Quality of life of long-term childhood acute lymphoblastic leukemia survivors: Comparison with healthy controls.

OBJECTIVE: Improved treatment landscape has led to better outcomes for paediatric acute lymphoblastic leukemia (ALL) survivors. As the number of survivors increase, we need to elucidate the long-term quality of life (QoL) and domains of complaints in these patients. Furthermore, the main priorities of these patients need to be clarified. We assessed long-term QoL outcomes of survivors of childhood ALL compared to matched population controls. METHODS: QoL data were collected from survivors recruited in France and Belgium between 2012 and 2017, including the Short Form Health Survey (SF-12) and the Quality of Life Systemic Inventory (QLSI). The Wilcoxon test was used to compare SF-12 scale scores between survivors and matched population controls. For the QLSI, comparisons were mainly descriptive. RESULTS: One hundred and eighty-six survivors (mean age: 27.6 years; range: 18.1-52.8) at follow-up completed QoL measures, amongst whom 180 were matched to controls. Overall, survivors had higher QoL on all SF12 scale scores, indicating that they had better functioning compared to controls. Statistically significant differences on the SF12 were observed for Vitality, Social Functioning, Role Limitations due to Emotional Problems and Mental Health scales. QLSI outcomes suggested that survivors were happier than controls with Couple and Social Relations. Controls were unhappiest compared to survivors with Money, Love life, Self-esteem, Nutrition and Paid Work. CONCLUSIONS: Our findings suggest that survivors of childhood ALL have better QoL outcomes on some domains compared to the general population, specifically around social and emotional functioning, and that they tend to prioritize their relationships more. Interventions for improving QoL outcomes, might build on existing positive experiences with family, friends and partners.

Transforming nursing home culture: Opinions of older people. A cross-sectional study in Belgium.

A culture change movement is taking place in some nursing homes: from the traditional biomedical to more person-centred and relational environments. However, knowledge of the institutional preferences of older people among the general population is limited. We focused on identifying what is important to older people when choosing a nursing home. We also wanted to determine which type of environment (traditional or relational) they would be more inclined to enter; where they would feel better cared for and respected; where professionals would offer more adequate support; where older people would feel more at home, and where they would feel freer to live the life they wanted. A cross-sectional study based on the analysis of two brochures was conducted: one integrated traditional nursing home information, the other included information related to the culture change environment. Participants (n = 71) were first asked, when choosing a nursing home, what the most important features were. They were then asked to consider the two brochures and, after reading each, to assess their desire to enter the nursing home, their feelings about the care given by the professionals, the respect of their personal habits and their choices, the professional support, the home-like atmosphere and freedom to live their life. Finally, they were asked to choose one nursing home. The features cited by the participants were then evaluated by independent evaluators to identify their orientation (traditional or culture change nursing home). The majority was assessed as having a culture change in orientation. After reading the culture change brochure, participants felt more inclined to enter the nursing home, and believed that they would be better cared for, be more respected (habits and choices), and freer to live the life they desired in a home-like atmosphere, compared to the traditional brochure. Finally, most participants chose the culture change nursing home as their final choice. The results support the potential benefits of culture change within nursing home environments.

Does caring lead to stigmatisation? The perception of older people among healthcare professionals and the general population: A cross-sectional study.

BACKGROUND: It is well recognised that healthcare professionals are particularly at risk for developing a negative perception of older people. Indeed, in addition to receiving education centred on a biomedical view of ageing, they are constantly exposed to the most vulnerable and dependent older individuals. AIM: The purpose of our study is to compare the perception of older people between health professionals, working in a nursing home and the general population. METHODS: This is a cross-sectional study. The perception of older people was measured using two different instruments: the image-of-ageing question and the Aging Semantic Differential (ASD) scale. We performed t-test to compare the perception of older individuals between the general population and healthcare professionals. RESULTS: The image-of-ageing question does not show any difference between the general population (n = 148) and healthcare professionals (n = 107). In these both groups, almost half of the words cited in reference to older individuals were negative. Concerning the ASD, results show that healthcare professionals have significantly more negative perceptions towards older individuals than the general population (with the control of age, gender and educational level). CONCLUSION: Healthcare professionals seem to have a more negative view of older people than the general population. Their regular contact with the frailest older adults could explain this finding. Another hypothesis could be a non-optimal quality of contact in nursing homes. IMPLICATIONS FOR PRACTICE: Such results highlight the importance to promote a more holistic view of ageing in educational programs of healthcare professional. Improving the quality of contact with nursing homes residents should be strongly considered to reduce ageism among healthcare professionals.

