Life Measurement Instruments Research Articles

PCR88 Perspectives of the Pedsql Generic Core Scales from Caregivers of Children with Spinal Muscular Atrophy (SMA)

The past five years have yielded many important advances in care, treatment and lifespan for individuals living with spinal muscular atrophy (SMA). Despite these improvements in research and innovation, it is important to understand outcomes that matter most to patients and ways to measure changes that can be used in clinical care and research settings. Health-related quality of life (HRQOL) measurement instruments enable benchmarking and assessing changes across populations.

How do common conditions impact health-related quality of life for children? Providing guidance for validating pediatric preference-based measures

BackgroundThere is increasing interest in the validation of pediatric preference-based health-related quality of life measurement instruments. It is critical that children with various degrees of health-related quality of life (HRQoL) impact are included in validation studies. To inform patient sample selection for validation studies from a pragmatic perspective, this study explored HRQoL impairments between known-groups and HRQoL changes over time across 27 common chronic child health conditions and identified conditions with the largest impact on HRQoL.MethodsThe health dimensions of two common preference-based HRQoL measures, the EQ-5D-Y and CHU9D, were constructed using Pediatric Quality of Life Inventory items that overlap conceptually. Data was from the Longitudinal Study of Australian Children, a nationally representative sample with over 10,000 children at baseline. Seven waves of data were included for the analysis, with child age ranging from 2 to18 years. Impacts to specific health dimensions and overall HRQoL between those having a specific condition versus not were compared using linear mixed effects models. HRQoL changes over time were obtained by calculating the HRQoL differences between two consecutive time points, grouped by “Improved” and “Worsened” health status. Comparison among various health conditions and different age groups (2–4 years, 5–12 years and 13–18 years) were made.ResultsConditions with the largest statistically significant total HRQoL impairments of having a specific condition compared with not having the condition were recurrent chest pain, autism, epilepsy, anxiety/depression, irritable bowel, recurrent back pain, recurrent abdominal pain, and attention deficit hyperactivity disorder (ADHD) for the total sample (2–18 years). Conditions with largest HRQoL improvement over time were anxiety/depression, ADHD, autism, bone/joint/muscle problem, recurrent abdominal pain, recurrent pain in other part, frequent headache, diarrhea and day-wetting. The dimensions included in EQ-5D-Y and CHU9D can generally reflect HRQoL differences and changes. The HRQoL impacts to specific health dimensions differed by condition in the expected direction. The conditions with largest HRQoL impacts differed by age group.ConclusionsThe conditions with largest HRQoL impact were identified. This information is likely to be valuable for recruiting patient samples when validating pediatric preference-based HRQoL instruments pragmatically.

Cultural and Linguistic Adaptation for the Romanian Language Version of the Cardiff Acne Disability Index: A Pilot Study on the Web-Based Experience of Cognitive Debriefing

Background The Cardiff Acne Disability Index (CADI) is a validated measurement instrument for quality of life evaluation in young patients with acne. The original version was designed in English, and it has been translated to other languages. An adaptation for the Romanian language was lacking. Objective The main objective of this study was to evaluate the comprehensibility of the Romanian language adaptation of the CADI in a small sample of patients with acne. Methods Guided by the team at Cardiff University, we conducted the stages of the standardized translation process—forward translation, the reconciliation of translated versions, back translation, and cognitive debriefing. The cognitive debriefing stage involved applying the CADI to a small sample of patients. This was followed by individual interviews in which each question was discussed. Ethical approval was obtained for the cognitive debriefing stage. We administered this measure as a web-based form. The completion times for each individual question and for the entire survey were automatically recorded. The interviews for assessing comprehensibility and suitability for the Romanian language and culture were also held as live, web-based meetings. Results A total of 7 patients with acne—4 females and 3 males—aged between 19 and 34 years were included. All subjects were native speakers of the Romanian language. They had mild or moderate acne. The mean completion time for the survey was 3.28 minutes. The mean score for the CADI was 5.4286. All participants agreed that the language used in this quality of life measurement instrument was simple, clear, and adequate for their native language. Conclusions Despite the epidemiologic restrictions against COVID-19, through teledermatology, we achieved cultural adaptation for the CADI in a language that previously lacked a specific tool for assessing quality of life impairment in patients with acne. Conflicts of Interest CMS receives royalties from Springer Nature, consulting fees from Vichy International, and support for attending meetings from Leo Pharma. SC has no conflicts of interest.

