Health-Related Quality of Life of Mothers and Children

Health-related quality of life (HRQOL) is an essential issue for maternal and child health. This thesis aims to extend the understanding of maternal HRQOL during pregnancy and after childbirth, as well as HRQOL of children. The studies presented in this thesis were embedded in the Generation R Study and the Dutch Health Interview Survey in the Netherlands. Seven studies have been included in this thesis. The main findings are: (1) Compared with women who never reported nausea, vomiting and fatigue in early pregnancy, women with daily presence of at least one of these symptoms had significantly worse physical and mental HRQOL; (2) Physical and mental trajectories of health-related quality of life during pregnancy differ, with the most common being healthy trajectories. Predictors indicative of suboptimal HRQOL trajectories included pregnancy-related physical symptoms and pregnancy-specific anxiety. (3) Multiple determinants are associated with worse maternal HRQOL at two months after delivery. Particularly, maternal psychopathology is a profound determinant of worse mental HRQOL after delivery. (4) We did not confirm the hypotheses that worse maternal physical and mental HRQOL in early, mid- and late pregnancy are associated with more preterm birth, shorter pregnancy duration, and lower birth weight in the total study population. (5) There are multiple determinants of worse HRQOL in childhood. Having a non-western immigrant background, parents who did not work, more health conditions/disorders and using more healthcare were associated with poorer physical HRQOL. Boys, single-parent family, obesity and having more health conditions/disorders were associated with poorer psychosocial HRQOL. (6) Children with a prevalent chronic condition (asthma, eczema, dyslexia, attention deficit hyperactive disorder, or migraine/severe headache) have a low physical /psychosocial HRQOL compared with children without any chronic conditions. The pattern of impaired HRQOL is specific across these conditions. (7) Our results support the feasibility, concurrent validity, and discriminant validity of the Health Status Classification System-Preschool (HSCS-PS) in the general population, which is a preference-based measure of HRQOL among preschool-aged children

Knowledge gaps in health-related quality of life research performed in children with bleeding disorders – A scoping review

Introduction: Bleeding disorders (BDs) may influence health-related quality of life (HRQoL) in children and caregivers. Measuring HRQoL gives insight into domains requiring support and provides an opportunity to evaluate the effects of novel therapies. Aim: To gain insight in the current body of literature on HRQoL in children with BDs in order to identify knowledge gaps for research and further development of this field. Methods: Scoping review. Results: We included 53 articles, describing studies mainly performed in Europe and North–America (60.4%) and mostly within the last ten years. Only 32% studies included children &lt;4 years. Almost all studies (47/53, 88.7%) were performed in boys with haemophilia, pooling haemophilia A and B (n = 21) and different disease severities (n = 20). Thirteen different generic and five disease-specific HRQoL-questionnaires were applied; all questionnaires were validated for haemophilia specifically. Six (11,3%) combined generic and disease-specific questionnaires. Self-reports were most frequently applied (40/53, 75.5%), sometimes combined with proxy and/or parent-reports (17/53, 32.1%). Eleven studies used a reference group (20.8%). Statistical analyses mostly consisted of mean and SD (77.4%).Conclusion: HRQoL-research is mainly performed in school-aged boys with haemophilia, treated in developed countries. Pitfalls encountered are the pooling of various BDs, subtypes and severities, as well as the application of multiple generic questionnaires prohibiting comparison of results. More attention is needed for broader study populations including other BDs, young children, feminine such as young children, feminine bleeding issues and platelet disorders, as well as the use of HRQoL as an effect-measurement tool for medical interventions, and more thorough statistical analysis.</p

Knowledge gaps in health-related quality of life research performed in children with bleeding disorders – A scoping review

Introduction: Bleeding disorders (BDs) may influence health-related quality of life (HRQoL) in children and caregivers. Measuring HRQoL gives insight into domains requiring support and provides an opportunity to evaluate the effects of novel therapies. Aim: To gain insight in the current body of literature on HRQoL in children with BDs in order to identify knowledge gaps for research and further development of this field. Methods: Scoping review. Results: We included 53 articles, describing studies mainly performed in Europe and North–America (60.4%) and mostly within the last ten years. Only 32% studies included children &lt;4 years. Almost all studies (47/53, 88.7%) were performed in boys with haemophilia, pooling haemophilia A and B (n = 21) and different disease severities (n = 20). Thirteen different generic and five disease-specific HRQoL-questionnaires were applied; all questionnaires were validated for haemophilia specifically. Six (11,3%) combined generic and disease-specific questionnaires. Self-reports were most frequently applied (40/53, 75.5%), sometimes combined with proxy and/or parent-reports (17/53, 32.1%). Eleven studies used a reference group (20.8%). Statistical analyses mostly consisted of mean and SD (77.4%).Conclusion: HRQoL-research is mainly performed in school-aged boys with haemophilia, treated in developed countries. Pitfalls encountered are the pooling of various BDs, subtypes and severities, as well as the application of multiple generic questionnaires prohibiting comparison of results. More attention is needed for broader study populations including other BDs, young children, feminine such as young children, feminine bleeding issues and platelet disorders, as well as the use of HRQoL as an effect-measurement tool for medical interventions, and more thorough statistical analysis.</p