Examining the Impact of Fictional Life Story of Resident with Dementia on Staff Levels of Empathy, Self-confidence, Workload Burden, and Perception of Resident: A Cross-sectional Survey in Long-term Care Communities.

OBJECTIVES: Determine the impact of fictional life story on staff members levels of empathy, self-confidence, workload burden, and perception of resident before the implementation of care for new resident with dementia in long-term care community. METHODS: An online cross-sectional survey based on two fictive clinical vignettes was used: one vignette described a resident with typical medical information (e.g., level of autonomy, health status, medication …), while the other contained typical medical information and life story information. The two vignettes were visually similar. The order in which vignettes were read was counterbalanced. Staff members (n = 95) were asked to consider the care needed by these residents and to assess, with a visual analogue scale, the amount of useful information provided by vignettes, their self-confidence and level of empathy, their perception of the resident's level of sympathy, his dependence, and the associated workload. RESULTS: After reading the vignette containing life story information, staff members considered that they had more useful information and empathy for the resident. They also felt more confident about the care. They perceived the resident as more sympathetic and less dependent, and the workload seemed lighter to them compared to the case described in the vignette that did not contain life story information. CONCLUSIONS: This quantitative study shows, in clinical fictive situations, the positive impact of life story on staff members before care begins. CLINICAL IMPLICATIONS: Results highlight the importance of considering life story early. Getting to know residents should be the first step of care.

Sociodemographic and Medical Determinants of Quality of Life in Long-Term Childhood Acute Lymphoblastic Leukemia Survivors Enrolled in EORTC CLG Studies.

BACKGROUND: due to increasing survival rates in childhood acute lymphoblastic leukemia (ALL), the number of survivors has been expanding. A significant proportion of these survivors can experience long-term emotional and psychosocial problems. However, the exact risk factors remain inconclusive. We investigated potential risk factors for decreased daily life quality and life challenges in long-term childhood ALL survivors enrolled between 1971 and 1998 in EORTC studies. METHODS: self-report questionnaires were collected from 186 survivors (109 females; mean age at diagnosis 5.62 years, range 0.2-14.7; median time since diagnosis of 20.5 years (12.9-41.6)), including the Short-Form Health Survey (SF-12) and Impact of Cancer-Childhood Survivors (IOC-CS). Multivariable linear regression models were used to assess the impact of gender, age at diagnosis, relapse/second neoplasm, National Cancer Institute (NCI) risk group and cranial radiotherapy on 2 subscales of the SF-12 (physical and mental health) and five subscales of the IOC-CS (life challenges, body and health, personal growth, thinking and memory problems and socializing). RESULTS: mental component scores of SF-12 were not significantly associated with any risk factor. Physical component scores were lower in relapsed, irradiated and NCI high-risk patients. Regarding IOC-CS negative impact subscales, life challenges was more negatively impacted by cancer in female, younger (i.e., <6 years) and relapsed patients. Regarding the positive impact scales, personal growth was more positively impacted in relapsed patients, whereas body and health, and socializing, were less positively impacted in these patients, compared to non-relapsed patients. Socializing was more positively impacted in older patients (>6 years). CONCLUSIONS: this study demonstrates that long-term outcomes can be both adverse and positive, depending on the patient's demographic and clinical characteristics. Younger, female, and relapsed patients might encounter more life challenges years after their disease, while physical challenges could occur more often in relapsed and high-risk patients. Finally, the positive effect on socializing in the older patients sheds new light on the importance of peer interactions for this subgroup. Specific individual challenges thus need specialized support for specific subgroups.

Old Age-Related Stereotypes of Preschool Children.

