Kristin Haraldstad

Predictors of health-related quality of life in a sample of children and adolescents: a school survey

AIM The aim is to study the health-related quality of life in a school sample of children and adolescents aged 8-18 years and to examine the relationship between health-related quality of life and the following variables; age, gender, perceived pain, body image, body mass index and bullying. BACKGROUND The study of health-related quality of life in children and adolescents have received little attention compared with adults in health care research and still little is known about the associations between health-related quality of life and other variables. DESIGN A cross-sectional design was chosen. METHOD We measured the health-related quality of life using the generic questionnaire KIDSCREEN-10. We administered the KIDSCREEN 52-item, and the 10 items were selected from this according to the KIDSCREEN manual. Multilevel regression models were used to evaluate the associations between health-related quality of life and the independent variables. RESULTS The sample included 1066 children and adolescents, 576 girls and 490 boys, with a response rate of 74%. The results show that body mass index was not significant associated with health-related quality of life in full model. However, in addition to age, being bullied, pain and body image were significant associated with health-related quality of life. Of these predictors, body image has the strongest impact in terms of explained variance in health-related quality of life. CONCLUSION The subjective sense of satisfaction or dissatisfaction with ones body, perceived body image, is a powerful predictor of health-related quality of life. RELEVANCE TO CLINICAL PRACTICE Knowledge about predictors of health-related quality of life is especially important for public health nurses. Health promotion and intervention programmes that aim to strengthen psychosocial well-being, especially those that strengthen body image, should be developed for both genders.

Associations between general self-efficacy and health-related quality of life among 12-13-year-old school children: a cross-sectional survey

BackgroundWhile research on school childrens health has mainly focused on risk factors and illness, few studies have examined aspects of health promotion. Thus, this study focuses on health promotional factors including general self-efficacy (GSE) and health-related quality of life (HRQOL). GSE refers to a global confidence in coping ability across a wide range of demanding situations, and is related to health. The purpose of this study was to examine associations between GSE and HRQOL, and associations between HRQOL and socio-demographic characteristics. Knowledge of these associations in healthy school children is currently lacking.MethodsDuring 2006 and 2007, 279 school children in the seventh grade across eastern Norway completed a survey assessing their GSE and HRQOL. The children were from schools that had been randomly selected using cluster sampling. T-tests were computed to compare mean subscale values between HRQOL and socio-demographic variables. Single and multiple regression analyses were performed to explore associations among GSE, HRQOL and socio-demographic variables.ResultsRegression analyses showed a significant relationship between increasing degrees of GSE and increasing degrees of HRQOL. In analyses adjusted for socio-demographic variables, boys scored higher than girls on self-esteem. School children from single-parent families had lower scores on HRQOL than those from two-parent families, and children who had relocated within the last five years had lower scores on HRQOL than those who had not relocated.ConclusionThe strong relationship between GSE and HRQOL indicates that GSE might be a resource for increasing the HRQOL for school children.

Health related quality of life in children and adolescents: Reliability and validity of the Norwegian version of KIDSCREEN-52 questionnaire, a cross sectional study

BACKGROUND A number of health-related quality of life instruments for children and adolescents have been developed and used in European countries during recent years. However, few well-validated instruments have been translated into Norwegian. As part of a larger investigation about pain and health-related quality of life, the KIDSCREEN-52, a cross-cultural 10-scale questionnaire, was translated into Norwegian. The aim of this study was to examine psychometric properties of the first Norwegian version of KIDSCREEN, particularly reliability and construct validity. METHODS A cross-sectional study was carried out, and a cluster sample of 20 randomly selected schools was drawn. The final study sample encompassed 1123 children and adolescents, aged 8-18 years. Internal consistency reliability was assessed using Cronbachs alpha. Construct validity was examined by confirmatory factor analysis, and by analysing whether the KIDSCREEN scales correlated with comparable KINDL scales, another health-related quality of life instrument. The analyses were conducted using SPSS (16.0) and Lisrel (8.7). RESULTS The Cronbachs alpha value was above 0.80 for all KIDSCREEN scales, suggesting good internal consistency reliability for the instrument. Confirmatory factor analysis shows that most of the KIDSCREEN scales fit the data well. Fit statistics for the 10-factor model were satisfactory, although some scales displayed residual covariance. Several confirmatory factor analysis models were fitted to the data, and the model specified according to the 10-dimensional KIDSCREEN-52 measurement model with correlated first-order factors fitted the data well (RMSEA=0.04; CFI=0.99). The KIDSCREEN scales correlated sufficiently highly with comparable KINDL scales. CONCLUSIONS The results of the present study indicate that the Norwegian version of the KIDSCREEN-52 seems to work well in a Norwegian context, and is a valid and reliable generic health-related quality of life instrument. It is considered appropriate for screening in the public health area, for example, in school health care.

