Gender differences in trajectories of health-related quality of life from childhood to adolescence in a 7-year follow-up study in a urban socially disadvantaged sample from Argentina.

PURPOSE: The transition from childhood to adolescence is a period of developmental changes, with social influences. Few previous studies have analyzed changes in health-related quality of life (HRQoL) during childhood and adolescence based on longitudinal studies in high-income countries. This study aimed to describe the evolution of HRQoL scores by gender in a school sample over a 7-year period in Argentina. METHODS: Prospective cohort of children attending fourth grade in public schools. HRQoL was measured using the KIDSCREEN-52 questionnaire. Trajectories of HRQoL were estimated for girls and boys through multilevel models, adjusted by socioeconomic status (SES). RESULTS: The study began in 2014 with a sample of 494 school children, reaching an 85.6% response rate in 2016, 31.4% in 2018, and 41.9% in 2021. Most of the predicted scores are negatively associated with linear age or/and quadratic age, suggesting a decrease in scores over the 7-year follow-up. Interactions between gender and age denote an increase in the differences in scores between girls and boys over time in favor of the latter. For the Index, Physical Well-being, Psychological Well-being, Autonomy, Parent relations, Social support and peers and Financial resources, individuals with medium or high SES have significantly higher scores than those with low SES. CONCLUSIONS: HRQoL scores decrease during the transition period from childhood to adolescence, with girls showing the greatest decrease. There were also socioeconomic inequalities in the evolution of HRQoL in a context characterized by social segregation and economic crisis, possibly aggravated by the COVID-19 pandemic.

[Modified version of the PCAT-A10 tool for the evaluation of primary care]. / Evaluación de la atención primaria, versión modificada del instrumento PCAT-A10.

OBJECTIVE: To evaluate the measurement characteristics of the Spanish and Catalan versions of the 10-Item Primary Care Assessment Tool for adults (PCAT-A10), shortened from the original Primary Care Assessment Tool (PCAT), with a new mental health item. DESIGN: Cross-sectional observational study. LOCATION: The city of Barcelona. PARTICIPANTS: Of the 3,496 people over 14 years of age from the representative random sample of the Barcelona population, from the 2016-17 Barcelona Health Survey, those who declared they had a family doctor, and had visited a specialist at some time in their lives, and had answered more than 50% of PCAT-A10 items were selected (n=3,107). MAIN MEASUREMENTS: Item descriptive analysis, analysis of internal consistency, corrected item - total correlation, of the PCAT-A10 index and the 10 items that make it up. Three scenarios for non-response to treatment were analysed: substitution by 0, by the intermediate value, and excluding people who did not answer any item. RESULTS: The PCAT-A10 index obtained Cronbach alphas of 0.73, 0.79, and 0.85 in the three mentioned scenarios, correlation item total corrected between 0.41 and 0.66, and 20.8% non-responses to the mental health item. CONCLUSIONS: The new version of PCAT-A10 has a high reliability with a higher response in the mental health item compared to the previous version.

Incipient Neighborhood and Socioeconomic Stratification Associated to Nutritional Status in Indigenous Qom Preschoolers from Formosa, Argentina.

Indigenous populations in Latin America are among the most socially vulnerable groups and their children often suffer severe deprivation in terms of access to proper nutrition, water, and shelter. This study describes the nutritional status of Qom preschoolers in general, and by neighborhood area and family's socioeconomic characteristics in a peri-urban village of Formosa, Argentina. Across-sectional study was carried out between January and December 2016, with 160 Qom children between 2 and 5 years of age. Interviews and anthropometric measures were conducted at the children's homes. Nutritional status was determined by body mass index. The prevalence of excess weight (overweight + obesity) and of stunting were associated with neighborhood area and socioeconomic level. The overall prevalence of stunting was 15.6% and it was found to be higher (25.8%) in areas of relatively lower access to material resources. The overall prevalence of excess weight reached 25%; however, neighborhood areas with greater access to material resources had a significantly higher prevalence of children with excess weight (41.2%). Despite the entire community living under the line of poverty, we found differences in nutritional status by neighborhood areas, suggesting an incipient social stratification and a deepening of inequalities in access to resources.