Ageist attitudes have been discovered in children as early as 3 years. However, so far very few studies, especially during the last decade, have examined age-related stereotypes in preschool children. Available questionnaires adapted to this population are scarce. Our study was designed to probe old age-related views in 3- to 6-year-old children (n = 126) using both an open-ended Image-of-Aging question and a new pilot tool, called Young Children's Views of Older People (YCVOP), based on a visual analog scale illustrated by cartoons. Parental views of older people were also collected. The YCVOP was easy to use and internally consistent. Both that scale and the Image-of-Aging question showed globally favorable views of older people in preschool children, especially regarding warmth and smartness traits. However, assessment of physical capacity and independence tended to be negative. The overall results were in line with the low-competence, high-warmth stereotype of older people that is common in young adults and school-age children and was found in parents in the current study (Stereotype Content Model). Strikingly, children's views did not correlate with those of their parents': The children's responses appeared more personal and emotional, while the parents tended to adopt global stereotypes. The preschoolers' views of older people were much more positive in those who spontaneously evoked their grandparents when asked to think of an old person. In conclusion, this study, introducing a new visual tool to assess age-related stereotypes, suggests ambivalent views of older adults start in preschool children and are influenced by grandparents relationships.

Speech accommodation toward older people in 7- To 12-year-old children.

From an early age, children develop stereotypes toward older adults leading to potential ageism. In young adults, ageism includes conversational changes, also known as elderspeak, characterized by louder, slower, and simplified speech. Although it has direct consequence on older adults, to date no studies have explored elderspeak in children. We invited 137 Belgian children aged 7-12 to take part in a guessing game through a dissimulated Skype session. The child had to make two female interlocutors in turn, one young (25 years old) and the other old (75), guess two different words each. During the session, children remained unaware of the real purpose of the game. Prosody, verbal fluency, and semantic content of their speech were measured using the Praat and VocabProfil software. The results, analyzed using mixed-design ANOVA, showed that children spoke louder to the older interlocutor and tended to judge her less competent to guess words than the younger participant. When the older person was second in turn, children engaged in lengthier and more detailed explanations. Unexpectedly, positive views on older people correlated with higher voice intensity, suggesting that the child's differential vocal attitudes may reflect benevolent ageism. In conclusion, significant speech accommodation can be detected in 7- to 12-year-old children when they speak to an older compared with a younger interlocutor. This accommodation is characterized by louder voice and lengthier explanations.

Impact of self-perception of aging on mortality of older patients in oncology.

OBJECTIVE: Several studies show that self-perception of aging (SPA) is a significant predictor of mental and physical health. In this study, we analyze the effect of SPA on mortality in the specific context of geriatric oncology. METHODS: The sample constituted of 140 individuals aged 65 years and older suffering from a recent nonmetastatic cancer (breast, lung, gynecological, or hematological), followed up to 6 years. We used Cox proportional hazards model to assess the effect of SPA at baseline on mortality. It was adjusted for age, gender, educational and cognitive level, oncological information (the site and kind of cancer), number of comorbidities, and physical and mental health at baseline. RESULTS: Patients were aged 73 years at diagnosis and were more often women (85.7%). Individuals with more negative SPA were 3.62 times more likely to die than those with a more positive SPA, with control of gender, age, education and cognitive level, mental and physical health, the category (breast, lung, gynecological, or hematological), and kind (initial or recurrence) of cancer. CONCLUSIONS: These findings suggest that SPA influence the mortality of older people in the particular context of oncology. Therefore, the need to change our attitudes toward aging and older people implied indirectly by these results is discussed.

[Role of "light therapy" among older adults with dementia: an overview and future perspectives]. / Place des « thérapies lumière ¼ auprès des personnes âgées souffrant de pathologie démentielle : état des lieux et perspectives futures.

Given the relatively modest therapeutic benefits of drug treatments (and their associated costs) in dementia, there is a growing interest in non pharmacological approaches, including light therapy (light based therapy, LBT). Although various literature reviews exist, little attention has been given to the effects of these therapies (according to their modalities of application) on parameters related to both circadian rhythm and clinical parameters associated with dementia. AIMS: To provide an overview of available studies using LBT as non-pharmacological approach for managing persons with dementia and to make recommendations for its use. METHOD: Systematic searches in Medline and PsycINFO were carried out, from their inception to February 2017, by means of the combination of key words including dementia and light therapy. RESULTS: Forty-two articles were reviewed with particular attention to the subjects' characteristics and the modalities of the therapy. The effect of LBT has been considered as a mean of intervention to entrain the circadian rhythm as well as in a clinical approach to reduce behavioral disorders, to reduce cognitive decline or loss of independence, and so on. Depending on the parameters and modalities, the effect of LBT is partially or non-significant. CONCLUSIONS: Based on this literature review, some recommendations were formulated: prioritizing 'naturalistic' devices, setting a minimum threshold of 2,000 lux light intensity peak, testing the modulation of the light intensity during the day and finally, assessing the adequacy between the type of light (color) and the desired therapeutic objective (relaxing or stimulating effect).

