Health related quality of life of immigrant children: towards a new pattern in Germany?

Background: To study Health related quality of life (HRQoL) of a sample of kindergarten children with migration background. Methods: Five kindergartens in Frankfurt/Main and Darmstadt (Germany) participated. HRQoL was measured with the Kiddy-KINDL (KK) in 3 to 5 year old children. We examined the associations of HRQoL with socio-demographic variables, positive development and resilience, socio-emotional and motor development. Linear regression models were applied to examine differences in HRQoL between migrant and native-born German children. Results: The response rate was 90.5% (N = 283). The children had predominantly migrant background (81.35%). Perceived health was slightly higher in migrants (69.85, SD 17.00) compared to native-born German children (68.33, SD 17.31, p > 0.05), even though migrant children were characterized by a lower socio-economic status (p < 0.01). Conclusions: Results suggest that HRQoL at early ages in our study exhibits a different pattern than reported previously in studies among older individuals. We attribute the discrepancy partly to a possible changing pattern of migration in Europe with more migrants capable to migrate with healthy profiles, and to the age of our population. Our findings underscore the need to study the life course trajectory of HRQoL among young immigrants and replication in representative samples

Pediatric Health-Related Quality of Life:A Structural Equation Modeling Approach

Objectives: One of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children.Methods: The contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3-5 years old) participating in a follow-up study that investigates pediatric health outcomes.Results: Model fit was chi(2) = 5.5; df = 6; p = 0.48; SRMR = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model.Conclusions: The goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.</p

A European perspective on auditory processing disorder-current knowledge and future research focus

Current notions of \u201chearing impairment,\u201d as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as \u201cAuditory Processing Disorder\u201d (APD) or \u201cCentral Auditory Processing Disorder\u201d is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimumdiagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus

Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk : a prospective population study

Objective: To investigate whether regulatory problems, i.e., crying and feeding problems in infants > 3 months of age, predict cognitive outcome in preschool children born at risk even when controlled for confounding factors. Methods: A prospective longitudinal study of children born in a geographically defined area in Germany. N = 4427 children of 6705 eligible survivors (66%) participated at all four assessment points (neonatal, 5, 20, and 56 months of age). Excessive crying and feeding problems were measured at 5 months. Mental development was assessed with the Griffiths Scale at 20 months, and cognitive assessments were conducted at 56 months. Neonatal complications, neurological, and psychosocial factors were controlled as confounders in structural equation modeling and analyses of variance. Results: One in five infants suffered from single crying or feeding problems, and 2% had multiple regulatory problems, i.e., combined crying and feeding problems at 5 months. In girls, regulatory problems were directly predictive of lower cognition at 56 months, even when controlled for confounders, whereas in boys, the influence on cognition at 56 months was mediated by low mental development at 20 months. Both in boys and girls, shortened gestational age, neonatal neurological complications, and poor parent-infant relationship were predictive of regulatory problems at 5 months and lower cognition at 56 months. Conclusion: Regulatory problems in infancy have a small but significant adverse effect on cognitive development

A European Perspective on Auditory Processing Disorder-Current Knowledge and Future Research Focus

Current notions of “hearing impairment,” as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as “Auditory Processing Disorder” (APD) or “Central Auditory Processing Disorder” is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus

Comparing the clinical effectiveness of different new-born hearing screening strategies. A decision analysis