A systematic review of utility-based and disease-specific quality of life measurement instruments for women with urinary incontinence.

This systematic review aims to identify disease-specific and generic quality of life (QoL) outcome measurement instruments used in populations of women with urinary incontinence (UI) and to determine the most psychometrically robust and appropriate disease-specific and generic tools for measuring the quality of life in this population. A systematic search was conducted of PubMed, Embase, SCIELO, and CINAHL databases for studies evaluating measurement properties of QoL instruments in women with UI. The methodological quality of studies and the quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement INtruments (COSMIN) checklist and quality criteria. Overall, evidence for measurement properties was graded using the modified grading of recommendations, assessment, development & evaluation approach. A total of 73 studies were included, and 27 specific and 6 generic instruments were identified. The Incontinence QoL questionnaire (IQoL) had the highest overall psychometric quality for English-speaking populations and was the most widely translated tool. Evidence for generic QoL tools in this population is limited. Few studies evaluated measurement error or cross-cultural validity. The IQoL is the most psychometrically robust disease-specific tool for use in this population. More research is needed to determine the most psychometrically robust generic tool. Future studies should also evaluate measurement error and cross-cultural validity as evidence for these properties is particularly lacking.

Validity and Reliability Testing of a Quality of Life Measurement Instrument “Child Health and Illness Profile-CHIP-AE” For Adolescents Aged Between 12 and 17

Objective: In this study, it was aimed to make a cultural adaptation of the Child Health and Illness Profile- Adolescents (CHIP-AE) measurement tool for adolescents, which was developed by Starfield in 1993, to analyze whether the Turkish version is reliable, valid and applicable. Material and Methods: The sample of the study consisted of adolescents aged between 12 and 17, receiving inpatient treatment in the Children’s Health and Diseases Clinic in the Faculty of Medicine at Eskisehir Osmangazi University, and adolescents aged between 12 and 17, studying in a private school. The original version of CHIP-AE in English was first translated into Turkish, and then back translated. All stages of the cultural adaptation were performed by a specialized committee. Confirmatory Factor Analysis was conducted on LISREL to test the validity of the instrument. Results: For the purpose of this study, the Turkish version of the CHIP-AE (12-17 years) was administered to 252 adolescents receiving inpatient treatment [148 (58.7%) female; 104 (41.3%) male] and 223 healthy adolescents [109 (48.9%) female; 114 (51.1%) male]. The average age was 14.32±1.70 in the group of ill adolescents, and 14.57±1.51 in the group of healthy adolescents. With regard to reliability, Cronbach’s was 0.852 in the group of ill adolescents, and 0.807 in the group of healthy adolescents. These values refer to perfect reliability. Confirmatory Factor Analysis (CFA) was conducted to test construct validity. Model fit results obtained in CFA were as follows: x2=1622.07, df=1061, p-value=0.000 RMSEA=0.046 in the group of ill adolescents; and x2=2082.33, df=1208, p-value=0.000 RMSEA=0.057 in the group of healthy adolescents. Thus, validity results comply with the standards. Conclusion: This study suggests that the version developed for Turkish adolescents has high validity for the groups of both healthy and ill Turkish adolescents.

Validity and Reliability of the Turkish Version of the Weiss Functional Impairment Rating Scale- Self Report Form (WFIRSS- TR).

