Els infants i les seves necessitats d'atenció sanitària

Especialistes europeus en salut han dut a terme un estudi entre més de 2.500 infants i adolescents per analitzar la relació que hi ha entre la valoració que fan aquests de la seva salut i la utilització dels serveis sanitaris. Els investigadors consideren que s'han de tenir més en compte les opinions dels nens si es pretén conèixer quines són les seves necessitats d'atenció mèdica.Especialistas europeos en salud han llevado a cabo un estudio entremás de 2.500 niños y adolescentes para analizar la relación que hayentre la valoración que hacen éstos de su salud y el uso de los serviciossanitarios. Los investigadores consideran que se han de tener más encuenta las opiniones de los niños si se pretende conocer cuáles son susnecesidades de atención médica

Els infants i les seves necessitats d'atenció sanitària

Especialistes europeus en salut han dut a terme un estudi entre més de 2.500 infants i adolescents per analitzar la relació que hi ha entre la valoració que fan aquests de la seva salut i la utilització dels serveis sanitaris. Els investigadors consideren que s'han de tenir més en compte les opinions dels nens si es pretén conèixer quines són les seves necessitats d'atenció mèdica.Especialistas europeos en salud han llevado a cabo un estudio entremás de 2.500 niños y adolescentes para analizar la relación que hayentre la valoración que hacen éstos de su salud y el uso de los serviciossanitarios. Los investigadores consideran que se han de tener más encuenta las opiniones de los niños si se pretende conocer cuáles son susnecesidades de atención médica

Understanding the impact of the economic crisis on child health: the case of Spain.

INTRODUCTION: The objectives of the study were to explore the effect of the economic crisis on child health using Spain as a case study, and to document and assess the policies implemented in response to the crisis in this context. METHODS: Serial cross-sectional data from Eurostat, the Spanish Health Interview Survey, and the database of childhood hospitalisation were analysed to explore impacts on child health, and key determinants of child health. A content analysis of National data sources/government legislation, and Spanish literature was used to describe policies implemented following the crisis. RESULTS: Unemployment rates in the general population (8.7% in 2005 and 25.6% in 2013), and children living in unemployed families (5.6% and 13.8%) increased in the study period. The percentage of children living under the poverty line, and income inequalities increased 15-20% from 2005 to 2012. Severe material deprivation rate has worsened in families with Primary Education, while the number of families attending Non-Governmental Organisations has increased. An impact on children's health at the general population level has not currently been detected; however an impact on general health, mental health and use of healthcare services was found in vulnerable groups. Investment in social protection and public policy for children showed a reduction as part of austerity measures taken by the Spanish governments. CONCLUSIONS: Despite the impact on social determinants, a short-term impact on child health has been detected only in specific vulnerable groups. The findings suggest the need to urgently protect vulnerable groups of children from the impact of austerity

Parent–child agreement on health-related quality of life (HRQOL): a longitudinal study

Background: Few studies have evaluated changes on parent–child agreement in HRQOL over time. The objectives of the study were to assess parent–child agreement on child’s HRQOL in a 3-year longitudinal study, and to identify factors associated with possible disagreement. Methods: A sample of Spanish children/adolescents aged 8–18 years and their parents both completed the KIDSCREEN-27 questionnaire. Data on age, gender, family socioeconomic status (SES), and mental health (Strengths and Difficulties Questionnaire, SDQ) was also collected at baseline (2003), and again after 3 years (2006). Changes in family composition were collected at follow-up. Agreement was assessed through intraclass correlation coefficient (ICC), and Bland and Altman plots. Generalizing Estimating Equation (GEE) models were built to analyze factors associated with parent–child disagreement. Results: A total of 418 parent–child pairs were analyzed. At baseline the level of agreement on HRQOL was low to moderate and it was related to the level of HRQOL reported. Physical well-being at baseline showed the highest level of parent–child agreement (ICC=0.59; 0.53-0.65) while less “observable” dimensions presented lower levels of agreement, (i.e. Psychological well-being: ICC= 0.46; 0.38-0.53). Agreement parent–child was lower at follow-up. Some interactions were found between rater and child’s age; with increasing age, child scored lower than parents on Parents relationships and Autonomy (Beta [B] -0.47; -0.71 / -0.23) and the KIDSCREEN-10 (−0.49; -0.73 /-0.25). Conclusions: Parent–child agreement on child’s HRQOL is moderate to low and tends to diminish with children age. Measuring HRQOL of children/adolescents mainly in healthy population samples might require direct self-assessments.This study represents the Minor Thesis of Amanda Rodríguez López to achieve the Master in Public Health degree at Pompeu Fabra University (Barcelona, Spain)