A cross-sectional study of Health Related Quality of Life and body mass index in a Norwegian school sample (8–18 years): a comparison of child and parent perspectives

BackgroundBecause consequences of pediatric overweight and obesity are largely psychosocial, the aim of this study was to describe health related quality of life (HRQoL), the prevalence of overweight and obesity, and to examine the relationships between HRQoL and body mass index (BMI), age, and gender in a Norwegian sample of schoolchildren. In addition, because children are dependent upon their parents’ judgment of their condition, the aim was also to compare child- and parent-reported HRQoL and BMI, age, and gender.MethodsThis cross-sectional study involved 1238 children (8–18 years) and 828 parents. HRQoL was measured with the Norwegian version of the KIDSCREEN-52, child and parent version. Child BMI was calculated based on objective measures of height and weight, and adjusted for age and gender. Multiple regressions were used to determine how variations in BMI, age, and gender affected child- and parent-reported HRQoL.ResultsHRQoL decreased significantly with age and girls had lower HRQoL than boys on the majority of the KIDSCREEN subscales. Of the total sample, approximately 16% were overweight and 3% were obese. BMI contributed significantly to explaining the variations in the KIDSCREEN subscales of Physical well-being and Self-perception. Higher BMI was associated with lower HRQoL scores. Although there were significant differences between child and parent ratings on most KIDSCREEN subscales, the direction of the differences varied. In some scales, parents rated their child’s HRQoL higher than the child, and in some scales lower. Increasing age of the child seems to increase the differences, while gender and the child being overweight and/or obese affected the differences to a smaller extent.ConclusionsThis study showed that almost 20% of the children and adolescents in a representative Norwegian school sample were overweight or obese. Age and gender were the most significant factors associated with variations in HRQoL in the sample; however, increasing BMI added to the negative effect of other factors. The study also found substantial differences between the child and parent ratings of the child’s HRQoL. Misinterpretations of the child’s well-being might result in less targeted actions to improve the child’s HRQoL.

Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training

The aim of this study was to investigate the effects of vitamin C and E supplementation on changes in muscle mass (lean mass and muscle thickness) and strength during 12 weeks of strength training in elderly men. Thirty‐four elderly males (60–81 years) were randomized to either an antioxidant group (500 mg of vitamin C and 117.5 mg vitamin E before and after training) or a placebo group following the same strength training program (three sessions per week). Body composition was assessed with dual‐energy X‐ray absorptiometry and muscle thickness by ultrasound imaging. Muscle strength was measured as one‐repetition maximum (1RM). Total lean mass increased by 3.9% (95% confidence intervals: 3.0, 5.2) and 1.4% (0, 5.4) in the placebo and antioxidant groups, respectively, revealing larger gains in the placebo group (P = 0.04). Similarly, the thickness of m. rectus femoris increased more in the placebo group [16.2% (12.8, 24.1)] than in the antioxidant group [10.9% (9.8, 13.5); P = 0.01]. Increases of lean mass in trunk and arms, and muscle thickness of elbow flexors, did not differ significantly between groups. With no group differences, 1RM improved in the range of 15–21% (P < 0.001). In conclusion, high‐dosage vitamin C and E supplementation blunted certain muscular adaptations to strength training in elderly men.

Active play exercise intervention in children with asthma: a PILOT STUDY

Objective Increased physical activity (PA) may be beneficial for children with asthma. Knowledge about how to intervene and encourage children with asthma to be physically active is required. In the present study, we aimed to pilot a 6-week exercise intervention designed as active play and examine attendance rate, exercise intensity and childrens perceptions of participating. Methods 6 children with asthma (4 boys, 2 girls) aged 10–12 years, participated in 60 min of active play exercise twice weekly. A mixed-methods design was applied. The data analysed included attendance rate, exercise intensity assessed by heart rate (HR) monitoring during exercise sessions, registration and description of the active play exercise programme, 3 semistructured focus groups, field observations of 5 exercise sessions, and preintervention and postintervention testing. Findings The average attendance rate was 90%. Intensity ≥80% of maximal HR (HRmax) was recorded for a median (IQR) time of 22 (8) out of 60 min per session. Median (IQR) HR during the sessions was 146 (9; 74% of HRmax) bpm. Children reported increased health-related quality of life (HRQoL) post-test compared with baseline. Children enjoyed participating and reported no limitations by asthma or serious asthma attacks. Instead, they perceived that their asthma and fitness had improved after the programme. The instructors created an inclusive atmosphere that was characterised by easy-to-master games, fair competition, humour and mutual participation. Conclusions The exercise intervention pilot focusing on active play had a high attendance rate, relatively high exercise intensity, and satisfaction; the children perceived that their fitness and asthma had improved, and reported increased HRQoL. A randomised controlled trial of active play exercise including children with asthma should be conducted to evaluate effect on PA level, physical fitness, asthma control and HRQoL.