The aim of this study was to demonstrate the validity and reliability of the WFIRS-S-TR, Turkish version of the Weiss Functional Impairment Rating Scale-Self Report form. The study comprised two groups of participants of 15-18 years of age, one consisting of 35 children diagnosed with attention deficit and hyperativity disorder (ADHD) based on the DSM-IV criteria and the other, 510 healthy volunteers attending high school. Apart from the WFIRS-S-TR, the Health Questionnaire for Children and Adolescents (KIDSCREEN-10 Index) which is a general quality of life and functionality measurement instrument, was used to check the concurrent validity of the WFIRS-S-TR. The Cronbach's alpha coefficient for the total scale was 0.939. The test-retest reliability assessed by repeated measurements two weeks apart gave a high correlation between the results (r=0.804, p<0.0001). Total mean score of the WFIRS-S-TR showed significant correlation with the KIDSCREEN-10 Index total mean score (r= -0.467, p<0.0001). Confirmatory factor analysis was carried out for the construct validity of the WFIRS-S-TR. The RMSEA and the CFI values were found to be 0.065 and 0.68, respectively. The WFIRS-S-TR can be used as a valid and reliable tool both in clinical practice and for research purposes.

Internalized stigmatization and quality of life in patients with bipolar disorders and schizophrenia

Aim: In this study the aim was to compare internalized stigmatization and quality of life between bipolar disorder and schizophrenia patients who were in remission.Material and Methods: Patients who were admitted to the psychiatry outpatient clinic of Gaziantep University Faculty with a diagnosis of bipolar disorder or schizophrenia according to DSM-5 were included in this cross sectional study. Assessment tools were the Internalized Stigma of Mental Illness Scale and the World Health Organization Quality of Life Measurement Instrument Short Form.Results: Schizophrenia and bipolar disorder groups were compared according to assessment tools. 58 bipolar disorder and 52 schizophrenia patients were included in the study. The Quality of Life of patients with bipolar disorder was found to be higher than patients with schizophrenia according to mental domain (p = 0.006) and social relationships domain (p = 0.050). Internalized Stigma of schizophrenia patients was higher than patients with bipolar disorder (p = 0.030). Internalized Stigma was higher in female patients with schizophrenia than female patients with bipolar disorder (p = 0.006). There were no significant differences between male schizophrenia patients and patients with bipolar disorder according to quality of life. Conclusion: Internalized stigmatization is a problem that should be considered in schizophrenia patients, especially in female schizophrenia patients. Internalized stigmatization may result in decreased quality of life in schizophrenia.

Instruments for quality of life assessment in individuals with human papillomavirus.

To identify scientific evidence on quality of life measurement instruments used in individuals with infections caused by human papillomavirus. This was an integrative review carried out from April 1995 to March 2017 in the LILACS, SciVerse Scopus, ISI Web of Science, CINAHL, and PubMed databases. The controlled descriptors adopted were: Infecções por Papilomavirus; Qualidade de Vida; Papillomavirus Infections; and Quality of Life. Of the 416 articles found, 12 were selected. Thirteen different types of instruments to evaluate the quality of life of individuals with human papillomavirus were identified, in that nine were generic and four specific. Different generic and specific instruments were used to evaluate the quality of life of individuals with human papillomavirus, which means no consensus or preference among the studies was identified. However, a lack of use of specific instruments to evaluate this construct in this population was observed.

An anthropometry-based equation of fat mass percentage as a valid discriminator of obesity.

To develop a new predictive equation for fat mass percentage (%FM) based on anthropometric measurements and to assess its ability to discriminate between obese and non-obese individuals. Cross-sectional study. Mexican adults.ParticipantsAdults (n 275; 181 women) aged 20-63 years with BMI between 17·4 and 42·4 kg/m2. Thirty-seven per cent of our sample was obese using %FM measured by air-displacement plethysmography (BOD POD®; Life Measurement Instruments). The fat mass was computed from the difference between weight and fat-free mass (FFM). FFM was estimated using an equation obtained previously in the study from weight, height and sex of the individuals. The %FM estimated from the obtained FFM showed a sensitivity of 90·3 (95 % CI 86·8, 93·8) % and a specificity of 58·0 (95 % CI 52·1, 63·8) % in the diagnosis of obesity. Ninety-three per cent of participants with obesity and 65 % of participants without obesity were correctly classified. The anthropometry-based equation obtained in the present study could be used as a screening tool in clinical and epidemiological studies not only to estimate the %FM, but also to discriminate the obese condition in populations with similar characteristics to the participant sample.