Interactions between stereotype threat, subjective aging, and memory in older adults.

This study examined whether the effects of stereotype threat on memory and subjective age were moderated by positive age stereotypes and self-perceptions of aging among older adults. Perceived threat as a mechanism underlying these effects was also explored. Results showed that stereotype threat (high vs. low threat) did not affect the dependent variables. Moreover, self-perceptions of aging did not moderate the effect of stereotype threat on the dependent variables. However, for people with more positive age stereotypes, older people under highthreat perceived more threat than people under low threat. This could be explained by an effect of age stereotypes in the high-threat group: the more positive age stereotypes held by participants, the more they perceived threat, which in turn decreased their memory performance and made them feel mentally older. We hypothesized that age group identity is stronger in people with more positive age stereotypes, which increase perceived threat.

Impact of Contact With Grandparents on Children's and Adolescents' Views on the Elderly.

Stereotypes, prejudice, and discrimination against the elderly (ageism) may manifest themselves in children at an early age. However, the factors influencing this phenomenon are not well known. Using both explicit and open-ended questions, this study analyzed the influence of personal and familial parameters on the views of 1,151 seven- to sixteen-year-old Belgian children and adolescents on the elderly. Four factors were found to affect these views: gender (girls had slightly more positive views than boys), age (ageism was lowest in 10- to 12-year-old, reminiscent of other forms of stereotypes and cognitive developmental theories), grandparents' health, and most importantly, quality of contact with grandparents (very good and good contacts correlated with more favorable feelings toward the elderly, especially in children with frequent contacts).

Association between self-perception of aging, view of cancer and health of older patients in oncology: a one-year longitudinal study.

BACKGROUND: Identifying older people affected by cancer who are more at risk of negative health outcomes is a major issue in health initiatives focusing on medical effectiveness. In this regard, psychological risk factors such as patients' perception of their own aging and cancer could be used as indicators to improve customization of cancer care. We hypothesize that more negative self-perception of aging (SPA) and view of cancer could be linked to worse physical and mental health outcomes in cancer patients. METHODS: One hundred one patients diagnosed with cancer (breast, gynecological, lung or hematological) were followed for 1 year. They were evaluated on four occasions (baseline, 3, 6 and 12 months after the baseline). Their SPA, view of cancer and health (physical and mental) were assessed at each time of evaluation. RESULTS: Negative SPA and/or view of cancer at baseline are associated with negative evolution of patients' physical and mental health. Moreover, when the evolution of SPA and cancer view were taken into account, these two stigmas are still linked with the evolution of mental health. In comparison, only a negative evolution of SPA was linked to worse physical health outcomes. CONCLUSIONS: Such results indicate that SPA and view of cancer could be used as markers of vulnerability in older people with cancer.

The link between self-perceptions of aging, cancer view and physical and mental health of older people with cancer: A cross-sectional study.

OBJECTIVES: Older people may suffer from stigmas linked to cancer and aging. Although some studies suggested that a negative view of cancer may increase the level of depression, such an association has never been studied in the elderly population. Similarly, even though it is established that a negative self-perception of aging has deleterious consequences on mental and physical health in normal aging, the influence in pathological contexts, such as oncology, has not been studied. The main aim of this study is thus to analyze the effect of these two stigmas on the health of elderly oncology patients. MATERIALS AND METHODS: 101 patients suffering from a cancer (breast, gynecological, lung or hematological) were seen as soon as possible after their diagnosis. Their self-perception of age, cancer view and health (physical and mental) was assessed. RESULTS: Multiple regressions showed that patients with a more negative self-perception of aging and/or more negative cancer view reported poorer global health. We also observed that negative self-perception of aging was associated with worse physical and mental health, whereas negative cancer views were only linked to worse mental health. No interaction was observed between these two stigmas, suggesting that their action is independent. CONCLUSION: Older patients with cancer face double stigmatization, due to negative self-perception of aging and cancer, and these stigmas have impacts on global and mental health. Self-perception of aging is also linked to physical health. Longitudinal studies will be necessary to analyze the direction of the association between this double stigmatization and health.

