleep and the relationship between sleep and HRQL for children in the maintenance phase of ALL treatment. Methods 89 caregivers (ages 20-52, M=35.95, SD=7.10) of children with ALL (ages 3-12, M=5.73, SD=2.21; 13.76 months from diagnosis) completed demographic questionnaires and reports of child sleep quality (Child Sleep Habits Questionnaire; CSHQ), and 64 caregivers reported on child HRQL (Pediatric Quality of Life Inventory). Descriptive statistics were calculated. T-tests compared CSHQ subscales to ratings of healthy normative values. Pearson correlations evaluated associations between sleep and overall HRQL. Hierarchical regression assessed whether CSHQ subscales uniquely predicted HRQL beyond demographic characteristics. Results This sample reported greater bedtime resistance [t(88)=6.413, p&amp;lt;.001], sleep onset delay [t(88)=3.180, p=.002], sleep anxiety [t(88)=4.271, p&amp;lt;.001], night awakenings [t(88)=6.031, p&amp;lt;.001], parasomnias [t(88)=3.900, p&amp;lt;.001], and daytime sleepiness [t(87)=1.781, p=.078] than normative values, although sleep duration [t(88)=1.781, p=.078] and sleep disordered breathing (SDB) [t(88)=-.061, p=.951] did not differ. HRQL was related to SDB (r=-.289, p=.021), bedtime resistance (r=-.263, p=.036), and total sleep score (r=-.34, p=.006). The regression model with SDB and bedtime resistance explained 24.2% of variance but was not significant [F(6,31)=1.651, p=.167]. Conclusion Caregiver ratings showed greater sleep impairments for children in this sample than of norms. Sleep subscales were associated with HRQL, but did not predict HRQL beyond demographic factors. Caregiver reports of child sleep and HRQL may vary depending on when during the monthly chemotherapy cycle questionnaires were completed. SDB did not differ from normative values but was related to HRQL, suggesting the need to screen for SDB symptoms to potentially improve child outcomes. Support This study was supported by funding from the American Cancer Society PF-13-238-01-PCSM (PI: Daniel).

Health-related quality of life among children with transfusion-dependent thalassemia: A cross-sectional study in Malaysia

BackgroundThe treatment of children with transfusion-dependent thalassemia (TDT) in Malaysia has progressed since 2005. This study provides an updated health-related quality of life (HRQoL) assessment for children with the disorder and the factors affecting the HRQoL.MethodsA cross-sectional HRQoL survey of Malaysian children with TDT was conducted using the PedsQL™ 4.0 Generic Core Scales. Patients with non-transfusion dependent thalassemia and other haemoglobinopathies were excluded. Parent-proxy and self-reported HRQoL scores were obtained using a multi-stage convenient sampling. The relationship between HRQoL scores and demographic factors were tested using association, correlation and regression analysis.ResultsA total of 368 patients were recruited. The mean (SD) Total Summary Score (TSS) was 80.12(13.87). Predictors for a lower TSS was an increasing age group and the use of dual chelating agents (R2 = 0.057, F (4, 359) = 5.40, p = < 0.001). The mean (SD) Physical Health Summary Score (PHSS) was 82.21 (16.82). Predictors of a higher PHSS score was being male, while predictors of a lower score was an increasing age group and parent-proxy reports(R2 = 0.075, F (5,358) = 5.80, p = < 0.001). The mean (SD) Psychosocial Health Summary Score (PCHS) was 79.39 (14.81). Predictors for a lower PCHS was the use of dual chelating agents(R2 = 0.041, F (1, 362) = 15.60, p = < 0.001). The school functioning score had the lowest mean (SD) score of 69.52(20.92) in the psychosocial dimension.ConclusionThe HRQoL of TDT children in Malaysia has improved over the last decade owing to the better access in treatment. However, further effort is needed to improve the school functioning dimension.

Concepts of Health-Related Quality of Life of Australian Aboriginal and Torres Strait Islander Children: Parent Perceptions

Health-related quality of life (HR-QoL) is a valued patient-related outcome measure. HR-QoL is typically measured using a psychometric tool. Although there are a number of general and illness-specific HR-QoL measurement tools available globally, no tool has been validated for Australian Aboriginal and/or Torres Strait Islander children. The purpose of this study was to gather Australian Aboriginal and Torres Strait Islander parent/carer perspectives of HR-QoL in children in order to inform the development of a culturally appropriate tool. Yarning circles and face to face interviews were used to document the experiences of parents and carers of Aboriginal and Torres Strait Islander children who had experienced a chronic illness. Participants were recruited through word of mouth and via established social and professional networks in Queensland and the Northern Territory of Australia. Information collected was transcribed and analysed thematically and placed into a concept map. HR-QoL was defined as more than just physical, social and psychological wellbeing. Family and social support were valued aspects of HR-QoL, as was knowledge, communication and the relationship with the health system. Participants described the importance of being heard; their voice trusted and valued by health practitioners. Racism and prejudicial behaviour had negative impacts on HR-QoL. The concepts of HR-QoL identified in this study are not included in conventional HR-QoL measurement tools. Consideration should be given to concepts proposed by Australian Aboriginal and Torres Strait Islander populations in order to adequately capture perceived HR-QoL.