Differences in health-related quality of life by academic performance in children of the city of Cordoba-Argentina.

PURPOSE: The purpose of the study was to assess the differences in health-related quality of life (HRQoL) according to academic performance (AP) in children who attend public schools in the city of Cordoba, Argentina. METHODS: Cross-sectional study carried out in a sample of 494 children aged 9-12 years (mean = 9.5; standard deviation [SD] = 0.65; IQR 1) who attended 4th grade of public schools in the city of Córdoba, Argentina in 2014. HRQoL was assessed by self-administration of the KIDSCREEN-52 child version in classroom. AP was established with the final grades in language and mathematics obtained from the school records. Marginal means and SD's of the HRQoL scores were compared between AP groups by calculating the effect size (ES), and linear mixed effect models were used to evaluate the (independent) association of AP with HRQoL. RESULTS: Statistically significant differences were found in the psychosocial dimensions of the HRQoL between the AP groups. The main differences in HRQoL between children with very good-excellent grades and those with unsatisfactory AP were found in school environment (ES = 0.69), parent relation and home life (ES = 0.61), autonomy (ES = 0.61), self-perception (ES = 0.49), and social acceptance (ES = 0.48). Children with very good-excellent grades scored better in all of these dimensions. CONCLUSIONS: Children with very good-excellent grades in language and mathematics scored better in the psychosocial domains of HRQoL. AP is an important factor in the analysis of the social and psychological aspects of children's health. Further research is required to explore more deeply the direction and characteristics of this association.

[Psychometric validation in Spanish of the Brazilian short version of the Primary Care Assessment Tools-users questionnaire for the evaluation of the orientation of health systems towards primary care]. / Validación psicométrica en español de la versión corta brasileña del cuestionario Primary Care Assessment Tools: usuarios para la evaluación de la orientación de los sistemas de salud hacia la atención primaria.

OBJECTIVE: To validate the Brazilian short version of the PCAT for adult patients in Spanish. DESIGN: Analysis of secondary data from studies made to validate the extended version of the PCAT questionnaire. LOCATION: City of Córdoba, Argentina. Primary health care. PARTICIPANTS: The sample consisted of 46% of parents, whose children were enrolled in secondary education in three institutes in the city of Cordoba, and the remaining 54% were adult users of the National University of Cordoba Health Insurance. MAIN MEASURES: Pearson's correlation coefficient comparing the extended and short versions. Goodness-of-fit indices in confirmatory factor analysis, composite reliability, average variance extracted, and Cronbach's alpha values, in order to assess the construct validity and the reliability of the short version. RESULTS: The values of Pearson's correlation coefficient between this short version and the long version were high .818 (P<.001), implying a very good criterion validity. The indicators of good global adjustment to the confirmatory factor analysis were good. The value of composite reliability was good (.802), but under the variance media extracted: .3306, since 3 variables had weak factorials loads. The Cronbach's alpha was acceptable (.85). CONCLUSIONS: The short version of the PCAT-users developed in Brazil showed an acceptable psychometric performance in Spanish as a quick assessment tool, in a comparative study with the extended version.

Neighborhood and family perceived environments associated with children's physical activity and body mass index.

BACKGROUND: A growing body of research has been examining neighborhood environment related to children's physical activity and obesity. However, there is still not enough evidence from Latin America. OBJECTIVE: To investigate the association of neighborhood and family perceived environments, use of and distance to public open spaces with leisure-time physical activity (LTPA) and body mass index (BMI) in Argentinean school-aged children. METHODS: School-based, cross-sectional study with 1777 children (9 to 11years) and their parents, in Cordoba city during 2011. Children were asked about LTPA and family perceived environment. Parents were asked about neighborhood perceived environment, children's use of public open spaces and distance. Weight and height were measured for BMI. We modeled children's LTPA and BMI z-score with structural equation models with latent variables for built, social and safety neighborhood environments. RESULTS: Parents' perceived neighborhood environment was not related with children's LTPA and BMI. Children's perceived autonomy and family environment were positively associated with LTPA. Use of unstructured open spaces and, indirectly, the distance to these, was associated with LTPA among girls. Greater distance to parks reduced their use by children. CONCLUSIONS: Policies to increase children's LTPA should include access to better public open spaces, increasing options for activity. A family approach should be incorporated, reinforcing its role for healthy development.

