The relationship between health-related quality of life, pain and coping strategies in juvenile idiopathic arthritis.

OBJECTIVES: To investigate the relationship between health-related quality of life (HRQL), experience of pain and pain coping strategies in children with juvenile idiopathic arthritis (JIA). To compare reports describing these variables obtained from children and their parents. METHODS: Participants were 59 children aged 8 to 18 yr with JIA and their parents. Parents and children completed the PedsQL generic core scales and arthritis module, the visual analogue scale of the Varni-Thompson Pediatric Pain Questionnaire, and the Waldron/Varni Pediatric Pain Coping Inventory. Parents rated children's functional disability using the Childhood Health Assessment Questionnaire. RESULTS: Parents reported significantly lower scores (indicating worse HRQL) than children on five of the eight PedsQL scales rating children's HRQL. Parents and children reported a significant negative relationship between pain levels and the PedsQL scores assessing children's physical, emotional and social functioning. They also reported a significant negative relationship between scores on several pain coping scales and scores on the PedsQL scales. However, the pattern of these relationships varied for reports from parents and children. CONCLUSIONS: Pain intensity and pain coping strategies have a significant and independent relationship with several domains that comprise the HRQL of children with JIA. However, parents and children have differing perceptions of the nature of these relationships. The differences emphasize the importance of clinicians obtaining information about children's HRQL, pain levels and pain coping strategies from both parents and children.

Vaginal ultrasound as an adjunct to cervical digital examination in women at risk of early delivery.

AIM: To study the utility of transvaginal ultrasound (TVU) in women at high risk of preterm delivery. METHODS: Women who were scheduled for frequent digital examinations of the cervix from 16 to 26 weeks of gestation had TVU determinations of cervical length before their clinical examinations. Clinicians were blinded to the TVU results. Therefore, clinical decision-making was independent of the unreported TVU data. The plan was to relate the ultrasound characterization of the cervix to the study's primary endpoint, the need for hospitalization prior to 26 weeks of gestation for: preterm premature rupture of membranes, preterm labor, cerclage placement, or delivery. RESULTS: Seventeen subjects completed the study. All 3 who met the primary endpoint had ultrasound cervical lengths <20 mm on earlier prenatal visits, when digital examinations of the cervix did not detect problems. A 4th woman had ultrasound lengths <20 mm (she delivered at 27(6)/(7) weeks). CONCLUSION: TVU determination of cervical length provides an earlier warning of cervical shortening than does digital examination.