Brief report: The KIDSCREEN follow-up study on Health-related Quality of Life (HRQoL) in Spanish children and adolescents. Pilot test and representativeness.

The Spanish KIDSCREEN follow-up study reassessed the Spanish baseline sample (n=840) of the European KIDSCREEN study 3 years later (2006). The aims of this paper were to describe the KIDSCREEN follow-up study and the pilot test, and to analyze participation rates and representativeness. Instruments included the KIDSCREEN-52 HRQoL measure and a set of scales including the possible explanatory variables. Focus groups and individual interviews were carried out in a pilot test. Participants were compared with non-participants at baseline, and also with Eurostat census data. Twenty-two out of 24 subjects were interviewed in the pilot test. Fifteen items needed to be modified after the pilot test. Participation rate reached 54% (n=454). Participants (mean age=12.71 years old) were on average 6 months younger than non-participants (p=0.03), and from more educated families. KIDSCREEN follow-up instrumentation seems adequate for collecting factors with potential influence on HRQoL. Follow-up respondents' representativeness seems to be acceptable.

A comparison of Rasch item-fit and Cronbach's alpha item reduction analysis for the development of a Quality of Life scale for children and adolescents.

OBJECTIVE: This study compares item reduction analysis based on classical test theory (maximizing Cronbach's alpha - approach A), with analysis based on the Rasch Partial Credit Model item-fit (approach B), as applied to children and adolescents' health-related quality of life (HRQoL) items. The reliability and structural, cross-cultural and known-group validity of the measures were examined. METHODS: Within the European KIDSCREEN project, 3019 children and adolescents (8-18 years) from seven European countries answered 19 HRQoL items of the Physical Well-being dimension of a preliminary KIDSCREEN instrument. The Cronbach's alpha and corrected item total correlation (approach A) were compared with infit mean squares and the Q-index item-fit derived according to a partial credit model (approach B). Cross-cultural differential item functioning (DIF ordinal logistic regression approach), structural validity (confirmatory factor analysis and residual correlation) and relative validity (RV) for socio-demographic and health-related factors were calculated for approaches (A) and (B). RESULTS: Approach (A) led to the retention of 13 items, compared with 11 items with approach (B). The item overlap was 69% for (A) and 78% for (B). The correlation coefficient of the summated ratings was 0.93. The Cronbach's alpha was similar for both versions [0.86 (A); 0.85 (B)]. Both approaches selected some items that are not strictly unidimensional and items displaying DIF. RV ratios favoured (A) with regard to socio-demographic aspects. Approach (B) was superior in RV with regard to health-related aspects. CONCLUSION: Both types of item reduction analysis should be accompanied by additional analyses. Neither of the two approaches was universally superior with regard to cultural, structural and known-group validity. However, the results support the usability of the Rasch method for developing new HRQoL measures for children and adolescents.

[Parent-child agreement in the health related quality of life (HRQOL) of children with attention-deficit/hyperactivity disorder (ADHD): a longitudinal study]. / Concordancia entre padres e hijos en la calidad de vida relacionada con la salud en niños con trastorno por déficit de atención con hiperactividad: estudio longitudinal.

OBJECTIVES: To assess parent-child agreement on changes over a short-term period of time in the HRQOL of children treated for ADHD over a short period of time, and to compare child and parent ratings of children with ADHD with general population norms. METHODS: Prospective study in children 6-12 years old with ADHD. Children and parents completed the Spanish versions of the Child Health and Illness Profile-Child Edition (CHIP-CE) before and after 8 weeks of treatment. CHIP-PE scores at both visits were compared using paired t tests and effect sizes (ES), intra-class correlation coefficients (ICC), and scatter plots. Child and parent ratings were compared with CHIP-CE scores for a general population sample. RESULTS: Thirty-one children and parents were included in the analysis. The highest change between the first and the follow-up visit was on the Risk Avoidance domain both children and parents (effect size [ES]=0.24 and 0.40, respectively). The ICC ranged from 0.44 (Satisfaction) to 0.01 (Risk avoidance). Child self-ratings were close to general population values. All domains of the parent version presented standardized means below the reference values at the baseline visit and closer to the general population norm after treatment. CONCLUSIONS: This study found poor parent-child agreement and suggests that both ratings should be collected in future studies on the impact of ADHD and treatment effectiveness.