BACKGROUND: Children with congenital hearing impairment benefit from early detection and treatment. At present, no model exists which explicitly quantifies the effectiveness of universal newborn hearing screening (UNHS) versus other programme alternatives in terms of early diagnosis. It has yet to be considered whether early diagnosis (within the first few months) of hearing impairment is of importance with regard to the further development of the child compared with effects resulting from a later diagnosis. The objective was to systematically compare two screening strategies for the early detection of new-born hearing disorders, UNHS and risk factor screening, with no systematic screening regarding their influence on early diagnosis. METHODS: Design: Clinical effectiveness analysis using a Markov Model. Data Sources: Systematic literature review, empirical data survey, and expert opinion. Target Population: All newborn babies. Time scale: 6, 12 and 120 months. Perspective: Health care system. Compared Strategies: UNHS, Risk factor screening (RS), no systematic screening (NS). Outcome Measures: Quality weighted detected child months (QCM). RESULTS: UNHS detected 644 QCM up until the age of 6 months (72,2%). RS detected 393 child months (44,1%) and no systematic screening 152 child months (17,0%). UNHS detected 74,3% and 86,7% weighted child months at 12 and 120 months, RS 48,4% and 73,3%, NS 23,7% and 60,6%. At the age of 6 months UNHS identified approximately 75% of all children born with hearing impairment, RS 50% and NS 25%. At the time of screening UNHS marked 10% of screened healthy children for further testing (false positives), RS 2%. UNHS demonstrated higher effectiveness even under a wide range of relevant parameters. The model was insensitive to test parameters within the assumed range but results varied along the prevalence of hearing impairment. CONCLUSION: We have shown that UNHS is able to detect hearing impairment at an earlier age and more accurately than selective RS. Further research should be carried out to establish the effects of hearing loss on the quality of life of an individual, its influence on school performance and career achievement and the differences made by early fitting of a hearing aid on these factors

Expressive Vocabulary: a Comparison of two Psychological Tests for Kindergarden Children

Eine Zufallsstichprobe von 55 normalen Kindergartenkindern im Alter von 3;4 bis 4;11 Jahren wurde mit zwei aktiven Wortschatztests im Einzelverfahren untersucht. Ziel war, die Übereinstimmung zwischen dem neuen Subtest „Wortschatz" aus der K-ABC (1991) und dem älteren AWST 3-6 (1979) zu prüfen. Die Zahl der richtigen Benennungen pro Test wurde jeweils gemäß Testmanual in einen Normwert transformiert. Die Korrelation zwischen beiden Testverfahren beträgt r=0.69 (p = 0.0001). Der Mittelwert der Differenzen beider Testergebnisse pro Kind liegt zwar nur bei 0,1, doch muss in Einzelfällen mit erheblichen Ergebnisdifferenzen zwischen beiden Tests gerechnet werden. Bei einer Standardabweichung von s = 7,8 streuen die Differenzen in einer relativ breiten Spanne von - 15,5 bis + 15,7, wenn man den Bereich von +/- zwei Standardabweichungen zugrunde legt. Hieraus folgt, dass der K-ABC-Subtest „Wortschatz" in der Eingangsdiagnostik aus zeitökonomischen Gründen gegebenenfalls vorzuziehen ist; allerdings sollte bei grenzwertigem Ergebnis der detailliertere AWST 3-6 nachgetragen werden. (DIPF/ Orig.)Fifty-five subjects were drawn from a population of average kindergarden children. Their ages ranged between 3;4 and 4;11 years. Two vocabulary tests were administered individually in a quiet room to each subject. A new instrument for testing the active vocabulary (Subtest "vocabulary" of the K-ABC, 1991) was compared with an established one (AWST 3-6, 1979) to see whether they agree sufficiently for the new to replace the old. Raw scores were computed according to the test instructions for each correct response and transformed into normscores. These were compared, and both tests correlated with r = 0.69 (p = 0.0001). So, the K-ABC-Subtest "vocabulary" may be administered in the first diagnostic setting. The mean of the differences of both vocabulary tests is 0,1; yet, in some cases large differences between the results of both vocabulary tests are to be expected, because the differences vary in the broad range from - 15,5 to + 15,7 (= +/- 2 SD). Therefore the more detailed AWST 3-6 should be used to assess the amount of active vocabulary in children with a low norm score in the KABC-Subtest "vocabulary". (DIPF/ Orig.