[Therapies, bonds and quality of life of children and adolescents with cerebral palsy: experiences and perceptions of their caregivers during the pandemic]. / Terapias, vínculos y calidad de vida de niños, niñas y adolescentes con parálisis cerebral: vivencias y percepciones de sus cuidadores durante la pandemia.

The COVID-19 pandemic affected the health of children and adolescents (CA). Isolation-related conditions could have impacted not only the functionality of children and adolescents with cerebral palsy (CP) but also their social and emotional well-being, affecting their health-related quality of life (HRQoL). OBJECTIVE: To analyze perceptions of impairment during the pandemic and differences in HRQoL dimensions compared with a previous registry in Argentinean children and adolescents diagnosed with CP from the perspective of their caregivers. SUBJECTS AND METHOD: Cross-sectional observational study at two time points (2019 and 2021) where 98 caregivers participated. We used the KIDSCREEN-27 and CP-QOL questionnaires for the assessment of HRQoL and an open-ended question regarding the impact of the pandemic on the health of children and adolescents, including in 2021. We compared mean scores of the dimensions of the questionnaires in both stages (significant differences: Cohen's d≥0.3). Responses to the open-ended question were analyzed via "open" and "axial" coding. RESULTS: The scores of the dimensions Participation, Emotional well-being, Social well-being, and School environment (CP-QOL) and Psychological well-being, Friends, School environment, and General HRQoL index (KIDSCREEN-27) were lower during the pandemic (2021) compared with 2019 (d>0.3). Regarding perceived affectation during the pandemic, we identified three main recurrences: "impairment due to interruption of therapies and treatments", "deterioration of peer bonding", and "increased and positive appraisal of self-care". CONCLUSIONS: The pandemic affected the psychosocial dimensions of health. Qualitative data highlight the positive assessment of self-care.

[Validity and reliability of the Argentine version of the PCAT-AE for the evaluation of primary health care]. / Validez y fiabilidad de la versión argentina del PCAT-AE para evaluar la atención primaria de salud.

OBJECTIVE: To determine the validity and reliability of the version of the Primary Care Assessment Tool for adult users, adapted for Argentina (known as AR-PCAT-AE). METHODS: Two cross-sectional pilot studies were conducted among people over age 17, largely through self-administered questionnaires. Items that were equivalent to the original version of the PCAT and 13 others proposed for the instruments were analyzed. The factorial validity and reliability of the scores for each dimension were studied. The validity indicators were: factors that had three or more items with a factorial load of > 0.35, item-total correlation > 0.30, and interpretation of the solution according to the theoretical model. RESULTS: The factorial analysis yielded nine factors that explained 57.4% of the variability. Considering the pre-established criteria for validity, two items were excluded from the dimensions of continuity and comprehensiveness and six were added to comprehensiveness and cultural competency. In the dimensions, the percentage of questions with an item-total correlation of greater than 0.30 ranged from 67% to 100% and the Chronbach's (alpha) coefficient of internal consistency ranged from 0.44 to 0.90. CONCLUSIONS: The validity and reliability of the AR-PCAT-AE questionnaire are adequate, maintaining high equivalence with the original version. The process presented could be adopted in other contexts to advance the evaluation of primary health care functions with quality tools.

[Properties of the CP-QOL-PCQ to measure health-related quality of life in children and adolescents with cerebral palsy in Argentina] / Propiedades del CP-QOL-PCQ para medir calidad de vida relacionada con la salud en niños, niñas y adolescentes con parálisis cerebral en Argentina.