[Spanish version of the TNO-AZL preschool children quality of life questionnaire (TAPQOL)]. / Versión española del TAPQOL: calidad de vida relacionada con la salud en niños de 3 meses a 5 años.

OBJECTIVES: To obtain a Spanish version of the TNO-AZL Preschool Children Quality of Life Questionnaire (TAPQOL) that would be both semantically and culturally equivalent to the original. MATERIAL AND METHODS: The TAPQOL questionnaire was designed to measure health-related quality of life in children aged 3 months to 5 years and contains 43 questions distributed in 12 subdimensions. The Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. Cognitive debriefing interviews were carried out with the parents of healthy children and with those of children with respiratory disease. RESULTS: During the adaptation phase, four items were modified after input from the authors of the original version to retain the meaning of the original. At the end of the adaptation process, 37 of the 43 items were classified as A, i.e. without difficulty in the adaptation. Four mothers and two fathers participated in the cognitive debriefing interviews. Four had secondary level education, and two had university level education. Their children were aged between 16 and 60 months. The average time taken to complete the questionnaire was 13.5 minutes. No comprehension problems regarding the questionnaire's content were found, and no items were modified after this phase of the study. The mothers of children with respiratory disease considered the questions related to their children's symptoms to be appropriate. CONCLUSIONS: The Spanish version of the TAPQOL has proven to be acceptable and culturally equivalent to the original version. Future studies should investigate the psychometric properties of this questionnaire and compare them with those of the original version.

[Preferences in the format of questionnaires and use of the Internet by schoolchildren]. / Preferencias en el formato de cuestionarios y en el uso de Internet en escolares.

OBJECTIVES: To describe the preferences to complete questionnaires via the internet by schoolchildren, as well as to analyze the attitude towards the use of internet to communicate with health professionals. METHODS: Cross-sectional study of a school population in Palafolls (Barcelona, n=923) was conducted in October and November 2013. Participants completed both internet and paper versions on a single school day, in random order, and with at least an interval of 2 hours. Preferences to answer internet vs paper version were recorded, along with the willingness to share information with health professionals. Percentages of use preferences and attitudes were estimated, and logistic regression models were fitted to analyze the association with the preferences and willingness to share information with health professionals. RESULTS: Participation rates were 77% (n=715), of whom 42.4% (38.7 to 46.0) preferred the internet version, and 20.6% (17.6 to 23.6) the paper version. Older children (odds ratio [OR]=0.89, 0.84 to 0.95 for age), and those from families with secondary school (OR=0.63, 0.43 to 0.93), and university degree (OR=0.61, 0.38 to 0.97) were less likely to prefer the internet version, while boys (OR=1.55, 1.10 to 2.16) and those children reporting sedentary habits (OR=1.78, 1.06 to 3.0) were more likely to prefer the internet version. Those scoring higher quality of life (OR=1.03, 1.01-1.05) and not reporting sedentary habits (OR=0.33, 0.15 to 0.73) were factors associated with a positive attitude to share information with health professionals. CONCLUSIONS: Younger children prefer to use the internet. Although Internet use is very widespread, it is less used to communicate with health professionals.

Gender inequalities in health and health care services use in Catalonia (Spain).

BACKGROUND AND OBJECTIVES: While socio-economically derived differences in health and health services use have long been a subject of study, differences based on gender, considered as the explicative variable, have scarcely been quantified from population-based data. The aim of this investigation was to analyse inequalities in health and health care services utilisation between men and women in Catalonia (Spain). DESIGN, SETTING, PARTICIPANTS, AND MEASURES: Data from the Catalan Health Interview Survey, a cross sectional survey conducted in 1994, were used. A total of 6604 women and 5641 men aged 15 years or over were included for analysis. Health related variables studied were self perceived health, restriction of activity (past two weeks), and presence of chronic conditions; health services use variables analysed were having visited a health professional (past two weeks), an optometrist (12 months), or a dentist (12 months); and hospitalisation (past 12 months). Age standardised proportions were computed according to gender, and prevalence odds ratios (OR) were derived from logistic regression equations. MAIN RESULTS: Women more frequently rated their health as fair or poor than men (29.8% v 21.4%; OR = 1.22; 95% CI: 1.10, 1.34). More women than men reported having restricted activity days (OR = 1.86; 95% CI: 1.59, 2.18) and chronic conditions (OR = 1.74; 95% CI: 1.60, 1.89). The proportion of women visiting a health professional was slightly greater than that for men (OR = 1.20; 95% CI: 1.09, 1.31), as was the proportion of women visiting an optometrist (OR = 1.21; 95% CI: 1.11, 1.33), and a dentist (OR = 1.43; 95% CI: 1.31, 1.55). The proportion of hospitalisation was lower in women (6.6%) than in men (7.7%; OR = 0.73; 95% CI: 0.63, 0.85). When health services use was analysed according to self perceived health, women declaring good health reported a greater probability of consulting a health professional (OR = 1.35; 95% CI: 1.20, 1.52). There were no differences in respect to hospitalisation, visits to the optometrist and to the dentist. CONCLUSIONS: These results indicate a pattern close to the inverse care law, as women, who express a lower level of health and thus would need more health care, are not, however, using health services more frequently than men.