Trajectories and predictors of women's health-related quality of life during pregnancy

The objective of this study was to identify distinct trajectories and their predictors of healthrelated quali

Applying SF-6D to measure health state utilities among the middle and old aged patients with hypertension in China

Purpose: Hypertension is a growing public health problem in China; however, little is known about health-related quality of life (HRQoL) especially health state utility (HSU) of patients with hypertension in rural China. This study aimed to examine the HSU as measured by SF-6D and to investigate its associated factors among middle and old aged patients with hypertension in rural China. Methods: Data were collected from twelve villages in Shandong Province in 2016. SF-36 was administrated to measure HRQoL of middle and old aged patients with hypertension and was got to the SF-6D values using Hong Kong’s tariff. Descriptive analyses, such as demographic characteristics, socio-economic status, and utility, were stratified by hypertension classification. Multiple linear regression models were applied to assess the associated factors of HSU. Results: A total of 933 (response rate:86.4%) middle and old aged patients (69.1 ± 8.2 years) with hypertension participated in the study. 39.4% of participants were male; 44.2% had stage I hypertension; 26.4% had stage II and above. The mean score of SF-6D utility score was 0.743 (SD: 0.14, range: 0.32–1.00, median: 0.756, Interquartile range:0.634–0.859). Being female (β = −0.046), having two or more comorbidities (2 vs. 1 β = −0.066; > 3 vs. 1 β = −0.098) and the health expenditure higher than 2000 RMB (2000–3999 vs. 6000 vs. 15,000 vs. < 5000 β = 0.064) and having stage I and above hypertension (stage I vs. Normotensive β = 0.047; stage II vs. Normotensive β = 0.079; stage III vs. Normotensive β = 0.095) were significantly associated with higher SF-6D overall score. Conclusion: SF-6D was capable to measure quality of life middle and old aged patients with hypertension in China. And multiple factors were demonstrated to be significantly associated with quality of life

Associations between Maternal Health-Related Quality of Life during Pregnancy and Birth Outcomes: The Generation R Study

The objective of this study was to assess associations between maternal health-related quality of life (HRQoL) in early, mid-, and late pregnancy and birth outcomes and to assess the differences in birth outcomes between subgroups of mothers reporting relatively "low" and relatively "high" HRQoL. HRQoL was measured by the 12-item Short Form Health Survey in early (n = 6334), mid- (n = 6204), and late pregnancy (n = 6048) in a population-based mother and child cohort; Physical and Mental Component Summary (PCS/MCS) scores were calculated. Birth outcomes included pregnancy duration, preterm birth, birth weight, low birth weight, and small for gestational age. We defined very high PCS/MCS scores as the >90th percentile and very low score as the <10th percentile. The lower PCS score in late pregnancy was significantly associated with a higher chance of having small-for-gestational-age birth (per 10 points: OR = 1.20, 95% CI: 1.08, 1.33, p value = 0.0006). In early, mid-, and late pregnancy, the subgroup mothers with a low MCS score had infants with a lower average birth weight than those with very high scores (p < 0.05). The association between higher physical HRQoL in late pregnancy and a higher chance of having small-for-gestational-age birth needs further research. The role of mother's mental HRQoL during pregnancy and the potential consequences for the child require further study

Determinants of health-related quality of life in school-aged children: A general population study in the Netherlands

Background: Health related quality of life is the functional effect of a medical condition and/or its therapy upon a patient, and as such is particularly suitable for describing the general health of children. The objective of this study was to identify and confirm potential determinants of health-related quality of life in children aged 4-11 years in the general population in the Netherlands. Understanding such determinants may provide insights into more targeted public health policy. Methods: As part of a population based cross sectional study, the Child Health Questionnaire (CHQ) Parental Form 28 was used to measure health-related quality of life in school-aged children in a general population sample. Parents of 10,651 children aged 4-11 years were interviewed from January 2001 to December 2009. Results: Multivariate and regression analyses demonstrated a declined CHQ Physical Summary score for children who had >1 conditions, disorders or acute health complaints and who were greater consumers of healthcare; children with a non-western immigrant background; and children whose parents did not work. Lower CHQ Psychosocial Summary score was reported for children who had >1 conditions, disorders or acute health complaints, boys, children of single parents and obese children. Conclusion: The best predictors of health-related quality of life are variables that describe use of health care and the number of disorders and health complaints. Nonetheless, a number of demographic, socio-economic and family/environmental determinants contribute to a child's health-related quality of life as well

