Cristian Tebé

Methods and representativeness of a European survey in children and adolescents: the KIDSCREEN study

BackgroundThe objective of the present study was to compare three different sampling and questionnaire administration methods used in the international KIDSCREEN study in terms of participation, response rates, and external validity.MethodsChildren and adolescents aged 8–18 years were surveyed in 13 European countries using either telephone sampling and mail administration, random sampling of school listings followed by classroom or mail administration, or multistage random sampling of communities and households with self-administration of the survey materials at home. Cooperation, completion, and response rates were compared across countries and survey methods. Data on non-respondents was collected in 8 countries. The population fraction (PF, respondents in each sex-age, or educational level category, divided by the population in the same category from Eurostat census data) and population fraction ratio (PFR, ratio of PF) and their corresponding 95% confidence intervals were used to analyze differences by country between the KIDSCREEN samples and a reference Eurostat population.ResultsResponse rates by country ranged from 18.9% to 91.2%. Response rates were highest in the school-based surveys (69.0%–91.2%). Sample proportions by age and gender were similar to the reference Eurostat population in most countries, although boys and adolescents were slightly underrepresented (PFR <1). Parents in lower educational categories were less likely to participate (PFR <1 in 5 countries). Parents in higher educational categories were overrepresented when the school and household sampling strategies were used (PFR = 1.78–2.97).ConclusionSchool-based sampling achieved the highest overall response rates but also produced slightly more biased samples than the other methods. The results suggest that the samples were sufficiently representative to provide reference population values for the KIDSCREEN instrument.

Fiabilidad y validez de la versión española del KIDSCREEN-52 para población infantil y adolescente

Fundamento y objetivo Analizar la fiabilidad y validez del KIDSCREEN-52, un nuevo cuestionario de calidad de vida relacionada con la salud (CVRS), desarrollado de forma transcultural para poblacion infantil y adolescente en 13 paises europeos. Sujetos y metodo El KIDSCREEN-52 se envio por correo a una muestra representativa de la poblacion espanola de entre 8 y 18 anos de edad. Se recogieron las caracteristicas sociodemograficas y se aplicaron otros cuestionarios de CVRS ademas del KIDSCREEN. Los padres respondieron a cuestionarios sobre necesidades en salud. Para el analisis de la fiabilidad y la validez se aplicaron tecnicas de analisis psicometrico clasicas, asi como la teoria de respuesta al item. En un 10% de la muestra se efectuo un retest al cabo de 2-4 semanas. Resultados La tasa de respuesta fue del 47% (n = 876 ninos/as). Los coeficientes alfa de Cronbach variaron entre 0,74 y 0,86, y el coeficiente de correlacion intraclase entre 0,55 y 0,79. El analisis Rasch mostro un ajuste satisfactorio de los items a cada una de las dimensiones (Infit media cuadratica de residuales [MSQ] = 0,7-1,2). El analisis factorial confirmatorio valido la estructura subyacente del modelo de 10 dimensiones (raiz cuadrada media del error de aproximacion [RMSEA] = 0,025; indice de ajuste comparativo [CFI] = 0,94). Las puntuaciones del KIDSCREEN fueron mejores en los chicos, en los mas jovenes, en los que no declararon necesidades en salud y en los de nivel socioeconomico mas favorecido. Conclusiones El KIDSCREEN-52 muestra aceptables niveles de fiabilidad y validez para la poblacion espanola de 8-18 anos. Futuros estudios tendran que evaluar la sensibilidad a los cambios y su aplicabilidad en diferentes condiciones clinicas.