Influence of proxy respondents in children's health interview surveys.

STUDY OBJECTIVES: To study the influence of the proxy respondent on health interview surveys in children. DESIGN: Cross sectional study. SETTING: Children under the age of 15 years drawn from the general population of Catalonia, Spain. PARTICIPANTS: The Catalan Health Interview Survey consisted of a multistage probability sample representative to the population of Catalonia. The sample size was 2433 children younger than 15 years of age. The interviews were answered by proxy respondents (the mother, father, or other carer), with the questionnaire adapted for the proxy respondent. Logistic regression models were used to analyse the relation between the proxy respondent's characteristics and health status and health care utilisation, controlling for the effect of sociodemographic factors. MAIN RESULTS: Proxy respondent's characteristics influenced the reports of chronic conditions and accidents within the last year. Proxy respondents over 55 years (OR = 0.47; 95% CI = 0.26, 0.82), men (OR = 0.69; 95% CI = 0.53, 0.89), the father (OR = 0.66; 95% CI = 0.50, 0.89), and the grandparents (OR = 0.49; 95% CI = 0.26, 0.89), reported a lower rate of chronic conditions. Age of the proxy 55 years or greater (OR = 0.41; 95% CI = 0.20, 0.82), men (OR = 0.70; 95% CI = 0.52, 0.94), fathers (OR = 0.68; 95% CI = 0.49, 0.92), and grandparents (OR = 0.40; 95% CI = 0.18, 0.85) showed a lower probability to report accidents. No variables related to the proxy were associated with physician visits or hospitalisation in the previous year. CONCLUSIONS: Selected characteristics of the proxy respondent can influence responses to health surveys involving children. A minimum set of basic data should be collected from the proxy respondent to evaluate different patterns of response.

Quality of life in children and adolescents: a European public health perspective.

OBJECTIVES: The measurement of health-related quality of life (HRQOL) is increasingly important as a means of monitoring population health status over time, of detecting sub-groups within the general population with poor HRQOL, and of assessing the impact of public health interventions within a given population. At present, no standardised instrument exists which can be applied with equal relevance in pediatric populations in different European populations. The collaborative European KIDSCREEN project aims to develop a standardised screening instrument for children's quality of life which will be used in representative national and European health surveys. Participants of the project are centres from Austria, France, Germany, Netherlands, Spain, Switzerland, and United Kingdom. By including the instrument in health services research and health reporting, it also aims at identifying children at risk in terms of their subjective health, thereby allowing the possibility of early intervention. METHODS: Instrument development will be based on constructing a psychometrically sound HRQOL instrument taking into account the existing state of the art. Development will centre on literature searches, expert consultation (Delphi Methods) and focus groups with children and adolescents (8-17 years). According to international guidelines, items will be translated into the languages of the seven participating countries for a pilot test with 2,100 children and their parents in Europe. The final instrument will be used in representative mail and telephone surveys of HRQOL in 1,800 children and their parents per country (total n = 25,200) and normative data will be produced. The potential for implementing the measurement tool in health services and health reporting will also be evaluated in several different research and public health settings. The final analysis will involve national and cross cultural-analysis of the instrument. RESULTS: The international, collaborative nature of the KIDSCREEN project means it is likely to provide many challenges in terms of producing an instrument which is conceptually and linguistically appropriate for use in many different countries, but it will also provide the opportunity to develop, test and implement the first truly cross-national HRQOL instrument developed for use in children and adolescents. This will help to contribute to a better understanding of perceived health in children and adolescents and to identify populations at risk.