Self-reported social class in adolescents: validity and relationship with gradients in self-reported health

Background: Analyzing social differences in the health of adolescents is a challenge. The accuracy of adolescent's report on familial socio-economic position is unknown. The aims of the study were to examine the validity of measuring occupational social class and family level of education reported by adolescents aged 12 to 18, and the relationship between social position and self-reported health./nMethods: A sample of 1453 Spanish adolescents 12 to 18 years old from urban and rural areas completed a self-administered questionnaire including the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), and data on parental occupational social class (OSC) and level of education (LE). The responsible person for a sub-sample of teenagers (n = 91) were interviewed by phone. Kappa coefficients were estimated to analyze agreement between adolescents and proxy-respondents, and logistic regression models were adjusted to analyze factors associated with missing answers and disagreements. Effect size (ES) was calculated to analyze the relationship between OSC, LE and the CHIP-AE domain scores./nResults: Missing answers were higher for father's (24.2%) and mother's (45.7%) occupational status than for parental education (8.4%, and 8.1% respectively), and belonging to a non-standard family was associated with more incomplete reporting of social position (OR = 4,98; 95%CI = 1,3–18,8) as was agreement between a parent and the adolescent. There were significant social class gradients, most notably for aspects of health related to resilience to threats to illness./nConclusion/n/nAdolescents can acceptably self-report on family occupation and level of education. Social class gradients are present in important aspects of health in adolescents

Self-reported social class in adolescents: validity and relationship with gradients in self-reported health

Background: Analyzing social differences in the health of adolescents is a challenge. The accuracy of adolescent's report on familial socio-economic position is unknown. The aims of the study were to examine the validity of measuring occupational social class and family level of education reported by adolescents aged 12 to 18, and the relationship between social position and self-reported health./nMethods: A sample of 1453 Spanish adolescents 12 to 18 years old from urban and rural areas completed a self-administered questionnaire including the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), and data on parental occupational social class (OSC) and level of education (LE). The responsible person for a sub-sample of teenagers (n = 91) were interviewed by phone. Kappa coefficients were estimated to analyze agreement between adolescents and proxy-respondents, and logistic regression models were adjusted to analyze factors associated with missing answers and disagreements. Effect size (ES) was calculated to analyze the relationship between OSC, LE and the CHIP-AE domain scores./nResults: Missing answers were higher for father's (24.2%) and mother's (45.7%) occupational status than for parental education (8.4%, and 8.1% respectively), and belonging to a non-standard family was associated with more incomplete reporting of social position (OR = 4,98; 95%CI = 1,3–18,8) as was agreement between a parent and the adolescent. There were significant social class gradients, most notably for aspects of health related to resilience to threats to illness./nConclusion/n/nAdolescents can acceptably self-report on family occupation and level of education. Social class gradients are present in important aspects of health in adolescents

Development of the web-based Spanish and Catalan versions of the Euroqol 5D-Y (EQ-5D-Y) and comparison of results with the paper version.

BACKGROUND: The objectives of the study were to develop web-based Spanish and Catalan versions of the EQ-5D-Y, and to compare scores and psychometric properties with the paper version. METHODS: Web-based and paper versions of EQ-5D-Y were included in a cross-sectional study in Palafolls (Barcelona), Spain and administered to students (n = 923) aged 8 to 18 years from 2 primary and 1 secondary school and their parents. All students completed both the web-based and paper versions during school time with an interval of at least 2 h between administrations. The order of administration was randomized. Participants completed EQ-5D-Y, a measure of mental health status (the Strengths and Difficulties Questionnaire), and sociodemographic variables using a self-administered questionnaire. Parents questionnaire included parental level of education and presence of chronic conditions in children. Missing values, and floor and ceiling effects were compared between versions. Mean score differences were computed for the visual analogue scale (VAS). Percentage of agreement, kappa index (k) and intraclass correlation coefficient (ICC) were computed to analyze the level of agreement between web-based and paper versions on EQ-5D-Y dimensions and VAS. Known groups validity was analyzed and compared between the two formats. RESULTS: Participation rate was 77 % (n = 715). Both formats of EQ-5D-Y showed low percentages of missing values (n = 2, and 4 to 9 for web and paper versions respectively), and a high ceiling effect by dimension (range from 79 % to 96 %). Percent agreement for EQ-5D-Y dimensions on the web and paper versions was acceptable (range 89 % to 97 %), and k ranged from 0.55 (0.48-0.61, usual activities dimension) to 0.75 (0.68-0.82, mobility dimension). Mean score difference on the VAS was 0.07, and the ICC for VAS scores on the two formats was 0.84 (0.82-0.86). Both formats showed acceptable ability to discriminate according to self-perceived health, reporting chronic conditions, and mental health status. CONCLUSIONS: The digital EQ-5D-Y showed almost identical VAS scores and acceptable levels of agreement on dimensions. Both formats demonstrated acceptable levels of construct validity. Availability of the Spanish and Catalan web-version will facilitate its use in HRQOL assessment and in economic evaluation.The study was financed by the Spanish Ministry of Health, contract N° PI12/01296