Measurement tools of resource use and quality of life in clinical trials for dementia or cognitive impairment interventions: A systematically conducted narrative review.

Knowledge is limited about the standardised instruments used to collect resource use and quality of life data alongside trials of dementia interventions. This review aimed to identify the trials using such instruments in order to guide the design of future trial-based cost-effectiveness studies. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research in major databases and general searches published until June 2017, including randomised clinical trials, pilot studies, or feasibility studies about interventions for older adults with dementia or cognitive impairment. Forty-one studies were identified. Only 8 collected the resource use data using adapted Client Service Receipt Inventory (CSRI), Resource Use Inventory (RUI), cost diary, or study-specific questionnaire. Quality of life was assessed using a wide range of instruments. The most frequently used dementia-specific instrument was Quality of Life in Alzheimer's Disease (QOL-AD) and Dementia Quality of Life questionnaire (DEMQOL). Among the generic measures, EuroQol 5-dimentison (EQ-5D) was mostly used to collect health utility data, and Short Form surveys (SF-36 or SF-12) were widely to measure general health. Several useful resource use and quality of life measurement instruments have been identified by this review. For resource use, CSRI was mostly used, but no studies have used Resource Utilisation in Dementia (RUD); for quality of life, we recommend the inclusion of dementia-specific DEMQOL, generic SF-12, and health utility EQ-5D-5L, based on both self-report and proxy-report.

Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia.

BackgroundMeasurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life.ObjectiveTo validate the Spanish translation of the ICECAP-O’s capability to measure Health-related quality of life in elderly with dementia who live in nursing homes.MethodCross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL).ResultsThe ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years).ConclusionsThis study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia.

PSY119 - Systematic Review of Quality of Life Measurement Instruments and Response Criteria Among Patients with Myelodysplastic Syndromes

PSY119 - Systematic Review of Quality of Life Measurement Instruments and Response Criteria Among Patients with Myelodysplastic Syndromes

Quality of life questionnaires in otorhinolaryngology: a systematic overview

The importance of quality of life (QOL) as an endpoint and the use of validated QOL questionnaires have increased over time. To evaluate health-related quality of life (HR-QOL) measurement instruments used in patients in otorhinolaryngology (ORL). We aimed to establish the use of QOL questionnaires in ORL over a period of time, establish the use of QOL questionnaires within different domains and determine the use of validated QOL questionnaires. We performed a comprehensive search in PubMed up to 1 January 2014. Articles were included that measured HR-QOL questionnaires in clinical practice in children, adolescents or adults in 42 journals of ORL. Multiple unique QOL questionnaires, organised according to domain, time and survey of validation, were extracted from reported articles. Of 2442 articles, we utilised 1196 publications with a total of 2103 QOL questionnaires regarding ORL. We evaluated a variety of 363 unique QOL questionnaires in which 60% (n = 220) QOL questionnaires had been validated. We found a continuing increase in the amount of articles which used QOL questionnaires since the beginning of the 20th century, while the percentage of validated QOL questionnaires remained the same (76%). Most QOL questionnaires were used in the domains oncology (35%), otology (21%) and rhinology (20%). The domain otology had the largest amount of unique QOL questionnaires (n = 122). We identified and evaluated all unique HR-QOL questionnaires utilised in patients in ORL. Recently, the use of validated and non-validated HR-QOL questionnaires has increased within all domains of ORL. The assessment of QOL has become an important outcome measure in clinical practice, in medical research and for healthcare organisations.

Measurement properties of quality of life measurement instruments for infants, children and adolescents with eczema: protocol for a systematic review.