[Factors related to drug consumption in children's population]. / Factores asociados al consumo de medicamentos en la población infantil.

BACKGROUND: To analyse the correlates of drug consumption in children's population. METHOD: Analyse interviews corresponding to children younger than 15 years old of the Catalan Health Survey (n = 2,433). RESULTS: The 25% consumed some drug in the previous 2 days. The factors related to drug consumption were low age, living in Barcelona (OR = 1.3), reporting double coverage (OR = 1.6), physician visits in the past 15 days (OR = 2.4), and reporting health problems. CONCLUSIONS: Drug consumption in children is high. It seems necessary to improve the education of families and health professionals related to drug consumption.

[The incidence of occupational diseases: a study of medical evaluations for work incapacity in Barcelona (1987-1991)]. / Incidencia de enfermedades profesionales: estudio de las valoraciones médicas por incapacidad laboral en Barcelona (1987-1991).

BACKGROUND: The number of professional diseases (PD) declared in Spain is low. The existence of diseases of labor etiology treated as a common disease is recognized, thus disregarding important labor health risks. METHODS: The incidence of PD in the province of Barcelona from 1987-1991 was prospectively studied by the Units of Medical Evaluation of Incapacities (UMEI). The sociodemographic, medical and administrative data of the cases of PD were reported by a protocol of data collection. The cases of PD are described and the annual incidence in relation with the active working population calculated. RESULTS: The UMEI of Barcelona confirmed 554 cases of PD of which 331 were evaluated as permanent invalidity over the five years of the study. The most frequent diagnoses of PD were pneumoconiosis, skin diseases, diseases causing tendinous fatigue and hypoacusis or deafness. Eleven neoplasms were reported, 9 being caused by asbestos. During the five years the incidence of PD increased from 76 cases to 144 per 100,000 active workers. The procedure of information probably underreported the incidence of PD. CONCLUSIONS: A low incidence of professional disease was observed. The clinical-labor history is generally not carried out. The way in which the Units of Medical Evaluation of Incapacities report data concerning incidence may contribute to greater detection of professional diseases on registration being integrated into a system of epidemiologic surveillance in which all the health care, labor and administrative centers were effectively coordinated.

[Haemophilus influenzae type b invasive disease and meningococcal disease: incidence and characteristics in Barcelona, 1994-1995. Work Group IMS-IUSPC for Surveillance and Control of Meningitis]. / Enfermedad invasiva por Haemophilus influenzae tipo b y enfermedad meningocócica: incidencia y características en Barcelona, 1994-1995. Grupo de Trabajo IMS-IUSPC para la Vigilancia y el Control de las Meningitis.

BACKGROUND: The purpose of the study is to estimate the incidence of Haemophilus influenzae type b invasive disease (HibID) and meningococcal disease (MD) in Barcelona (Catalonia, Spain) for the years 1994-1995. MATERIAL AND METHODS: Data were obtained from the nominal registry of the surveillance system for reportable transmissible diseases of the Barcelona City Health Department, combining the reporting system with active surveillance, including microbiological reports and the review of hospital discharge registries to ensure completeness. RESULTS: During this two-years period there were 17 cases of HibID (12 meningitis), and for 12 cases there was a laboratory confirmation. The annual incidence rate can be estimated at 15.4 cases of HibID for 100,000 children below 5 years of age, and 4.5 cases for 100,000 children below 15 years. The annual incidence rates for Hib meningitis were 3.2 for 100,000 below 15 years. There were 60 cases of MD, and for 33 there was a laboratory confirmation, with a majority of serogroup B. The annual incidence rate of MD can be estimated at 32.6 cases for 100,000 below 5 years and 16 cases for 100,000 below 15 years. The incidence rate of meningococcal meningitis is at least 5.9 cases for 100,000 below 15 years of age. CONCLUSIONS: These results confirm the relatively low incidence of Hib meningitis in Barcelona, Spain, while the Hib vaccine was not in systematic use, much lower than the incidence of MD. The incidence rates are similar to all other population-based studies in Spain, except for the Basque Country study.

The consequences of universalizing health services: children's use of health services in Catalonia.