Ageism in Belgium and Burundi: a comparative analysis.

BACKGROUND: Recent cross-cultural comparisons between Asian and Western cultures have shown that ageism arises more from the lack of availability of social and economic resources for older adults than from the culture itself. We tested this assumption by conducting a survey among people living in a least developed country compared with those living in a developed country. PARTICIPANTS AND METHODS: Twenty-seven Belgians living in Belgium, 29 Burundians living in Belgium, and 32 Burundians living in Burundi were included in this study. Their attitudes toward older adults were assessed using several self-reported measures. RESULTS: Statistical analyses confirmed that older people are more negatively perceived by Burundians living in Burundi than by Burundians and Belgians living in Belgium, whose attitudes did not differ from each other. CONCLUSION: Consistent with our hypothesis, our results suggest that the level of development of a country and more particularly the lack of government spending on older people (pension and health care systems) may contribute to their younger counterparts perceiving them more negatively.

Ageism and overestimation of cognitive difficulties in older people: a review.

Stigmatization related to age (i.e., ageism) is a widespread phenomenon in the modern industrial societies where older people are perceived as cognitively incompetent. Therefore negative stereotypes about age-related cognitive decline may have a detrimental influence on older adults on their cognitive performance. The aim of the present review is to understand how stereotypes can influence the performance of the elderly on cognitive tests. We first describe the stereotype threat phenomenon by providing an overview of situations likely to produce stereotype threat, as well as contextual and personal characteristics that moderate its effects. Possible mechanisms underlying these influences on cognitive performance are also presented. Secondly, we address self-stereotyping, which explains long-term negative effects of stereotypes and their unconscious influence on older adults' cognitive performance. However, some age stereotypes have also positive effects on aged people, as shown by some studies describing such beneficial effects of positive stereotypes on cognitive performance. Finally we try to understand why negative age stereotyping has a much stronger influence on important behavioral outcomes among older adults than does positive age stereotyping. Given all these results, we examine how negative age stereotypes may impact older adults' cognitive performance in real-world settings such as during a cognitive assessment.

A comparison of a tablet version of the Quality of Life Systemic Inventory for Children (QLSI-C) to the standard paper version.

Integration of e-Health technologies for purposes of both assessment and intervention has recently become an interest area in pediatric psychology. The purpose of this study is to present psychometric characteristics of a technology-based (i.e., tablet administration) approach for measuring quality of life (QOL) in children. Eighty children (8-12 years) completed the Quality of Life Systemic Inventory for Children (QLSI-C) twice over a 2-week delay, in a crossover design that used paper and tablet-based modes of administration. Equivalence of scores across methods was examined using intraclass correlation coefficients (ICC), augmented by paired t test and Pearson's correlations. Test-retest reliability was assessed using paired t test and Pearson's correlations while internal consistency was assessed using Cronbach's coefficient. Results showed a good concordance across methods of administration (ICCs = .72 to .91; r = .56 to .83). Paired t test showed no significant differences between the tablet and paper version of the QLSI-C. Internal consistency reliability yielded acceptable Cronbach's alphas for all QLSI-C scores, with all α > .70. Test-retest reliability for the tablet-administered QLSI-C was good (r = .66 to .90). Paired t test showed no significant difference between Time 1 and 2 for the QLSI-C scores, except for the state score. Findings established the reliability of the tablet-administered QLSI-C scores. This technology approach to assessment is more attractive for children, decreases time for administration, and enhances the ease of scoring. These advantages might encourage both clinicians and researchers to consider using e-Health developments in assessment in pediatric psychology. (PsycINFO Database Record

A Validation of the French Version of the Attitudes to Aging Questionnaire (AAQ): Factor Structure, Reliability and Validity.