Health related quality of life in immigrants and native school aged adolescents in Spain

Objectives: To compare health related quality of life (HRQL) between native and immigrant adolescents aged 12 to 18 years, and to analyse psychosocial factors associated with HRQL. Design: A cross sectional study of adolescents (12–18 years old) who answered a self administered questionnaire. Setting: All the secondary schools from Lloret de Mar (Girona, Spain). Participants: 1246 participants (88.9% of the eligible students). Main outcome measures: Main outcome was the Spanish version of the Vecu et Sante Percue de l’Adolescent (VSP-A), a HRQL measure addressed to adolescents. Mean scores of the VSP-A index of natives and immigrants were compared, as well as their sociodemographic and health related factors. Multiple regression examined the relation between HRQL and psychosocial factors, controlling for the effect of socioeconomic variables. Results: Half of the sample were boys, in the middle socioeconomic status, and 18.2% were immigrants (n = 226). HRQL score was higher in native Spanish adolescents than immigrants (p<0.01). Multiple regression model explaining 48.1% of the VSP-A variance showed that migration in itself has no statistically significant impact on HRQL, and age, socioeconomic status, social support, discrimination, and psychological distress do play a part. Conclusions: Migrants have worse HRQL than natives but it seems to be mediated by their disadvantage in socioeconomic status, social support, and psychological distress.

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.

Population norms and cut-off-points for suboptimal health related quality of life in two generic measures for adolescents: the Spanish VSP-A and KINDL-R.

BackgroundHealth-related quality of life (HRQL) outcome measures are complex and for further application in clinical practice and health service research the meaning of their scorings should be studied in depth. The aim of this study was to increase the interpretability of the Spanish VSP-A and KINDL-R scores.MethodsA representative sample of adolescents aged 12 to 18 years old was selected in Spain. The Spanish VSP-A and KINDL-R, two generic HRQL measures (range: 0–100), were self-administered along with other external anchor measures (Strengths and Difficulties Questionnaire, Oslo Social Support Scale and self-declaration of chronic conditions) and sent by post. Percentiles of both HRQL questionnaires were obtained by gender, and age group and effect sizes (ES) were calculated. Receiver Operating Characteristic curves and related sensitivity (SE) and specificity (SP) values were also computed.ResultsThe Spanish VSP-A and KINDL-R were completed by 555 adolescents. A moderate ES was shown in Psychological well-being between younger and older girls (ES: 0.77) in the VSP-A and small ES in the KINDL (ES: 0.41) between these groups. A SE and SP value close to 0.70 was associated to a global HRQL score of 65 in the VSP-A and 70 in the KINDL-R, when compared to anchors measuring mental and psychosocial health. Adolescents with scores bellow these cut-off points showed a moderate probability of presenting more impairment in their HRQL.ConclusionThe results of this study will be of help to interpret the VSP-A AND KINDL-R questionnaires by comparing with the general population and also provide cut-off points to define adolescents with health problems.

Factores de riesgo de fracturas por fragilidad en una cohorte de mujeres españolas

INTRODUCTION Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD). METHODS A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR) of fragile fracture using a Cox regression model. RESULTS A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5). Of these, 3631 women (7.1%) reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age ≥ 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4) and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1.8-2.2). A personal history of humerus, hip or vertebral fractures had an adjusted HR of 1.2 (95% CI: 1.1-1.3). CONCLUSIONS The main risk factors for fragility fracture were advanced age, BD result and a personal history of fracture, although 74% of fractures were detected with a bone mineral density classified as normal or osteopenia. Other relevant factors were rheumatoid arthritis or having received prolonged corticosteroid therapy.

Developing a universal tool for the prioritization of patients waiting for elective surgery

The objective was to elaborate a priority scoring system for patients on waiting lists for elective surgery to be implemented in the Catalan public health system. This tool should ideally be universal (for all patients and across the entire region) with common criteria and weights (for all surgical procedures), simple and user-friendly. A tool based on a point-count linear scale ranging from 0 (lowest priority) to 100 (highest priority) was developed. Patients are scored in three major dimensions: clinical and functional impairment, expected benefit, and social role, which include 8 criteria (with their weights): disease severity (23%), pain (or other main symptoms) (14%), rate of disease progression (15%), difficulty in doing activities of daily life (14%), probability and degree of improvement (12%), being dependent with no caregiver (5%), limitation to care for ones dependents (if that be the case) (8%), and limitations in the ability to work, study or seek for employment (9%). As in previous studies developed in Canada, New Zealand and Catalonia, the tool obtained is mainly based on severity and need. The success of this tool depends very much on implementation mechanisms. Furthermore, prior to implementation, a definition of specificities in the selected criteria for the most frequent surgical procedures is advised.