The purpose of this study was to assess the role of needs and social factors in the use of health services among children under age 15 in Catalonia, Spain, where health care reform was explicitly designed to facilitate universal access to primary care according to health needs. Data from the Catalan Health Interview Survey of 1994, a multistage probability sample (2,433 children under 15 years old), were analyzed. Multiple regression examined the relationship between health needs and number of visits in the last year, controlling for the effect of sociodemographic characteristics. Two logistic regression equations were selected to predict heavy (more than seven visits per year) and light (less than two visits) utilization of services. The multiple regression model explained 14.3 percent of the variance in number of visits, with health status perception, disability, reported chronic condition, restriction of activities, and having had a recent accident by far the most important determinants. No familial socioeconomic characteristics, including social class, education, or family size, influenced the extent of use. In contrast to health systems not designed to achieve either universal access according to need or strong primary care, universal access to health services in Catalonia appears to enhance the use of services among children with health needs, regardless of socioeconomic characteristics.

[Reference population values for the Spanish Child Health and Illness Profile-Adolescent Edition (CHIP-AE) using a representative school-based sample]. / Valores poblacionales de referencia del perfil de salud CHIP-AE a partir de una muestra representativa de adolescentes escolarizados.

AIM: The Child Health and Illness Profile (CHIP-AE) is a generic health status instrument for adolescents aged 12-19 years adapted for use in Spain. The aim of this study was to obtain reference population values of the Spanish version of the CHIP-AE. METHODS: The CHIP-AE was administered to a representative sample of adolescents from schools in Barcelona. The sample was selected by using cluster-sampling, stratified by type of school (public or private) and an ecological socioeconomic index (Indice de Capacidad Familiar: low, middle, and high). The CHIP-AE scores were standardized to a mean of 20 and a standard deviation (SD) of 5. Means and percentiles were computed. Means were compared by age, gender, and socioeconomic status using analysis of variance. RESULTS: The response rate was 81% (n = 902). The distribution of the CHIP-AE scores presented a wide range with scores generally skewed toward positive health status. Nevertheless, the results suggest that the sample selected from a general population was not free of health problems. Twenty-five percent of adolescents presented scores below 17.2 in the domain of discomfort, indicating an effect size of 0.56 standardized SD units. The distribution of scores in the reference samples from Barcelona was similar to the original results in Baltimore (USA), with some marginal differences in individual risks. CONCLUSIONS: The CHIP-AE systematically gathers information on health domains in adolescents. The results from this reference sample will allow comparisons with adolescents from other regions, and/or with different health problems, as well as description of inequalities in health during adolescence.

[Prevalence of mental disorders in the general population of Catalonia. Team of the Health Survey of Catalonia]. / Prevalencia de trastornos mentales en la población general de Catalunya. Equipo de la Encuesta de Salud de Catalunya.

OBJECTIVE: The objective of the study is to estimate the prevalence of mental disorders in the general population of Catalonia. METHODS: Data comes from the Health Interview Survey of Catalonia (Enquesta de Salut de Catalunya, ESCA) and from an epidemiological study of Tres Cantos (Madrid). The General Health Questionnaire (GHQ-12) was administered to all the individuals older than 14 years (n: 12,455). The prevalence was estimated according to the GHQ score obtained and its correspondence to the probabilities score of the Madrid study. This study determined the probability of being a psychiatric case in a logistic regression using the Present State Examination (PSE) as gold standard. Morbidity Comparative Index (MCI) was used to compare the prevalences between health regions. The population of reference was the population of Catalonia. RESULTS: The 17.42% (CI 95%: 17.02-17.82) of the population of Catalonia older than 14 years suffered a probable mental disorder, the 18.66% (CI 95%: 18.07-19.25) in women and the 15.77% (CI 95%: 15.26-16.28) in men. The prevalence was higher in women with regard to men in all age groups. The MCI was lower in the Health Regions of Lleida and Girona and it was higher in the Health Regions of Tarragona and Tortosa, both in men and women. CONCLUSIONS: The figures are at intermediate level with respect others Spanish and Anglo-Saxon published studies based on population data and lower than the obtained for primary care users in Spain and in other international settings.

[Determinants of quitting smoking in Catalonia, Spain]. / El abandono del hábito tabáquico en Cataluña.