Impact of monitoring health-related quality of life in clinical practice in children with type 1 diabetes mellitus

PURPOSE: To test whether the systematic monitoring of health-related quality of life (HRQOL) in clinical practice in Spanish pediatric patients with T1DM helps improve their daily life in a multicenter longitudinal study. METHODS: One hundred thirty-six patients participated, recruited from five centers in Barcelona, Spain (72 girls, mean age 13.4 years). Complete data were collected for 119 patients (85%). Pediatricians were randomly assigned to the HRQOL intervention (n = 70), or control group (n = 49). The intervention group discussed the results of HRQOL face to face with the physician, quarterly over a year. The control group received care as usual. HRQOL was assessed using KIDSCREEN-27 collected online. Standardized mean differences (effect size, ES) and generalized estimating equation (GEE) were computed to compare group differences between baseline and follow-up, taking into account sociodemographic and clinical variables. RESULTS: Statistically significant higher scores were seen in the intervention group at follow-up for the dimensions of Psychological well-being (ES = 0.56), School environment (ES = 0.56), and the KIDSCREEN-10 index (ES = 0.63). No differences were found in the control group. GEE analysis showed an improvement in HRQOL at follow-up with statistically significant association of the intervention on Psychological well-being (B = 4.32; p 0.03 for the interaction of group by follow-up) and School environment (B = 4.64; p 0.02 for the same interaction term). CONCLUSIONS: Routine assessment and face-to-face patient-physician discussion of HRQOL results improved HRQOL scores after a year of follow-up, especially in Psychological well-being and school environment. The results support the routinary use of HRQOL assessment in clinical practice

Reliability and validity of the Spanish version of the Child Health and Illness Profile (CHIP) Child-Edition, Parent Report Form (CHIP-CE/PRF)

Background: The objectives of the study were to assess the reliability, and the content, construct, and convergent validity of the Spanish version of the CHIP-CE/PRF, to analyze parent-child agreement, and compare the results with those of the original U.S. version. Methods: Parents from a representative sample of children aged 6-12 years were selected from 9 primary schools in Barcelona. Test-retest reliability was assessed in a convenience subsample of parents from 2 schools. Parents completed the Spanish version of the CHIP-CE/PRF. The Achenbach Child Behavioural Checklist (CBCL) was administered to a convenience subsample. Results: The overall response rate was 67% (n = 871). There was no floor effect. A ceiling effect was found in 4 subdomains. Reliability was acceptable at the domain level (internal consistency = 0.68-0.86; test-retest intraclass correlation coefficients = 0.69-0.85). Younger girls had better scores on Satisfaction and Achievement than older girls. Comfort domain score was lower (worse) in children with a probable mental health problem, with high effect size (ES = 1.45). The level of parent-child agreement was low (0.22-0.37). Conclusions: The results of this study suggest that the parent version of the Spanish CHIP-CE has acceptable psychometric properties although further research is needed to check reliability at sub-domain level. The CHIP-CE parent report form provides a comprehensive, psychometrically sound measure of health for Spanish children 6 to 12 years old. It can be a complementary perspective to the self-reported measure or an alternative when the child is unable to complete the questionnaire. In general, the results are similar to the original U.S. version.This research was partially financed by grants from the Fondo de Investigación Sanitaria of the Spanish Ministry of Health (contract No 01/0420) and the CIBER en Epidemiología y Salud Pública CIBERES

Validation of 'POIBA-How do we eat?' questionnaire in 9-10 years old schoolchildren

La salud de las personas ha mejorado a lo largo del siglo XX, al mismo tiempo que se consolidaba el Estado del bienestar. Este trabajo explora la relación actual del Estado del bienestar y la salud pública. Las funciones esenciales de la salud pública se ejercen como parte del Estado, y su principal reto en la actualidad es conseguir que la salud sea protegida y promocionada en las diferentes políticas públicas, entre otras las de empleo. Los resultados de los estudios que valoran el efecto sobre la salud de los distintos tipos de Estado del bienestar son contradictorios, pero cuando se valora el impacto de políticas concretas, como por ejemplo el subsidio de desempleo, los resultados son positivos y consistentes. Sin embargo, la actual crisis del Estado del bienestar dificulta su continuidad, en gran medida por los cambios en el mercado de trabajo, con empleos más flexibles e inseguros