Introduction: The Attitudes to Aging Questionnaire (AAQ) was developed to measure attitudes toward the aging process as a personal experience from the perspective of older people. The present study aimed to validate the French version of the AAQ. Participants and methods: This study examined factor structure, acceptability, reliability and validity of the AAQ's French version in 238 Belgian adults aged 60 years or older. In addition, participants provided information on demographics, self-perception of their mental and physical health (single items), quality of life (WHOQOL-OLD) and social desirability (DS-36). Results: Exploratory Factor Analysis produced a three-factor solution accounting for 36.9% of the variance. No floor or ceiling effects were found. The internal consistency, measured by Cronbach's alpha coefficients for the AAQ subscales were 0.62 (Physical Change), 0.74 (Psychological Growth), and 0.75 (Psychosocial Loss). A priori expected associations were found between AAQ subscales, self-reported health and quality of life, indicating good convergent validity. The scale also showed a good ability to discriminate between people with lower and higher education levels, supporting adequate known-groups validity. Finally, we confirmed the need to control for social desirability biases when assessing self-reported attitudes toward one's own aging. Conclusion: The data support the usefulness of the French version of the AAQ for the assessment of attitudes toward their own aging in older people.

Ageism and its clinical impact in oncogeriatry: state of knowledge and therapeutic leads.

Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism). These stigmas can result in deleterious consequences for elderly people's mental and physical health in "normal" aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals' attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients' mental and physical health.

[Impact of double stigmatization in oncogeriatry: reviewing existing data]. / Impact de la double stigmatisation en oncogériatrie : état des lieux.

Cancer is a major health problem for which age is a proved risk factor. Paradoxically, elderly suffering from cancer are often excluded from clinical trials and undertreated compared to younger patients. Also, their psychosocial needs remain unknown. An explanatory factor for these observations is the age stigma (that is to say our stereotypes about age and so, ageism), age being currently cited as the main reason for discrimination. Besides these age-related stigmas, cancerous patients face pathology-related stigmas because nowadays cancer (especially some types of cancer such as lung cancer) still conveys a lot of negative representations. These observations bring us to the notion of double stigmatization in oncogeriatry. Moreover, the aim of this review is to present ageism phenomenon on the basis of several studies that had proved negative influence of ageism on elderly's mental and physical health and on the attitude of elderly's interlocutors. Afterwards, we will broach the way by which ageism and stigmatization linked to cancer is observed in the specific context of oncogeriatry, which will allow us to identify current shortcomings.

Avaliação da qualidade de vida infantil: o inventário sistémico de qualidade de vida para crianças / Children's quality of life assessment: child quality of life systemic inventory

A avaliação da qualidade de vida infantil apresenta especificidades metodológicas. O objetivo do presente estudo é analisar as características psicométricas da versão portuguesa do Inventaire Systémique de Qualité de Vie pour Enfants (ISQV-C), que assenta numa abordagem conceptual e metodológica inovadora para a autoavaliação da qualidade de vida, por ser interativo e lúdico, possuir uma psicometria que explora diversas pontuações e permitir uma análise de cada domínio de vida. Participaram do estudo 120 crianças portuguesas, dos 8 aos 12 anos de idade. Os resultados apontam para uma consistência interna satisfatória das quatro pontuações do ISQV-C (Estado, Objetivo, Importância e Qualidade de Vida), atestam validade convergente ao instrumento, não sendo favoráveis à existência de uma estrutura fatorial. Demonstra-se a adequação psicométrica e o interesse da versão portuguesa do ISQV-C.(AU)

The assessment of children's quality of life presents specific methodological aspects. The objective of this study was to examine the psychometric properties of the Portuguese version of the Child Quality of Life Systemic Inventory (CQLSI). It is based on an innovative conceptual and methodological approach to quality of life self-assessment. It is interactive and playful, has a psychometry which operates several scores, and allows the analysis of each domain of life. One hundred twenty Portuguese children, from 8 to 12 years old, participated in the study. Results show that internal consistency of the four scores of the CQLSI (State, Goal, Rank and Gap) is satisfactory and all scores have their own specificity. Findings reveal the feasibility of this self-assessment instrument for children's quality of life, demonstrating psychometric adequacy of the Portuguese version.(AU)