[Does talking about it make a difference? Opinions of chronically ill young adults after being transferred to adult care]. / Est-ce qu'en discuter fait la différence ? Opinions de jeunes adultes atteints de maladies chroniques après avoir été transférés vers des soins pour adultes.

INTRODUCTION: The goal of transition in healthcare for young people with chronic illnesses is to maximize their functioning and potential. The purpose of this pilot study was to assess whether young adults with chronic illnesses found that the transition to adult care was easier when the transition was discussed in advance with their pediatric specialist. METHODS: Two groups were created according to whether patients had discussed (n=70) or not (n=22) the transition with their pediatric specialist and compared regarding demographic and health-related variables. All the significant variables at the bivariate level were included in a backward stepwise logistic regression. RESULTS: Youth who had discussed the transition were significantly more likely to feel ready for the transfer (72.9% vs 45.5%) and accompanied (58.6% vs 27. %) during transfer, to have consulted their specialist for adults (60.0% vs 31.8%), and seen their doctor without the presence of their parents (70.0% vs 40.9%). At the multivariate level, only feeling accompanied during transfer (adjusted odds ratio (aOR): 3.56) and having consulted their specialist for adults (aOR: 4.14) remained significant. CONCLUSIONS: Preparing chronically ill youths for transfer to adult care appears to be beneficial for them. However, transfer is only a small part of the much broader transition that is preparation for adult life. A well-planned transition should allow these young people to reach their full potential.

Health-related quality of life in Swiss adolescents with asthma. Validation of the AAQOL-D and comparison with Australian adolescents.

PRINCIPLES: The Adolescent Asthma Quality of Life Questionnaire (AAQOL) is the only asthma-specific quality-of-life questionnaire to date for use specifically in adolescents. The aim of this study was translation of the AAQOL into German, revalidation of the German version (AAQOL-D) and comparison of health-related quality of life (HRQOL) in Swiss and Australian adolescents. METHODS: 60 adolescents with frequent episodic or persistent asthma aged 12-17 years were recruited. The standardised method consisted of (1) translation of the AAQOL; (2) additional item selection via semistructured interviews (n = 11); (3) item reduction and re-validation (n = 56). For item reduction the clinical impact method was applied. RESULTS: The same 32 items were identified as relevant for the AAQOL-D as in the original version (AAQOL). Internal consistency for the 6 dimensions and the total score was high (alpha = 0.76-0.87). Despite consideration of psychosocial aspects relevant to adolescents, high correlation with the Pediatric Asthma Quality of Life Questionnaire was confirmed for the AAQOL-D (rho = 0.85; p <0.0001). Correlation with a health status thermometer consisted in rho = 0.74 (p <0.0001). There was moderate correlation with clinical parameters of asthma severity (rho = 0.51-0.73; p < or = 0.0002), not however with frequency of medication (rho = 0.22; p = 0.13). Comparison of Swiss and Australian adolescents showed that Swiss adolescents were more bothered by cigarette smoke and the need to avoid places where cigarettes were smoked. CONCLUSIONS: The AAQOL-D is a valid multidimensional instrument in German for assessing HRQOL of adolescents with asthma. HRQOL of Swiss adolescents with asthma may be enhanced by implementing non-smoking policies promoting smoke-free environments.

Consultations with adolescents: the gap between their expectations and their experiences.

AIM: To study the expectations and experiences of adolescents when in consultation with doctors, particularly with regard to issues of confidentiality. METHODS: In a cross-sectional study, 613 seventh- and ninth-grade students (347 students aged 13 y and 266 students aged 15 y) completed a 40-item questionnaire specifically developed for this study. Students anonymously completed the self-administered questionnaire at school. RESULTS: Of these adolescents, 89% aged 13 y and 57% aged 15 y were accompanied by one of their parents to appointments with private practitioners. Of the respondents, 33%/52% (13-y-olds/15-y-olds) said that seeing the doctor alone for some time was important but only 18%/20% were given the opportunity to do so. Although 79%/90% of respondents stated that it was important for the doctor to keep information confidential, on request, only 37%/40% of private practitioners had spoken about confidentiality; 64%/78% of adolescents said that doctors should give assurance of confidentiality even with regard to their parents. However, only 26%/27% of private practitioners explicitly assured confidentiality with regard to parents. Acceptance of conditional confidentiality was high in all subpopulations. Short waiting times and the opportunity to talk about topics such as nutrition, drugs and sexuality were rated as important. CONCLUSION: Physicians should adapt their consultation style to the needs of adolescents by seeing the adolescent patient alone for some time and by assuring them of conditional confidentiality. Furthermore, they should provide opportunities to talk specifically about issues of potential concern to adolescents such as nutrition, drugs and sexuality. To accomplish these tasks, educational curricula in adolescent healthcare are required for physicians.

Development and validation of the Adolescent Asthma Quality of Life Questionnaire (AAQOL).