Rezeptive und produktive Sprachentwicklungsleistungen frühgeborener Kinder im Alter von 2 Jahren

Ziel war die normbezogene Bestimmung rezeptiver und expressiver Sprachverarbeitungsfähigkeiten frühgeborener Kinder im Alter von 2 Jahren.Stichprobe: 39/66 hörgesunde Frühgeborene (Geburtsjahrgang 1999), die postnatal im Rahmen eines neonatologischen Konsils zur Hördiagnostik a. d. Abt. Phoniatrie/Pädaudiologie überwiesen u. als normalhörig befundet worden waren (Geburtsgewicht: 390 - 2590 g; Gestationsalter: zw. 26 u. 36 Wochen). Methode: Erhebung soziodemografischer Daten, Entwicklungsanamnese, Elternschätzurteil des Umfangs des produktiven Lexikons, Sprachentwicklungstest für 2-jährige Kinder (SETK-2, ). Ergebnisse: Durchschnittl. Sprechbeginn (erste Worte) mit 14.9 (SD 3.8), Zwei-Wort-Satz mit 21.2 (SD 4.3) Monaten. Die mittl. Sprachtestleistungen lagen in der Norm mit Ausnahme der Satzproduktion (T-W: 39.9 (SD 9.8). Wortverstehen war im Durchschnitt am besten ausgebildet: T-W: 52.7 (SD 12.7); Satzverstehen: T-W: 48.1 (SD 12.4); Wortproduktion: T-W: 43.6 (SD 12.9). Biologische Parameter der Frühgeburt wie Geburtsgewicht oder Gestationsalter korrelierten nicht signifikant mit den Testergebnissen. Extremgruppen- und Split-Half-Vergleiche nach Geburtsgewicht bzw. Gestationsalter zeigten ebenfalls keine signifikanten Leistungsunterschiede im SETK-2, hingegen bzgl. des Zeitpunkts des freien Laufens und des Zwei-Wort-Satzbeginns. Fazit: Variationen im Ausmaß der Frühgeburtlichkeit gehen nicht zwangsläufig mit defizitären Leistungen in der Sprachentwicklung einher

Why can't you cry baby? - Klinisch-psychologische Bausteine in der Betrachtung funktioneller Dysphonien

Trennscharfe Zuordnungen von Stimmfunktionsstörungen zu einer diagnostischen Kategorie aus dem aktuellen klinischen Bild sind nicht selten schwierig. Daher sollte die Herausarbeitung psychosozialer Ursachen und der Lebensgeschichte eines Patienten im Kontext jeder Stimmstörung zumindest durch eine klinisch-psychologische u./o. psychosomatische Untersuchung ergänzt werden - selbst bei organischen Dysphonien kann es sich um sekundär organische Veränderungen aufgrund bestimmter individueller psychischer Belastungssituationen und der Unfähigkeit, diese adäquat zu verarbeiten, handeln. Häufig löst der Patienten einen emotionalen Konflikt vordergründig mit der Beeinträchtigung seiner Stimmfunktion in der sozial-kommunikativen Funktion des Sprechens (funktionelle Dysphonie).Derzeit besteht ein theoretischer und methodischer Pluralismus zur Bestimmung dessen, was funktionelle Dysphonien sind, dem durch eine multiple Ätiopathogenese (z.B. anlagebedingte organische Schwächen, die die Schwelle zur Organwahl senken; habituell stimmschädigende Sprechgewohnheiten; ponogene Faktoren; bestimmte Persönlichkeitsmerkmale; unbefriedigende Lebensumstände wie akute Konflikte am Arbeitsplatz; lebensbelastende Ereignisse wie Partnerverlust etc.) Vorschub geleistet und in der klinisch-diagnostischen Praxis häufig pragmatisch nachgegangen wird. Die sinnvolle Interpretation einer funktionellen Dysphonie ist aber ohne eine verbindliche, möglichst standardisierte Diagnostik nicht möglich. Hierzu zählen auch die klinisch-psychologische, psychosomatische, ggf. psychiatrische Diagnostik, da es eine Vielzahl von klinisch relevanten Dimensionen und Hypothesen abzuklären gilt, die sich in ihrer Operationalisierung und Zusammenstellung unterscheiden. Kiese-Himmel & Kruse haben bereits 1996 eine "Systematisierung der klinischen Differentialdiagnostik vorrangig funktioneller Stimmstörungen" gefordert. Im Vortrag wird ein diagnostischer Pfad vorgestellt, der eine Brücke zu einer methodisch geschlossenen theoretischen Konzeption zu bilden vermag