Reliability and validity of the KIDSCREEN-52 questionnaire to measure health related quality of life in the 8 to 18 year-old Argentinean population.

INTRODUCTION The KIDSCREEN questionnaire is an instrument to measure health-related quality of life (HRQoL). It allows to differentiate health levels or to assess the efficacy of interventions. The objective was to evaluate the reliability and validity of the Argentine version of the questionnaire in the population aged 8-18 years-old in the city of Bahía Blanca. POPULATION AND METHODS Cross sectional study conducted in public and private schools in 2008 using a district-stratified sampling. The questionnaire was self-administered and included the KIDSCREEN questionnaire (52 items) and questions about age, gender and family socioeconomic level (SEL). Reliability was analyzed using standard psychometric analysis techniques and the item response theory. The analysis of the factorial structure was performed using a confirmatory factor analysis (CFA), and that of the construct validity was conducted comparing dimension mean scores by age, gender and SEL. RESULTS Most dimensions had a Cronbachs alpha of >0.7 and 80% of items, and sufficient infit or outfit values (<0.8). The CFA showed an adequate data adjustment to the ten-dimension structure. The mean values of the dimensions confirmed lower scores in adolescents than in children, and lower scores in females than in males, as expected in several of the HRQoL dimensions. CONCLUSIONS The reliability and validity of the Argentinean version of the KIDSCREEN-52 questionnaire were acceptable; therefore its use can be recommended for the 8-18 year-old Argentinean population.

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

BackgroundThe 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.MethodsParents 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.ResultsThe 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).ConclusionsThe 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.

Geriatric Assessment Predicts Survival and Competing Mortality in Elderly Patients with Early Colorectal Cancer: Can It Help in Adjuvant Therapy Decision‐Making?

BACKGROUND The challenge when selecting elderly patients with colorectal cancer (CRC) for adjuvant therapy is to estimate the likelihood that death from other causes will preclude cancer events from occurring. The aim of this paper is to evaluate whether comprehensive geriatric assessment (CGA) can predict survival and cancer-specific mortality in elderly CRC patients candidates for adjuvant therapy. MATERIAL AND METHODS One hundred ninety-five consecutive patients aged ≥75 with high-risk stage II and stage III CRC were prospectively included from May 2008 to May 2015. All patients underwent CGA, which evaluated comorbidity, polypharmacy, functional status, geriatric syndromes, mood, cognition, and social support. According to CGA results, patients were classified into three groups-fit, medium-fit, and unfit-to receive standard therapy, adjusted treatment, and best supportive care, respectively. We recorded survival and cause of death and used the Fine-Gray regression model to analyze competing causes of death. RESULTS Following CGA, 85 (43%) participants were classified as fit, 57 (29%) as medium-fit, and 53 (28%) as unfit. The univariate 5-year survival rates were 74%, 52%, and 27%. Sixty-one (31%) patients died due to cancer progression (53%), non-cancer-related cause (46%), and unknown reasons (1%); there were no toxicity-related deaths. Fit and medium-fit participants were more likely to die due to cancer progression, whereas patients classified as unfit were at significantly greater risk of non-cancer-related death. CONCLUSION CGA showed efficacy in predicting survival and discriminating between causes of death in elderly patients with high-risk stage II and stage III resected CRC, with potential implications for shaping the decision-making process for adjuvant therapies. IMPLICATIONS FOR PRACTICE Adjuvant therapy in elderly patients with colorectal cancer is controversial due to the high risk for competing events among these patients. In order to effectively select older patients for adjuvant therapy, we have to weigh the risk of cancer-related mortality and the potential survival benefits with treatment against the patients life expectancy, irrespective of cancer. This prospective study focused on the prognostic value of geriatric assessment for survival using a competing-risk analysis approach, providing an important contribution on the treatment decision-making process and helping clinicians to identify elderly patients who might benefit from adjuvant chemotherapy among those who will not.