Introduction: The impact of cerebral palsy (CP) on quality of life requires the incorporation of subjective assessments of health, functional status, and well-being. A specific health-related quality of life (HRQoL) measure for CP is the Australian CP-QOL questionnaire, whose version for caregivers (PCQ) was adapted in Argentina. This study aimed to achieve the final structure and evaluate the reliability and validity of the CP-QOL-PCQ for the Argentine child and adolescent population. Methods: 100 caregivers of people from 3 to 24 years old with a diagnosis of CP from Argentina participated. In addition to the CP-QOL-PCQ, the KIDSCREEN-27 questionnaire was applied. Analysis of response distributions of all items, inter-item correlations, and internal consistency of the scales were performed using Cronbach's alpha. The convergent validity of the instrument was tested through the correlation with scales of similar content from the KIDSCREEN and through a priori hypotheses in groups of different ages and functional impairment. Results: A final structure of the CP-QOL-PCQ was achieved with 8 multidimensional scales, with satisfactory inter-item correlations (>0.30) and internal consistency (>0.70). Moderate and high correlations (r>0.30) were obtained between similar dimensions of the CP-QOL-PCQ and the KIDSCREEN with similar concepts. Higher HRQoL scores were confirmed at a younger age and at a lower level of functional impairment (Cohen's d >0.20). Conclusion: This provides evidence of reliability and validity to be expected for a HRQoL measurement instrument that can be implemented in the Argentine child and adolescent population with CP.

Introducción: El impacto de la parálisis cerebral (PC) en la calidad de vida exige la incorporación de valoraciones subjetivas de la salud, el estado funcional y el bienestar. Una medida de calidad de vida relacionada con la salud (CVRS) específica para PC es el cuestionario australiano CP-QOL, cuya versión para cuidadores (PCQ) fue adaptada en Argentina. Este estudio se propuso lograr la estructura final y evaluar la fiabilidad y validez del CP-QOL-PCQ para población infantil y adolescente argentina. Métodos: Participaron 100 cuidadores de personas de 3 a 24 años con diagnóstico de PC de Argentina. Además del CP-QOL-PCQ se aplicó el cuestionario KIDSCREEN-27. Se realizaron análisis de distribuciones de respuesta de todos los ítems, correlaciones inter-ítems y consistencia interna de las escalas mediante el alfa de Cronbach. Se probó la validez convergente del instrumento mediante la correlación con escalas de similar contenido del KIDSCREEN y mediante hipótesis a priori en grupos de diferente edad y afectación de la funcionalidad. Resultados: Se logró una estructura final del CP-QOL-PCQ con 8 escalas multidimensionales, con satisfactorias correlaciones inter-ítems satisfactorias (>0.30) y consistencia interna (>0.70). Se obtuvieron correlaciones moderadas y altas (r>0.30) entre dimensiones similares del CP-QOL-PCQ y del KIDSCREEN con conceptos similares. Se confirmaron mayores puntuaciones de CVRS a menor edad y a menor nivel de afectación funcional (d de Cohen >0,20). Conclusión: Este trabajo aporta evidencias de fiabilidad y validez esperables para un instrumento de medición de la CVRS que puede ser implementado en población infantil y adolescente argentina con PC.

Assessment of primary care in health surveys: a population perspective.

BACKGROUND: The objective of this study was to evaluate the metric properties of a selection of items of the Primary Care Assessment Tool (PCAT) included into 2006 Catalonia Health Survey and adapted to evaluate experiences of primary care (PC) under population perspective. METHODS: This was a cross-sectional study. The study population was composed of non-institutionalized residents of Catalonia over 15 years of age (n = 12,933). The instrument used was a 10-item selection of the adult user's version of the PCAT (PCAT10-AE). We assessed internal consistency, correlation between items and performed exploratory factor analysis and external validity analysis. RESULTS: The instrument presented adequate internal consistency (0.72). All items showed acceptable correlation with other items that constitute the scale. The single extracted factor explained 64% of the common variance in the responses, allowing the construction of a global index for evaluation of PC. We observed an association between better evaluation of PC and more satisfaction with the health system. CONCLUSIONS: Metric analysis supported the integrity and general adequacy of this very short tool included in a population health survey. The global index proposed could be a good measure for assessing and monitoring the adequacy of part of the PC experiences in first-contact care and person-focused care over time, under population perspective. On the other hand, the loss of content as a consequence of the selection of items, suggesting use of the expanded versions of the PCAT-AE whenever a global evaluation of PC is desired and it is possible.

Properties of a short questionnaire for assessing primary care experiences for children in a population survey.