Experiences of community-dwelling older adults with the use of telecare in home care services: a qualitative systematic review

Background: The aging population will lead to a rise in the number of people with age-related diseases, and increasing demand for home care services. Telecare is seen as a solution to this challenge by promoting aging in place. Nevertheless, there is still a poor understanding of older adults’ experiences with the actual use of telecare. Objective: The aim of this review was to identify and synthesize the best available qualitative evidence of community-dwelling older adults’ experience with the use of telecare in home care services. Inclusion criteria: This review considered studies that focused on qualitative data, examining older adults’ experiences with the use of active and passive technology devices, such as personal alarms and sensor technology, in the context of home care services. Search strategy: This review systematically searched the databases Scopus, CINAHL, PsycINFO, and SveMed+ to find both published and unpublished studies in English, Norwegian, Swedish and Danish, from 2005 to 2017. Methodological quality: Methodological quality of the included studies was assessed independently by two reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data extraction: Qualitative data were extracted from papers included in the review using the standardized Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Data synthesis: Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument, and involved aggregation and synthesis of findings. Results: A total of 118 findings from 11 studies were aggregated into 20 categories. The categories generated seven synthesized findings: 1) Aging in place is desired; however, it may also be related to feeling isolated and lonely. 2) Telecare contributes to safety, security, and aging in place. 3) Privacy is not seen as a problem by most older adults because the technology is intended to help them live safely in their own home. 4) Some telecare devices have side effects, especially new technology. Some devices do not work outside the home, thus limiting active aging. 5) Some older adults experience a misfit between technology and needs. They must see the value of a telecare device to use it. 6) Telecare may enforce an identity with negative connotations on older adults, as frail and helpless people. Autonomy is considered important. 7) Lack of understanding can hamper the correct use of telecare. Specific strategies may be needed. Conclusions: The experiences with the use of telecare are diverse. Findings indicate telecare systems can promote safety and security to age in place that is a wish of many older adults. However, “one size does not fit all”- Telecare systems must fit individual needs, and be supported by service providers to accommodate sustainable use over time.

Adolescents and young adults' experiences of living with everyday pain: a systematic review protocol of qualitative evidence