PRO85 IMPACT OF NEUROFIBROMATOSIS TYPE 1 AND PLEXIFORM NEUROFIBROMAS ON PATIENT-REPORTED HEALTH-RELATED QUALITY OF LIFE

To identify the patient-reported health-related quality of life (HRQOL) of patients with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PN). A systematic literature review (SLR) was conducted in PubMed, Embase, and Cochrane from January 1, 2009, to May 31, 2019, using search terms for impact on patient (all ages) HRQOL. The HRQOL SLR was part of a broader SLR to understand patient characteristics, treatment patterns, and health care resource use and costs associated with NF1 + PN. Seven studies were identified that described the HRQOL of children, adolescent, and adult patients with NF1 + PN, including development of a conceptual model (n=1), conduct of a HRQOL cross-sectional survey study (n= 2), conduct of a phase 2 longitudinal study measuring HRQOL (n=1), and measuring pain interference with HRQOL (n=3). The conceptual framework included five domains: pain, social functioning, physical function impact, stigma, and emotional distress. In a survey study, HRQOL was more altered for patients with NF1 + PN than patients with NF-1 without PN regarding symptoms and feelings, and during school or holidays. In another survey study, children with NF1 + PN reported worse HRQOL scores than population norms on most domains. Children with NF1 + PN reporting pain also had significantly worse symptoms and functioning on most HRQOL domains compared with population norms. Pain interferes with daily functioning in most youth with NF1 + PN even when using pain medication. In a phase 2 longitudinal study with selumetinib, 74% of patients had clinically significant decreases of > 2 points in their target tumor pain from baseline to cycle 12, and child physical domain scores improved significantly (p<0.05). NF1 + PN has a substantial impact on HRQOL including physical, social, and emotional function, and pain, highlighting the need for effective drug therapies.

An Analysis of the Educational and Health-Related Benefits of Nature-Based Environmental Education in Low-Income Black and Hispanic Children.

Background: Low-income and non-white children experience disparities in health, education, and access to nature. These health disparities are often associated and exacerbated by inequities in the U.S. educational system. Recent research suggests that nature contact may reduce these health and educational disparities for urban low-income populations. Nature-based education (NBE) uses nature contact to inspire curiosity and improve health. This study examines the health and educational outcomes of a 15-week NBE intervention for urban low-income, black and Hispanic children 10–15 years of age.Methods: Children (n=122) completed a pre-intervention and post-intervention survey that addressed seven science, technology, engineering, and math (STEM)-capacity items (leadership, teamwork, science relevance, sustainability relevance, STEM self-efficacy, science interest, and overall STEM capacity) and six widely used health-related quality-of-life (HRQoL) domains (physical health functioning, emotional health functioning, school functioning, social functioning, family functioning, and overall HRQoL). Focus groups with participating students and post-intervention surveys of NBE mentors and teachers explored perceptions of the intervention impact.Results: There were statistically significant positive changes in STEM capacity and HRQoL for participating students. For example, children's overall STEM capacity and overall HRQoL scores improved by 44% and 46%, respectively (both p<0.05). Qualitative data highlighted the intervention's educational and health benefits.Conclusions: These results support further research quantifying the effects of NBE on STEM capacity and HRQoL in urban, low-income, black and Hispanic children.

Systematic Review With Meta‐analysis of the Health‐related Quality of Life in Children With Celiac Disease

The aim of this article is to systematically review and meta-analyze the published data on the comparison of the health-related quality of life (HRQOL) in children and adolescents with celiac disease (CD) and healthy children. Moreover, the meta-analysis was performed to compare the parent proxy-report and child self-report of HRQOL. The databases of PubMed, Embase, Scopus, and Cochrane library were searched from inception to April 2019 to identify observational studies that evaluated the HRQOL in children with CD. Studies comparing the HRQOL in celiac patients and healthy children, and also comparing the parent's proxy-report and child self-report of HRQOL were included. Comprehensive meta-analysis software was used for statistical analysis. Through our systematic search, 26 articles met our predefined inclusion criteria. The result of our meta-analysis on studies using the PedsQL questionnaire showed that the total score of HRQOL was not significantly different between celiac patients and healthy controls (SMD (95% confidence interval; CI]: -0.11[-0.45 to 0.23], P = 0.52). The result of our meta-analysis showed that the parents reported the child's diet and communication scores lower than that of children. Only 4 out of 11 studies showed a significant correlation between HRQOL and gluten-free diet (GFD) compliance and 2 of 4 studies showed a significant negative association between HRQOL and age at diagnosis. The results of the present study showed that there was no significant difference between children with CD and healthy controls regarding HRQOL. Moreover, the parental perception of their children's HRQOL was lower than the children's perception.