BACKGROUND: The Primary Care Assessment Tool (PCAT) is an interesting set of tools for primary care research. A very short version could inform policy makers about consumer experiences with primary care (PC) through health surveys. This work aimed to investigate the validity and reliability of a selection of items from the child short edition (CS) of the PCAT. METHODS: A 24 item questionnaire permitted the identification of a regular source of care and the assessment of the key attributes of first contact, ongoing care over time, coordination, services available and services received (comprehensiveness), and cultural competence. Structural validity, reliability, and construct validity were assessed using responses from 2,200 parents of a representative sample of the population aged 0 to 14 years in Catalonia (Spain) who participated in the 2006 Health Survey. Structural validity was analyzed using exploratory and confirmatory factor analyses and reliability was assessed using Cronbach's alpha. Construct validity was assessed using linear regression analysis between PC experience scores and a measure of overall user satisfaction with healthcare services. RESULTS: A total of 2,095 (95.2%) parents provided useable responses on PC. After Confirmatory Factor Analysis (CFA), the best fitting model was a 5-factor model in which the original dimensions of first contact and ongoing care were collapsed into one. The CFA also showed a second order factor onto which all domains except services available loaded (root mean square error of approximation = 0.000; comparative fit index = 1.00). Cronbach's alpha values for one of the original scales (first-contact) was poor (alpha < 0.50), but improved using the modified factor structure (alpha > 0.70). Scores on the scales were correlated with satisfaction with healthcare services (p < 0.01), thereby providing some preliminary evidence of construct validity. CONCLUSIONS: This very short questionnaire obtained from the PCAT-CE yields information about five attributes of PC and a summary score. It has shown evidence of validity and reliability for judgments about experiences with primary care overall. If space on surveys is at a premium, the instrument could be useful as a measure of PC experiences.

[Linguistic acceptability in the comprehension of health services assessment questionnaires in Ibero-America]. / Aceptabilidad lingüística en la comprensión de cuestionarios de valoración de servicios de salud en Iberoamérica.

The use of questionnaires as measuring tools involves the use of language. Spanish intralinguistic variation entails differences in the ways of perceiving the world, analyzing events and behaving, which must be taken into account when designing and adapting questionnaires. The IA-PCAT (Primary Care Assessment Tools for Iberomerica) harmonization process differs from the cross-cultural adaptation scenarios described in the scientific literature, since it intends to obtain a single Spanish product suitable for multiple target populations, that emanates from questionnaires previously adapted in several populations. Hence, this work requires the use of new analysis categories. The aim of this methodological note is to propose discriminant definitions of conceptual equivalence, practical equivalence and linguistic acceptability as analysis categories of the data collected during cognitive interviews to assess the questionnaires' comprehension, carried out with health professionals and users of healthcare services.

Setting priorities in clinical and health services research: properties of an adapted and updated method.

OBJECTIVES: The objectives of this study is to review the set of criteria of the Institute of Medicine (IOM) for priority-setting in research with addition of new criteria if necessary, and to develop and evaluate the reliability and validity of the final priority score. METHODS: Based on the evaluation of 199 research topics, forty-five experts identified additional criteria for priority-setting, rated their relevance, and ranked and weighted them in a three-round modified Delphi technique. A final priority score was developed and evaluated. Internal consistency, test-retest and inter-rater reliability were assessed. Correlation with experts' overall qualitative topic ratings were assessed as an approximation to validity. RESULTS: All seven original IOM criteria were considered relevant and two new criteria were added ("potential for translation into practice", and "need for knowledge"). Final ranks and relative weights differed from those of the original IOM criteria: "research impact on health outcomes" was considered the most important criterion (4.23), as opposed to "burden of disease" (3.92). Cronbach's alpha (0.75) and test-retest stability (interclass correlation coefficient = 0.66) for the final set of criteria were acceptable. The area under the receiver operating characteristic curve for overall assessment of priority was 0.66. CONCLUSIONS: A reliable instrument for prioritizing topics in clinical and health services research has been developed. Further evaluation of its validity and impact on selecting research topics is required.

[Effectiveness of population-based interventions on the prevention of overweight in children and adolescents]. / Efectividad de las intervenciones de base poblacional dirigidas a la prevención del sobrepeso en la población infantil y adolescente.