Review question/objective What are the experiences of adolescents and young adults (AYA) living with everyday pain? The objective of this systematic review is to identify and synthesize the best available evidence from qualitative primary studies on how adolescents and young adults’ experience living with everyday pain. Background During the last 10 years pain has been recognized as a growing health problem in children and adolescents worldwide, and there is increasing evidence that daily life, function and well‐being are affected by pain.1 The literature shows that as much as 15%‐30 % of adolescents are suffering from persistent or chronic pain conditions, and this is regarded as a significant public health problem.2‐6 According to the International Association for the Study of Pain (IASP), pain is always subjective.8 Pain is a common concept in the nursing literature, and McCafferys well‐known definition of pain is often cited: “Pain is whatever the experiencing person says it is, existing whenever he says it does”.7(p.15) The International Association for the Study of Pain also recognizes the central role of emotions in pain defining pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.8(p.94) According to Eccleston two core aspects of pain are however missing from these definitions. In addition to the private felt character of pain it is also a social and communicative event. Pain expression may function to communicate to others the possibility of danger and presence of personal suffering.9 Further pain may function to override other concerns and to motivate escape or avoidance. Everyday pain is described by Eccleston as: “pain that is clinically unimportant that arises from normal everyday activity. Pain functions to interrupt current concerns and promote problem solving typically in the form of escape, pain management, or request for assistance”.10(p.47) The literature shows that self‐reported pain increases with age, and older children report more pain than younger children.3,5 The expression of pain as having an emotional basis also increases with age, and is expressed more frequently by adolescents.11 The most commonly reported pains in adolescents are headache, abdominal pain, backache, and limb pain, and many adolescents report multiple pain sites.5 Qualitative studies on adolescents’ experiences reveal how living with chronic everyday pain strongly influences adolescents’ daily life in different ways. It may result in absence from school, poor school performance, problems with social activities, isolation, stigma and sleeping problems.3,12‐14 The adolescents’ pain experience is influenced by a complex interaction between biological, sociocultural, and psychological factors.15 Children from families with low socioeconomic status report more pain than children from families with higher socioeconomic status.6,16 Moreover social factors such as parents’ income, education, and also psychosocial variables, such as divorce, anxiety, and depression, have been shown to be related to pain in children and adults.16 Pain may be symptoms of underlying causes, and have been associated with psychosomatic problems, such as stress, problems in relations with schoolmates, and with lack of sleep or exercise.17 The association between stress and headaches is stronger among teens with frequent headaches,18 and living with a high stress level over time may give adolescents feelings of helplessness. It has been suggested that changes in modern society and in the lifestyles of adolescents such as their frequent use of computers, more sedentary behaviour, greater stress, less sleep and greater psychological burdens may contribute to the increase in self‐reported pain.19,20 Managing stability through stressful challenges called allostasis (stability through change) is a challenge to adolescents and young adults.21 Continuous stress may induce allostatic overload, which might partly explain why some adolescents frequently experience pain and become high frequency users of over‐the‐counter (OTC) analgesics.22 Holmströms study of Swedish teenagers’ OTC drug use revealed how vulnerable teenagers may be as new consumers of OCT drugs.23 A knowledge gaps among the teenagers concerning OTC drugs was identified, and also that their OCT drug use was significantly influenced by parents and peers. The high prevalence of pain is a cause of concern, especially because pain negatively affects adolescents’ daily life and activities in different ways. Adolescence is a period in life in which great changes occur, and children are faced with physical, psychological and social changes that may be challenging. Pain problems may also have serious long term consequences, as pain problems can persist into adulthood and develop into chronic or persistent pain.24 Studies show that children with recurrent headaches, abdominal pain and other symptoms are at increased risk of developing chronic musculoskeletal pain in adulthood.25 Different coping strategies are described in the literature, and a passive coping strategy has been associated with higher levels of pain.26 Peer influence is apparent in the socialization of pain experience,27 and qualitative studies have shown that girls are more likely to talk to friends about pain problems than boys.28 Studies have also showed that more girls than boys use pain medication as coping strategy.28 Moreover, qualitative studies illuminated that children describe a stressful life and too little sleep as common causes of pain. Adolescents’ and young adults’ search for pain relief may lead to an increase in the use of pain relievers as OTC analgesics, illicit drugs and alcohol.29 Recent Nordic studies show that adolescents have a high frequency use of analgesics.22 The frequence of adolescent users of OTC analgesics in Norway and Denmark has also increased remarkably from 5% among boys and 14% among girls, to 26% for both genders during the last years.22,23,30 Even if we have knowledge of the prevalence and impact of pain, and this topic has been well investigated during the last years, much remains unknown about the causes of pain, adolescents own experience of living with pain, and also their coping strategies. To be able to support adolescents to relate to their pain in such way that it does not lead to chronic or persistent pain, we need more knowledge about their own thoughts and experience according to pain experience. There are few such studies in a non‐clinical population.9 An initial search on the keywords “adolescent*” OR “young adults” AND “pain” in the databases Medline, CINAHL, PsychINFO, EMBASE, JBIConnect+, PROSPERO or Cochrane Library indicated that no systematic review of qualitative evidence on this topic exists, or is currently underway. Thus a qualitative systematic review with metasynthesis by meta‐aggregation may provide important and relevant evidence about this topic.

Experiences of the home-dwelling elderly in the use of telecare in home care services: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this systematic review is to identify and synthesize the best evidence on the home-dwelling elderlys experiences with the use of telecare in home care services. Furthermore, the study will identify experiences with telecare devices and examine what beliefs the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place.Review question 1: How do the home-dwelling elderly experience the use of telecare in the context of home care services?Review question 2: How do the home-dwelling elderly experience telecare devices?Review question 3: What beliefs do the home-dwelling elderly hold regarding the impact of telecare on the ability to age in place?

Teachers' experiences of adolescents' pain in everyday life: a qualitative study

Objectives More adolescents report pain now than previously. In Norway, episodic pain problems have been reported by 60% of children and adolescents aged 8–18 years, with 21% reporting duration of pain of more than 3 months. Since adolescents spend much time at school, the attitude and behaviour of teachers play important roles regarding the experience of pain felt by adolescents in everyday life. Yet research on how teachers perceive the pain experienced by adolescents in a school setting is limited. We therefore seek to gain insight to teachers’ classroom experiences with (1) adolescents self-reported pain symptoms; (2) adolescents management of their pain and (3) how to help adolescents manage their pain. Setting Teachers in 5 junior high schools in Norway representing municipalities in 3 rural areas and 2 cities. Research design A qualitative study with an explorative design comprising 5 focus group interviews. Each group consisted of 3–8 junior high school teachers. A semistructured interview guide was used to cover the issues. The transcribed text was analysed with qualitative content analysis. Participants 22 teachers participated (5 men, 17 women; age range 29–62 years) with teaching experience ranging from 3 to nearly 40 years. Results The main theme describing the experience of teachers with adolescents’ pain in everyday life is that pain and management of pain is a social, physical and psychological interwoven phenomenon. Through empirical analyses, 3 subcategories emerged: (1) everyday pain—expressing strenuous life; (2) managing pain—escaping struggle and (3) strategies of teachers—support and normalisation. Conclusions Teachers have a biopsychosocial understanding and approach to pain experienced by adolescents. This understanding influences the role of teachers as significant others in the lives of adolescents with regard to pain and management of their pain in a school setting.