Elementary School-Aged Children's and Parents' Report of Health-Related Quality of Life and Relationships with Lifestyle Measures: A Cross-Sectional Study.

Supporting a child's health-promoting lifestyle is an investment in their future health and health-related quality of life (HRQoL). Particularly children with overweight and obesity may be at an increased risk of a poor HRQoL. Currently, a comprehensive evaluation of lifestyle factors and age in relation to HRQoL in healthy children and, further, separate child and parental proxy-reports of HRQoL are lacking. The aims of this cross-sectional study in Finland are to compare healthy elementary school-aged children's and parents' reports of the child's HRQoL, and to view them in relation to lifestyle markers. The HRQoL was measured with Pediatric Quality of Life InventoryTM 4.0, and the following lifestyle markers: leisure-time physical activity as MET, diet quality via a validated index (ES-CIDQ), sleeping time and screen time by questionnaires. Furthermore, age and BMI were recorded. Data were obtained from 270 primary school-aged children (6-13 years). Female gender, the child's older age (8-13 years), high physical activity level and less screen time were strong predictors of a higher HRQoL in both the child's and parental proxy-reports. Means to promote healthy lifestyles should be particularly targeted to young children, especially boys, and new ways to promote physical activity and other forms of free-time activities should be sought.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland.

BACKGROUND: Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors' roles in implementing the local obesity program. METHODS: Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009-2016 and five representatives of other core parties. RESULTS: Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children's lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process. CONCLUSION: Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

Estimating the minimum important change in the 15D scores.

PURPOSE: To facilitate the interpretation of empirical results produced by the 15D, a generic, preference-based instrument for measuring health-related quality of life (HRQoL), a subjective five-category global assessment scale (GAS) was used as an external anchor to determine the minimum important change (MIC) in the 15D scores. METHODS: Altogether 4,903 hospital patients representing sixteen disease entities and having the 15D score at baseline repeated the HRQoL assessment at 6 months after treatment and answered the question: compared to the situation before treatment, my overall health status is now (1) much better, (2) slightly better, (3) much the same, (4) slightly worse, (5) much worse. Regression analysis was used to estimate the MIC for improvement/deterioration, defined as the lower/upper limit of 99.9 % confidence interval of the regression coefficient, standardized for baseline HRQoL, for categories (2) and (4), respectively, and confirmed by ROC curve analysis. RESULTS: The limits or intervals for classifying the changes of 15D scores into GAS categories were >.035 for (1), .015-.035 for (2),>-.015 and<.015 for (3), -.035--.015 for (4) and <-.035 for (5). The lower/upper limits of ±.015 for categories (2) and (4) can be regarded as the generic MIC thresholds for improvement/deterioration, respectively. CONCLUSIONS: The generic MICs for the change of 15D scores are ±.015. Follow-up studies using the 15D should report the mean change in the 15D score, its statistical significance, relationship to the MIC, and the distribution of the changes of the 15D scores into the five categories.

Living ordinary family life with an allergic child-the mother's perspective.

Ecocultural theory considering family as an entity may serve as a new point of view instead of "impact of disease"-perspective. Aims were to reveal ecocultural themes and activities of daily routines in the treatment of a child's food allergy and eczema. Interviews (N=24) were held with mothers with allergic children aged 12 months and mothers repeat interviews at 24 months. The theme; "living an ordinary family life", was implemented across the family activities of routines essential for treating the child's allergy. New or altered treatment regimens can be tailored to families on the basis of existing activities.

Mothers' perceptions of factors affecting their abilities to care for infants with allergy.

AIM: To identify mothers' perceptions of the supporting or straining factors involved in motherhood generally and in relation to child's atopic dermatitis and food allergy at the age of 1-2 years. BACKGROUND: The main person who cares for a child in the early years of life is usually the mother. Information on mothers' perceptions of factors affecting their resources to care for their healthy or allergic children is incomplete and needs to be identified. DESIGN: A descriptive qualitative study with semi-structured interviews. METHOD: Altogether 32 interviews with mothers having a one-year-old healthy or allergic child and repeat interviews with mothers of allergic children aged two years were conducted. Deductive content analysis was applied, based on the concept of empowerment and an empowerment model for family nursing. RESULTS: A child's food allergy at the age of one year caused considerable strain for the mother, chiefly because the adoption of new foods into the child's diet was delayed, and waking at night because of itching related to atopic dermatitis. This delay was still causing the mother additional strain, when the child was two years old. Specific allergy-related strengthening factors were the mother's own knowledge, hope for an improvement, social support and work. CONCLUSIONS: This qualitative study succeeded in identifying strain situations for mothers with one- and two-year-old allergic children. Such mothers should be recognised and provided with individual support by nurses and healthcare professionals to focus on the supporting factors. RELEVANCE TO CLINICAL PRACTICE: Mothers of allergic children should be recognised. An inquiry or questionnaire based on personal abilities and the family's internal and external capabilities may contribute to identifying these mothers. Mothers should be provided with individual encouragement and support from mother and child health clinics by focusing on factors felt to be strengthening ones.

Nutrition economic evaluation of allergy treatment in infants and children: background for probiotic studies.

The treatment of food allergy is based on avoidance of the foods, which cause symptoms, and their replacement with nutritionally comparable foods. The cost of food allergy and elimination diets to families and society is poorly known. Our results suggest that estimation of dietary costs on the basis of dietary records was possible but challenging. In infancy, cost differences were small but vary depending on the age group with the reduction of median yearly costs around 180-240€. Thus, further studies are required for a more accurate cost estimate and an estimation of the impact of specific probiotics.

Long-term effects of growth hormone therapy on patients with Prader-Willi syndrome.

AIM: To assess the effects of recombinant human growth hormone (rhGH) treatment in children with Prader-Willi syndrome. DESIGN: A 1-year study and an observational follow-up visit 10 years later. METHODS: In 20 patients with Prader-Willi syndrome (PWS): clinical assessment, laboratory tests, body composition analysis by dual energy X-ray absorptiometry, sleep polygraphy, health-related quality of life assessed by 16D. RESULTS: Only two patients had normal growth hormone secretion at baseline. All patients were significantly shorter than their expected heights, but experienced catch-up growth during growth hormone treatment. At follow-up, 13 patients had reached adult heights and were markedly taller than historical controls. The cumulative dose of rhGH over 10 years correlated inversely with the total body fat percentage (p = 0.033). However, patients remained severely obese at 10 years. Sleep polygraphy was abnormal in more than half of the patients. Health-related quality of life of the patients remained substantially below that of normal population. CONCLUSION: Growth hormone markedly improved adult height in subjects with PWS when compared to historical data. The cumulative dose of growth hormone correlated with reduction in body fat; nevertheless, patients remained severely obese.