This study aimed to assess the available scientific evidence on the effectiveness or cost-effectiveness of interventions to prevent obesity, carried out in child and adolescent population. We conducted a systematic review, searching 10 databases and other resource directories for the period January 1998-July 2008. We assessed study quality and extracted and summarized information that met the established criteria. Results included 40 studies that evaluated interventions showing mostly components of physical activity, nutrition and education. We found no evaluations of cost-effectiveness. Thirteen studies resulted in a significant reduction in favor of intervention in some of the anthropometric measurements. In conclusion, some interventions showed an impact in preventing weight gain. However, it is weak, since most studies have not had the expected result, were heterogeneous and of short duration.

Inequities in neighborhood public park use for schoolchildren's physical activity: multilevel evidence from Cordoba, Argentina.

INTRODUCTION: The complexity of urbanization processes across Latin American societies encourages investigating its implications in health conditions, especially during childhood. One of the possible links between them is recreation, a component of the daily life of children and, therefore, essential to produce health and life itself. The objective of this study was to examine the associations between neighborhood context and active public park use among school-aged children in Cordoba, Argentina. METHODS: A cross-sectional study was conducted with 1466 children, aged 9 to 11, attending 19 schools and living in 110 neighborhoods. Multilevel models with Poisson distribution were used for the analyses, stratified by gender. Socio-demographic, behavioral, and physical covariates were included at the individual level, and socioeconomic neighborhood conditions at second level. RESULTS: Girls residing in neighborhoods with a worse socioeconomic context were less likely to report frequent public park use for physical activity, while those from neighborhoods with better socioeconomic conditions were more likely to, regardless of individual characteristics. CONCLUSION: This study suggests that socioeconomic conditions of neighborhoods are associated with public park use for physical activity in school-aged girls, demonstrating gender inequality in the use and appropriation of public spaces.

Food Intake and the Significance of Feeding in Qom Children of Northern Argentina.

BACKGROUND: As part of the ubiquitous nutritional transition indigenous are experiencing, the typical diet of most indigenous communities is being substituted by one with high-fat and high-energy-density foods. Domestic feeding transmits cultural factors through meaning and symbolism influential in food, preparation, and meal experiences, which in turn influence children's eating habits differently among social groups. OBJECTIVES: The aims of this study were to explore the food consumption patterns of Qom preschoolers and to describe cultural domains about the significance of feeding in this indigenous population in northern Argentina. METHODS: This cross-sectional and mixed-methods study was conducted in 2016-2017 and focused on 160 preschoolers and their mothers in the village of Namqom. It used a closed questionnaire, three 24-h recalls, and free listing techniques. RESULTS: Qom preschoolers had a high prevalence of excess weight (25%) and stunting (16%). Mothers reported only 38 food items consumed by preschoolers. Almost all of the children (96%) consumed white bread, whereas 89% consumed milk, 87.5% sweet cookies, 84.7% some sort of stew, 72% fried dough, and 63.1% soup. In addition, it was found that preschoolers consumed neither fresh and varied vegetables, nor available fruits. They did not consume fresh fish and other meats, either. Caregivers related the term "feeding" with "having to eat," which might be associated with the context of poverty in which they live. Caregivers also mentioned "eating right" to get healthy or grow up strong. CONCLUSIONS: The present study revealed a relatively elevated consumption of high-energy but nutritionally poor food, and malnutrition, which reflects the impacts of poverty. We found that the cultural domain of food is linked to survival and depletion ideas.

Correlates of use of health care services by children and adolescents from 11 European countries.

