Effect of growth hormone treatment on quality of life of short-stature children.

While enhanced growth velocity is a well-established benefit following the initiation of growth hormone treatment (GHT), the potential benefit of GHT on quality of life (QOL) of short-stature children has not yet been documented. We compare QOL of two groups of short-stature children who attended the Endocrine Unit (EU) and were 2 SD or more below the average for age and gender. The first group included 96 patients of whom 65 were without any underlying disease, 15 had classical GH deficiency and 16 had Turner syndrome or renal disease. These patients were on GHT for at least 2 years. The other group included 33 patients. Owing to lack of resources to include these 33 patients in a clinical trial, they did not get GHT. They were normal variant of short stature, and their height was similar to the height of the 65 children included in the first group. QOL was assessed using self-administered questionnaires, which were filled out by the patients on their regular visit to the EU. QOL was defined in terms of school achievements, leisure activities, emotional and physical self-esteem, relationships with peers and family members. No significant differences were found between the two groups. The mean scores for the different domains of QOL ranged between 2.6 and 3.8 on a scale ranging from 1 (very pessimistic view) to 4 (very optimistic view).

Coping and satisfaction with growth hormone treatment among short-stature children.

The ability of children to cope with a chronic medical problem requiring prolonged treatment has an effect on the quality of life of these children and of their parents and serves as an index of the quality of treatment. This study deals with coping ability and satisfaction with treatment of children whose stature was two or more SD below the average for age and gender. The study population included 96 patients, 53 of whom were male, who were on growth hormone (GH) treatment for at least 1 year. 65 patients were without any underlying disease, 15 had classical GH deficiency and 16 had Turner syndrome or renal disease. All patients were treated with daily injections at home from 12 to 66 months. Using a self-administered questionnaire, the ability to cope and the degree of satisfaction and compliance with treatment were assessed. No significant differences were found with respect to gender, the presence of an underlying disease, age at which treatment commenced or duration of treatment. Despite the fact that the outcome of GH treatment on final height has yet to be established, satisfaction and compliance were high.

Is psychotherapy mandatory during the acute refeeding period in the treatment of anorexia nervosa?

Forty-five adolescent and preadolescent patients (42 females, three males) with anorexia nervosa (AN) were treated in a pediatric day care unit of a large urban hospital by a multidisciplinary team. In our treatment model, the pediatrician has the responsibility for the initial evaluation and physical rehabilitation while the pediatric psychiatrist does the initial evaluation of the patient and family and is available for intervention in an emergency. Parents are actively involved in the treatment program. Family psychotherapy is recommended for each patient and his or her family. Among 45 patients, 24 did not enter psychotherapy during the first 2 months of the refeeding period, while the remaining 21 patients started psychotherapy (family and/or individual) during this period. Weight gain was higher in the group without formal psychotherapy during the initial period of refeeding (7.3 +/- 3.1 kg versus 5 +/- 2.5 kg; p less than 0.01). It is suggested that the initiation of structured psychotherapy is not mandatory and does not contribute to treatment effectiveness in the acute phase when emaciation and negativism may hinder the psychotherapeutic process. We believe a multidisciplinary team, together with the parents, is the treatment of choice during the acute phase of AN.