Calidad de vida relacionada con la salud (CVRS) en niños de educación primaria de Islas Canarias que usan dispositivos auditivos

IntroductionThe objectives of the study were first, to evaluate the health-related quality of life (HRQoL) of primary school children from the Canary Islands with cochlear implants (CIs) and hearing aids (HAs). And second, to analyse parents’ perceptions of their children with CIs and HAs regarding HRQoL, and finally, to explore the agreement between the children's self-reports and their parents’ reports concerning HRQoL. Material and methodsData consisted of 89 children with CIs and 63 children with HAs and their 152 parents. Two standardised instruments were used: Kid-KINDLR_children_7-13, Kid_Kiddo-KINDLR_Parents_ 7-17 and a demographic and audiological survey, which were answered by the children and their parents. Student's t-test, one-way ANOVA, post hoc analysis and 3 concordance correlation coefficients (CCC) were used to address the 3 objectives. Results and discussionThe children with CIs exhibited a perception of better HRQoL in comparison with the children with HAs. The children with CIs and HAs and their parents were significantly distinct in the provinces of Tenerife and Gran Canaria. The cchildren with CIs and HAs from Gran Canaria were better on Emotional well-being and Family, while the children with CIs and HAs from Tenerife emphasised Self-esteem or Friends. The parents of the children with CIs had a higher average score in the perception of the total HRQoL and per dimension related to their children compared to the parents of the children with HAs. The agreement between children and parents was low except in the Self-esteem dimension. The children with CIs and their parents demonstrated a perception of better HRQoL than the children with HAs and their parents. The children with CIs and HAs had lower self-perception of the HRQoL than their parents’ reports. ConclusionsThe findings suggest that the children with CIs and HAs in Primary Education in the Canary Islands have discrepant perceptions of their HRQoL; the children with CIs self-perceive better HRQoL than the children with HAs. The parents of the children with CIs achieved a higher average score of their children's HRQoL than the parents of the children with HAs due to their belonging to a province. Professionals working with CI and HA recipients need to be sensitive to psychological issues to optimise HRQoL dimensions in children with CIs and HAs.

Child-level evaluation of a web-based intervention to improve dietary guideline implementation in childcare centers: a cluster-randomized controlled trial

ABSTRACTBackgroundAlthough it is recommended that childcare centers provide foods consistent with dietary guidelines, the impact of implementing sector-specific guidelines on child outcomes is largely unknown.ObjectivesThis study aims to examine the impact of a web-based program and support to implement dietary guidelines in childcare centers on children's 1) diet; 2) BMI z scores; and 3) child health-related quality of life (HRQoL).MethodsThis study was a cluster-randomized controlled trial utilizing a Type-3 Hybrid implementation-effectiveness design conducted between October 2016 and March 2018. This study reports on child outcomes. Fifty-four childcare centers in New South Wales, Australia were randomly assigned to the intervention (a web-based menu-planning tool and support) or control group (usual care). The intervention was designed to address barriers and enablers to dietary guideline implementation according to the Theoretical Domains Framework. A quota of 35 consenting childcare centers undertook child-level evaluation of dietary intake where 522 parents consented to completing ≥1 component of data collection for their child. Child consumption of core and discretionary (unhealthy) foods while in care was assessed via dietary observations by blinded research assistants, childcare diet quality was assessed via educator-completed questionnaires, BMI z scores were assessed via measured weight and height, and child HRQoL was assessed via parent report at baseline and 12-mo follow-up.ResultsThere was a significant increase in mean child consumption of fruit (0.39 servings; 95% CI: 0.12, 0.65 servings) and dairy foods (0.38 servings; 95% CI: 0.19, 0.57 servings) and a significant reduction in consumption of discretionary foods (−0.40 servings; 95% CI: −0.64, −0.16 servings) in care in the intervention group, relative to control at 12-mo follow-up. No significant differences were observed in diet quality, BMI z scores, or HRQoL.ConclusionsA web-based intervention to support planning of childcare menus consistent with dietary guidelines can improve child consumption of healthier foods in daycare. This trial was registered at www.anzctr.org.au as ACTRN12616000974404.

Relationship between Health-Related Quality of Life and Physical Activity in Children with Hyperactivity.

The main purpose of this paper was to evaluate the relationship between health-related quality of life (HRQoL) and the frequency of physical activity in Spanish children aged 8 to 14 years with attention deficit hyperactivity disorder (ADHD). Sample selection was performed using the data obtained from the children’s questionnaire of the National Health Survey of Spain 2017 that is carried out with the children’s parents, and that had an initial size of 6106 participants. After the application of the inclusion and exclusion criteria, the sample size was reduced to 496 subjects. Results show significant differences between the different levels of physical activity frequency, as well as a positive correlation of the average between HRQoL and ADHD. In conclusion, the practice of physical activity may contribute to the improvement of HRQoL in children with ADHD, possibly achieving greater benefits at higher levels of physical activity practice.