OBJECTIVE: To examine the association between use of health care services and health status, sociodemographic, and health care system characteristics in children and adolescents from 11 European countries. RESEARCH DESIGN: Cross-sectional surveys in representative samples included using phone or school-based sampling. SUBJECTS: Children and adolescents aged 8-18 years and their parents. Questionnaires were administered in households or at schools in Austria, Czech Republic, France, Germany, Greece, Hungary, Poland, Spain, Switzerland, the Netherlands, and the United Kingdom. MAIN OUTCOME MEASURES: Any visit to ("access") and number of visits ("intensity of use") to health care professionals during the previous 12 months. RESULTS: The study included 16,210 parent-child pairs. In a multivariate analysis, variables statistically associated with access included the following: health status (more disability days, more chronic conditions), sociodemographic characteristics (being younger, being female, having a higher socioeconomic status, or higher parental educational level), and health system variables (higher percentage of public health expenditure, widespread private health care coverage, pediatrician-led system). The strongest association was with disability days [odds ratio (OR) = 6.92; 95% confidence interval (CI) = 5.24-9.14 for 5-15 days]. In the "intensity of use" model, sociodemographic (being younger, strong social support) and health status (chronic conditions, disability days, psychiatric disorders, psychosomatic complaints, poor health-related quality of life) characteristics were associated with greater intensity of use. Health system variables were not significant in this model. CONCLUSIONS: The likelihood of contacting the health services is a function of health status, socioeconomic factors, and health system characteristics. Intensity of use among those having made contact is associated with health status and sociodemographic characteristics but not with health system characteristics.

Health-related quality of life measurement in children and adolescents: a systematic review of generic and disease-specific instruments.

OBJECTIVE: To identify currently available generic and disease-specific health-related quality of life (HRQOL) instruments for children and adolescents up to 19 years old, to describe their content, and to review their psychometric properties. STUDY DESIGN: Previous reviews on the subject and a new literature review from 2001 to December 2006 (MEDLINE, the ISI Science Citation Index, HealthSTAR and PsycLit) were used to identify measures of HRQOL for children and adolescents. The characteristics (country of origin, age range, type of respondent, number of dimensions and items, name of the dimensions and condition) and psychometric properties (reliability, validity, and sensitivity to change) of the instruments were assessed following international guidelines published by the Scientific Committee of the Medical Outcomes Trust. RESULTS: In total, 30 generic and 64 disease-specific instruments were identified, 51 of which were published between 2001 and 2005. Many generic measures cover a core set of basic concepts related to physical, mental and social health, although the number and name of dimensions varies substantially. The lower age limit for self-reported instruments was 5-6 years old. Generic measures developed recently focused on both child self-report and parent-proxy report, although 26% of the disease-specific questionnaires were exclusively addressed to proxy-respondents. Most questionnaires had tested internal consistency (67%) and to a lesser extent test-retest stability (44.7%). Most questionnaires reported construct validity, but few instruments analyzed criterion validity (n = 5), structural validity (n = 15) or sensitivity to change (n = 14). CONCLUSIONS: The development of HRQOL instruments for children and adolescents has continued apace in recent years, particularly with regard to disease-specific questionnaires. Many of the instruments meet accepted standards for psychometric properties, although instrument developers should include children from the beginning of the development process and need to pay particular attention to testing sensitivity to change.

[Reliability and validity of the Spanish version of the KIDSCREEN-52 for child and adolescent population]. / Fiabilidad y validez de la versión española del KIDSCREEN-52 para población infantil y adolescente.

BACKGROUND AND OBJECTIVE: This study assesses the reliability and validity of the KIDSCREEN-52, a new questionnaire of health-related quality of life (HRQoL), cross-culturally developed for children and adolescents in 13 European countries. SUBJECTS AND METHOD: The KIDSCREEN-52 was sent by post to a representative sample of the Spanish population aged 8-18 years old. Sociodemographic characteristics and other measures of HRQoL were collected. A health needs instrument was collected from parents. Psychome tric properties were assessed using the classical test theory, and item response theory approaches. Test-retest reliability was assessed in 10% of the sample 2-4 weeks later. RESULTS: Response rate was 47% (n = 876). Cronbach's alpha values ranged from 0.74 to 0.86, and the intraclass correlation coefficient ranged between 0.55-0.79. Rasch analysis showed a good item-fit in each dimension (infit msq = 0.7-1.2). Confirmatory factor analysis confirms underlying structure of the 10 dimensions model (root mean square error of approximation [REMSEA] = 0.025; comparative fit index [CFI] = 0.94). KIDSCREEN scores were better in boys, in younger children, in those who did not report health care needs, and in those in the high socioeconomic level. CONCLUSIONS: The KIDSCREEN-52 questionnaire has acceptable levels of reliability and validity for the Spanish population aged 8-18. Further work is needed to assess sensitivity to change and its applicability in clinical settings.