Determinants of depression, problem behavior, and cognitive level of adolescents in China: Findings from a national, population-based cross-sectional study

IntroductionWe aimed to assess the associated factors for adolescent depression, problem behavior and cognitive level in China.MethodsA total of 2,584 adolescents aged from 10 to 15 years old in 2018 were included for analyses. Information on a comprehensive set of potential determinants was collected by the questionnaire, including demographic, health-, school- and family-related factors. Differences in average scores of depression, problem behavior, and cognitive level across subgroups were assessed by two independent sample t-tests and one-way analysis of variance (ANOVA). The clinical relevance among subgroups was assessed by the effect size. Multivariate linear regression models were applied to identify the statistically significant determinants.ResultsSchool-related factors and parental depressive status were strongly associated with depression. Low maternal education, poor/bad health of adolescents, high academic pressure, and parental depression were significantly associated with behavior problems. The socioeconomic factors, poor academic performance and father’s depression were significantly associated with adolescent cognitive level.DiscussionMultiple associated factors were identified for depression, problem behavior, and cognition of Chinese adolescents, which will provide insights into developing more targeted public health policies and interventions to improve their mental health

Feasibility and validity of the Health Status Classification System-Preschool (HSCS-PS) in a large community sample: The Generation R study

Objectives To evaluate the feasibility, discriminant validity and concurrent validity of the Health Status Classification System-Preschool (HSCS-PS) in children aged 3 years in a large community sample in the Netherlands. Design/setting A prospective population-based cohort in Rotterdam, the Netherlands. Participants A questionnaire was administrated to a sample of parents of 4546 children (36.7±1.5 months). Outcome measures Health-related quality of life (HRQOL) of children was measured by HSCS-PS. The HSCS-PS consists of 10 original domains. Two single-item measures of General health' and Behavior' were added. A disability score was calculated by summing up all 10 original domains to describe the overall health status. Feasibility was assessed by the response rate, percentages of missing answers, score distributions and the presence of floor/ceiling effects. Discriminant validity was analysed between subgroups with predefined conditions: low birth weight, preterm birth, wheezing, Ear-Nose-Throat surgical procedures and behaviour problems. In the absence of another HRQOL measure, this study uses the single-items General health' and Behavior' as a first step to evaluate concurrent validity of the HSCS-PS. Results Feasibility: response rate was 69%. Ceiling effects were observed in all domains. Discriminant validity: the disability score discriminated clearly between subgroups of children born with a very low birth weight', very preterm birth', with four or more than four times wheezing', at least one ear-nose-throat surgical procedures', behaviour problems present' and the reference' group. Concurrent validity: HSCS-PS domains correlated better with hypothesised parallel additional domains than with other non-hypothesised original domains. Conclusions This study supports the feasibility and validity of the HSCS-PS among preschoolers in community settings. We recommend developing a utility-based scoring algorithm for the HSCS-PS. Further empirical studies and repeated evaluations in varied populations are recommended

Social gradients in ADHD by household income and maternal education exposure during early childhood : findings from birth cohort studies across six countries

Objective: This study aimed to examine social gradients in ADHD during late childhood (age 9–11 years) using absolute and relative relationships with socioeconomic status exposure (household income, maternal education) during early childhood (<5 years) in seven cohorts from six industrialised countries (UK, Australia, Canada, The Netherlands, USA, Sweden). Methods: Secondary analyses were conducted for each birth cohort. Risk ratios, pooled risk estimates, and absolute inequality, measured by the Slope Index of Inequality (SII), were estimated to quantify social gradients in ADHD during late childhood by household income and maternal education measured during early childhood. Estimates were adjusted for child sex, mother age at birth, mother ethnicity, and multiple births. Findings: All cohorts demonstrated social gradients by household income and maternal education in early childhood, except for maternal education in Quebec. Pooled risk estimates, relating to 44,925 children, yielded expected gradients (income: low 1.83(CI 1.38,2.41), middle 1.42(1.13,1.79), high (reference); maternal education: low 2.13(1.39,3.25), middle 1.42(1.13,1.79)). Estimates of absolute inequality using SII showed that the largest differences in ADHD prevalence between the highest and lowest levels of maternal education were observed in Australia (4% lower) and Sweden (3% lower); for household income, the largest differences were observed in Quebec (6% lower) and Canada (all provinces: 5% lower). Conclusion: Findings indicate that children in families with high household income or maternal education are less likely to have ADHD at age 9–11. Absolute inequality, in combination with relative inequality, provides a more complete account of the socioeconomic status and ADHD relationship in different high-income countries. While the study design precludes causal inference, the linear relation between early childhood social circumstances and later ADHD suggests a potential role for policies that promote high levels of education, especially among women, and adequate levels of household income over children’s early years in reducing risk of later ADHD