OBJECTIVE: While trends in the prevalence of smoking and ex-smoking in Catalonia, Spain have been monitored, the characteristics of those smokers who quit have not been investigated. The aim of this investigation was to analyze the prevalence of cessation, or quit ratio, in Catalonia and to study its sociodemographic, life-style, and smoking correlates. SUBJECTS AND METHODS: We analyzed data collected in the Catalan Health Interview Survey conducted in 1994. This is a cross-sectional study based on a representative sample of the non-institutionalized population of Catalonia. We included for analysis a total of 5,424 subjects (3,649 males and 1,775 females) who declared to be current smokers (2,335 males and 1,331 females) or past smokers (1,314 males and 444 females). We computed the crude and age-standardized quit ratios (QR) or prevalence of cessation, as well as the odds ratio (OR) of quitting smoking, according to gender and the variables studied. RESULTS: The age-standardized QR was 31. 8% for males and 30.9% for females and increased with age. The QR was, both in males and females, greater among married subjects, with higher socioeconomic status, and with healthy life-styles (moderate and heavy leisure physical activity and moderate alcohol consumption). The OR of quitting smoking was higher in heavy smokers (OR = 2.9; 95% CI: 2.2-3.8; smokers of > 30 cigarettes/day vs. 1-10 cigarettes/day) in males, while it was < 1 for females of medium intensity, conforming a shaped curve rather than a linear trend (OR = 1.7; 95% CI: 1.0-2.9, in heavy smokers). CONCLUSIONS: This study confirms a positive association in males and females between quitting smoking and increasing age, a higher socioeconomic level, heavy smoking, and healthy life-styles. The identification of these groups should facilitate the planning of successful interventions. Further effort is also necessary to target groups with low cessation rates, such as individuals in disadvantaged social classes and light smokers.

[The Spanish version of the German health-related quality of life questionnaire for children and adolescents: the Kindl]. / Versión española del cuestionario alemán de calidad de vida relacionada con la salud en población infantil y de adolescentes: el Kindl.

OBJECTIVES: To obtain a Spanish version of the Kindl semantically and culturally equivalent to the original German version and to test its psychometric properties. MATERIAL AND METHODS: The methodology used in the adaptation process was based on the forward-backward translation method. To assess the psychometric properties of the Spanish Kindl, the pilot test of the project "Screening for and promotion of HRQL in children and adolescents: a European Public Health perspective (Kidscreen)" it was include in. A classroom was selected for each educational level (8-16 years old) from three schools in Gerona and Barcelona. The Spanish Kindl was administered twice, one week apart. Internal consistency was assessed by computing Cronbach alpha and test-retest stability was assessed using intraclass correlation coefficients (ICC). Analysis of variance was performed according to age, sex, type of school, and self-perceived health status. RESULTS: Half of the items (12/24) required minor changes during the adaptation process. The response rate was 91 % (n = 447). Internal consistency was acceptable for most domains (alpha range = 0.40-0.88), as was test-retest stability (ICC range = 0.52-0.80). Girls and older teenagers scored worse in most domains (p < 0.01). No differences were found by type of school. CONCLUSIONS: The Spanish version of the Kindl showed adequate reliability and validity coefficients and represents a new HRQL instrument that can be applied in pediatric clinical practice and public health.

[Cross-cultural adaptation of the Spanish version of the Child Health and Illness Profile, Child Edition (CHIP-CE)]. / Adaptación de la versión española del Perfil de Salud Infantil (Child Health and Illness Profile-Child Edition, CHIP-CE).

OBJECTIVES: To obtain a Spanish version of the CHIP-CE semantically and culturally equivalent to the original version. METHOD: The methodology used was based on the forward-backward method. Two translations into Spanish were performed. After the first reconciled version, 44 cognitive interviews were carried out with children aged 6-11 years old, selected from two schools in Barcelona. The interviews were recorded and transcribed. A qualitative content analysis of the textual data was carried out. A panel of experts developed the second reconciled version taking into account the children's comments. A back-translation into English was carried out and was compared with the original version. RESULTS: Of a total of 45 items induced in the first reconciled version, 21 were considered equivalent, 23 required changes and 1 was considered not equivalent. Comprehension of abstract concepts differed according to age. Older children differentiated among concepts and gave different examples of experiences related to these concepts, while younger children (6 to 7-year olds) provided similar examples for different concepts. The children's comments were used in the reformulation of the items. An illustrative figure reinforced understanding. Children aged 7 or more started to use an adequate recall period and used the response options correctly. CONCLUSIONS: The Spanish version of the CHIP-CE seems appropriate for children aged 6-11 in Spain. The present study shows that children from the age of 6 years onwards are able to describe the health concepts included in the CHIP-CE.