BackgroundEczema is a common chronic or chronically relapsing, inflammatory skin disease that exerts a substantial negative impact on quality of life (QoL). The Harmonising Outcome Measures for Eczema (HOME) initiative has used a consensus-based process which identified QoL as one of the four core outcome domains to be assessed in all eczema clinical trials. A number of measurement instruments exist to measure QoL in infants, children, and adolescents with eczema, and there is a great variability in both content and quality of the instruments used. Therefore, the objective of the proposed research is to comprehensively and systematically assess the measurement properties of the existing measurement instruments that were developed and/or validated for the measurement of patient-reported QoL in infants, children, and adolescents with eczema.Methods/designThis study is a systematic review of the measurement properties of patient-reported measures of QoL developed and/or validated for infants, children, and adolescents with eczema. A systematic literature search will be carried out in MEDLINE via PubMed and EMBASE using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing, or comparing measurement properties of QoL instruments for infants, children, and adolescents with eczema. Two reviewers will independently perform eligibility assessment and data abstraction. Evidence tables will be used to record study characteristics, instrument characteristics, measurement properties, and interpretability. The adequacy of the measurement properties will be assessed using predefined criteria. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist will be used to evaluate the methodological quality of included studies. A best evidence synthesis will be undertaken if more than one study has examined a particular measurement property.DiscussionThe proposed systematic review will yield a comprehensive assessment of measurement properties of existing QoL instruments in infants, children, and adolescents with eczema. The results will serve as a basis to recommend a QoL measurement instrument for infants, one for children, and one for adolescents for use in future clinical trials.Systematic review registrationPROSPERO CRD42015023483Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0202-z) contains supplementary material, which is available to authorized users.

Quality of life measurement instrument for thyroid cancer and its application

The study was to introduce quality of life measurement instruments for thyroid cancer, as well as the application of these scales. (1)Quality of life scales such as generic scale SF-36, tumor-specific scale EORTC QLQ-C30 were used in previous studies. (2)In these studies, the quality of life assessment was mainly used for measurement of quality of life in patients with thyroid cancer, comparative effectiveness research and specific psychological intervention evaluation, analysis of relevant factors affecting quality of life in patients with thyroid cancer.(Chin J Endocrinol Metab, 2015, 31: 1074-1077) Key words: Thyroid cancer; Quality of life; Instrument

Sex and age-related differences in perceived, desired and measured percentage body fat among adults.

Body image distortion/discrepancy leads to psychological stress, disordered eating and mental and physical disease. To begin to assess body image distortion/discrepancy, we compared perceived, desired and measured percentage body fat in male versus female and college-aged versus non-college aged individuals. In addition, we assessed the acute stress response to body composition measurement. Body fat percentage of 15 college aged ('College Students'; CS) (mean = 19 years) and 16 non-college aged ('Non-College Aged Students'; NCS) (mean = 39 years) males and females was assessed with the BodPod Body Composition Tracking System (Life Measurement Instruments, Concord, CA, USA). Participants indicated their perception of body fat and their desired body fat using a somatomorphic matrix. Salivary cortisol, heart rate and blood pressure were also measured. Data were analysed by analysis of variance and alpha was set at 0.05. Mean (SD) percentage body fat of males [15.2% (6.1%)] was significantly lower than that of females [28.4% (6.4%)] (P < 0.0001). Both CS and NCS females perceived their body fat to be lower (5%) than measured body fat and desired their body fat to be lower (12%) than measured (P < 0.05). CS and NCS male participants demonstrated the opposite result; both CS and NCS male populations perceived their body fat to be higher (5%) than measured body fat and desired their body fat to be higher (4%) than measured (P < 0.05). No differences between any groups were observed in heart rate, blood pressure or cortisol response to body fat measurement. Sex-related but not age-related differences in perceived, desired and measured percentage body fat were observed.

Health-related quality of life questionnaires in lung cancer trials: a systematic literature review.