Current asthma-specific quality of life questionnaires have major conceptual and methodological deficiencies for use in adolescents. The aim of this study was to develop and validate the "Adolescent Asthma Quality of Life Questionnaire (AAQOL)", specifically developed for adolescents with asthma. One-hundred and eleven adolescents with frequent-episodic or persistent asthma aged 12-17 yrs were recruited from three tertiary paediatric asthma clinics. The standardized multi-step method consisted of: 1) item selection including semistructured interviews (n=14); 2) item reduction and validation (n=66); and 3) assessment of reproducibility (n=31). Item reduction was performed applying the clinical impact method. The 32 item AAQOL covers six domains: symptoms, medication, physical activities, emotion, social interaction and positive effects. There was high internal consistency for the six domains (alpha=0.70-0.90) and for the total score (alpha=0.93). Test-retest reliability was high for all domain scores (r=0.76-0.85) and the total score (r=0.90), indicating high reproducibility of the AAQOL. There was high correlation with the paediatric Asthma Quality of Life Questionnaire (rho=0.81) which focuses primarily on symptoms and emotional well-being. There was weak to moderate correlation with clinical parameters of asthma severity (rho=0.25-0.65). The 32-item Adolescent Asthma Quality of Life Questionnaire is a valid, developmentally age-appropriate and dimensionally comprehensive asthma-specific quality of life measure for use in adolescents.

Quality-of-life assessment in children and adolescents with asthma.

Health-related quality of life has become an essential part of health outcome measurement in chronic disorders. However, it is only recently that health professionals have focused on quality-of-life assessment in children and adolescents. Several generic, as well as the asthma-specific quality-of-life instruments specifically designed for use in children and adolescents are reviewed in this article with particular regard to the conceptual and methodological features of the measures and their applicability in clinical studies. The recently published Child Health Questionnaire is a useful generic instrument to comprehensively assess quality of life, in particular when comparing young people with different chronic disorders. The Pediatric Asthma Quality-of-life Questionnaire has shown responsiveness to change over time, but it lacks age-specificity with regard to psychosocial issues and comprehensiveness of quality-of-life assessment. In contrast, the Childhood Asthma Questionnaire provides three different versions for different target ages. However, its generic part is not reflective of the respondent's health status. The other asthma-specific instruments have major conceptual deficiencies when used as a single measure for quality-of-life assessment. In the absence of a single ideal instrument, the use of batteries of quality-of-life instruments is therefore recommended and further research is required to identify the impact that age and developmental status have on quality-of-life assessment.

Smoking prevention and cessation in adolescents.

Tobacco smoking is the most important preventable health risk factor in Australia. It has lost popularity and acceptability in Australia as a result of public health campaigns and their reinforcement through government legislation. The rate of smoking in Australia has gradually declined due to increased cessation in adults. Adolescents, however, are smoking as much as ever. The aim of this paper is to provide family practitioners with practical, simple clinical strategies to reduce teenage smoking.

[The pilot project "Soteria Bern" in treatment of acute schizophrenic patients. II. Results of a comparative prospective follow-up study over 2 years]. / Das Pilotprojekt "Soteria Bern" zur Behandlung akut Schizophrener. II. Ergebnisse einer vergleichenden prospektiven Verlaufsstudie über 2 Jahre.

Following on a previous publication [15], outcomes of 22 acute schizophrenic index patients treated mainly with no- or low-medication strategies and with milieu therapeutic, socio-therapeutic and psychotherapeutic methods in the open therapeutic community "Soteria Berne" are compared, in a 2-year prospective study, with pairwise matched controls from 4 different traditional settings. There were no significant differences concerning psychopathology, living situation, work situation, combined evaluation and relapse rate after 2 years. Total dosage of medication was less than half, but total costs about 1/3 higher in the index group. Differences of costs were directly related to the inclusion of the-often prolonged-phase of rehabilitation in the in-patient treatment in "Soteria", and disappear when this phase is shifted to other settings. These results and additional observations concerning subjective aspects speak in favour of the creation of other treatment facilities of the same type.

Evaluation of visual fields by ophthalmologists and by OCTOSMART program.

The introduction of Goldmann perimetry standardized measuring conditions as much as possible. In spite of this, it had been possible for the perimetrist to influence the results of perimeter measurements. The introduction of computer-controlled perimetry, however, has largely eliminated the influence of the investigator on perimetry results. Nevertheless, the interpretation of a perimetric result in the everyday clinical situation is still extensively subjectively coloured and is liable to vary, depending on the doctor carrying it out. The OCTOPUS Program G1 was introduced a few years ago and used above all for glaucoma. This program greatly simplified visual field assessment thanks to its visual field indices. The indices make it possible to compare visual field results with those of a normal population. The present introduction of the OCTOSMART program represents a further step forward. This program analyses measured visual fields with the aid of standardized, statistical criteria based on a large, normal value study. This analysis standardizes and thereby simplifies the interpretation of visual field results. This study compares the outcome of the OCTOSMART program with visual field interpretations by eye doctors.

The distribution of normal values in automated perimetry.

From 354 visual fields of 137 normal subjects, various components of variance were calculated separately for each test location of the Octopus automated-perimetry program J0. The method of component analysis of variance was used. The following components were analyzed: interindividual variation (variation of visual-field measurements in different subjects), long-term fluctuation (variation of different visual-field measurements in the same subject), differences between the right and left eyes and fluctuation within one visual field test in one subject, i.e., short-term fluctuation. The results show increased variations at the center relative to the paracentral area and a slight increase with eccentricity.

Retests in static perimetry.

A large pool of visual field data measured with the JO program on the Octopus automated perimeter was used to compare the outcomes of simulated selective retests to those of global retests. Compared to global retesting, with selective retesting an increase in the mean sensitivity and a decrease in the number of pathological test locations were found on the average. We conclude that global retests should be preferred to selective ones so that the perimetric results are not falsified.