[Role of paediatrics in primary care and coordination with specialist care]. / Papel del pediatra de atención primaria y coordinación con atención especializada.

OBJECTIVES: Primary care (PC) paediatricians are trained mainly in the hospital setting, with little contact with PC. This study aimed to find out what perceptions and experiences they have on the attributes of PC (first contact, comprehensiveness and continuity of care) that are assumed and performed by PC paediatricians. MATERIAL AND METHODS: A qualitative study was performed based on focus groups and semi-structured individual interviews with paediatricians with pre-defined sociodemographic and speciality training characteristics. Two focus groups (5 and 4 people each) and 5 interviews were made. Participants responded to two questions: how would you explain your function as a primary care paediatrician? and what is your opinion on the relationship between primary care paediatricians and the specialists to whom your patients are referred? The conversations of the groups and interviews were recorded and transcribed, and a content analysis was performed. RESULTS: Paediatricians assume that PC must be comprehensive, and take into account the context of the child. Paediatricians declare a lack in their training and poor social and institutional recognition. Coordination with specialists and the transfer of information are not satisfactory. Helpful factors are personal knowledge, the shared training and the face-to-face clinical sessions. CONCLUSION: Despite their hospital-based training, paediatricians assume the attributes of PC. Difficulties in performing their function include poor adaptation of their training to PC, and little institutional and social recognition. Coordination with specialists is not satisfactory. Approaching these difficulties can help maintaining a high quality level in the care of the paediatric population.

Social inequalities in health among adolescents in a large southern European city.

BACKGROUND: Numerous health problems are initiated in childhood and adolescence. For example, obesity, which has increased significantly in recent years, often begins in early life. The objective of this study is to describe social inequalities in obesity and other health problems among adolescents, by sex. METHODS: Data were from a cross-sectional study conducted in a representative sample of 903 adolescents aged 12-16 years old, from secondary schools in Barcelona, Spain. Associations between socioeconomic indicators and health outcomes (perceived health status, and overweight and obesity) were examined through generalised estimating equation models. All analyses were stratified by sex. RESULTS: Boys were more likely to report very good perceived health status than girls (64.1% and 46.3%, respectively). Some of the less privileged socioeconomic position indicators were associated with the presence of overweight and obesity (prevalence ratio 2.41 for low family affluence scale in girls), and with a lower probability of reporting very good perceived health status among boys (prevalence ratio 0.75 for primary level of paternal education). CONCLUSIONS: This study suggests that there are social inequalities in perceived health status, overweight and obesity, measured by different socioeconomic indicators among the adolescent population of Barcelona, and that these inequalities were distributed differently among boys and girls. Gender differences in the impact of socioeconomic variables in health need to be considered in epidemiological and intervention studies.

[Socio-economic inequalities in children's mental health in Catalonia]. / Desigualdades sociales en la salud mental infantil en Cataluña.

OBJECTIVES: To analyse socio-economic and health status factors associated with poor mental health in a representative sample of children 4 to 14 years old in Catalonia. METHODS: The data comes from a subsample of the Catalan Health Interview Survey 2006 (CHIS) (n=1821). Proxy-respondents, mainly mothers, answered the Strengths and Difficulties Questionnaire (SDQ). The SDQ dimension scores and the Total difficulties score were analysed by socio-demographics and health status factors. Multivariate linear regression models were fitted to analyse the influence of socio-economic and health status factors on mental health. RESULTS: In general, being in a disadvantaged family, single-parent families, a family whose mother had lower level of education, and those children reporting physical health problems, have been factors associated with worse child mental health in most of SDQ dimension scores. Factors associated with Total difficulties were, being a girl (beta coefficient: -1.6), from disadvantaged social classes (group IV-V: 1.6), at lower level of maternal education (mother's educational primary level or less: 1.2), being in a single-parent family (1.5), and reporting health problems (3 or more health problems: 3.9). CONCLUSIONS: Children from disadvantaged families, and single-parent families are at higher risk of worse mental health than their counterparts in the advantaged groups. The study contributes to collecting information for monitoring and approaching mental health in children.