BackgroundLung cancer is one of the leading causes of cancer deaths. Treatment goals are the relief of symptoms and the increase of overall survival. With the rising number of treatment alternatives, the need for comparable assessments of health-related quality of life (HRQoL) parameters grows. The aim of this paper was to identify and describe measurement instruments applied in lung cancer patients under drug therapy.MethodsWe conducted a systematic literature review at the beginning of 2011 using the electronic database Pubmed.ResultsA total of 43 studies were included in the review. About 17 different measurement instruments were identified, including 5 generic, 5 cancer-specific, 4 lung cancer-specific and 3 symptom-specific questionnaires. In 29 studies at least 2 instruments were used. In most cases these were cancer and lung cancer-specific ones. The most frequently used instruments are the EORTC QLQ-C30 and its lung cancer modules LC13 or LC17. Only 5 studies combined (lung) cancer-specific questionnaires with generic instruments.ConclusionsThe EORTC-C30 and EORTC-LC13 are the most frequently used health-related quality of life measurement instruments in pharmacological lung cancer trials.

Quality of Life

The focus of this column is to provide a brief overview of several conceptual analyses of quality of life along with their resulting definitions. A discussion of the more specific construct of health-related quality of life in terms of chronic illness is considered followed by an in-depth review of health-related quality of life measurement instruments. Finally, the idea of health-related quality of life considered as input to decision-making instead of designated as an outcome measure is proposed.

Effects of botulinum toxin type a on quality of life assessed with the WHOQOL-BREF in hemifacial spasm and blepharospasm

ObjectiveThe aim of the study was to compare Quality of life (QoL), depression and anxiety in hemifacial spasm (HFS) and essential blepharospasm (BSP) patients and to analyze the effect of Botulinum Toxin Type A (BtxA) therapy. Materials and methodsSeventy nine consecutive patients with HFS (N=53, 76% women, mean age 58 years, mean disease duration 98 months) and BSP (N=26, 62% women, mean age 63 years, mean disease duration 105 months) were included in this study. Quality of Life was measured by the World Health Organization Quality of Life Measurement Instrument Short Form, Turkish Version (WHOQOL-BREF TR), depression by the Hamilton Depression Rating Scale (HDRS) and anxiety by the Hamilton Anxiety Scale (HAS) before the treatment with BtxA and four weeks after the treatment. ResultsAt baseline, physical health, psychological well-being, and satisfaction with the environment domain scores of WHOQOL-BREF TR, HDRS and HAS scores were not significantly different in two patient groups. Social relationship domain score was found significantly higher in HFS group compared with BLS group. BtxA therapy resulted in a significant improvement of clinical symptom severity, of all domain scores of WHOQOL-BREF TR and of depression and anxiety scores in both HFS and BSP groups. ConclusionsThis study demonstrates significant benefit of Botulinum toxin therapy on quality of life, depression and anxiety in patients with BSP and HFS.

Effects of a randomized maintenance intervention on adiposity and metabolic risk factors in overweight minority adolescents.

The objective of this study was to assess the effects of a maintenance programme (monthly newsletters vs. monthly group classes and telephone behavioural sessions) on obesity and metabolic disease risk at 1 year in overweight minority adolescents. After a 4-month nutrition and strength training intervention, 53 overweight Latino and African-American adolescents (15.4 ± 1.1 years) were randomized into one of two maintenance groups for 8 months: monthly newsletters (n = 23) or group classes (n = 30; monthly classes + individualized behavioural telephone sessions). The following outcomes were measured at months 4 (immediately following the intense intervention) and 12: height, weight, blood pressure, body composition via BodPod™ (Life Measurement Instruments, Concord, CA, USA), lipids and glucose/insulin indices via frequently sampled intravenous glucose tolerance test. There were no significant group by time interactions for any of the health outcomes. There were significant time effects in several outcomes for both groups from months 4 to 12: bench press and leg press decreased by 5% and 14%, respectively (P = 0.004 & P = 0.01), fasting insulin and acute insulin response decreased by 26% and 16%, respectively (P < 0.001 & P = 0.046); while high-density lipoprotein cholesterol and insulin sensitivity improved by 5% and 14% (P = 0.042 & P = 0.039). Newsletters as opposed to group classes may suffice as follow-up maintenance programmes to decrease type 2 diabetes and cardiovascular risk in overweight minority adolescents.