Orawan Louthrenoo

Disclosure of HIV/AIDS diagnosis to HIV-infected children in Thailand

Background:  With the availability of highly active antiretroviral therapy, more HIV‐infected children have lived longer. Many children are at the age that they should know the diagnosis.

Poor Cognitive Functioning of School-Aged Children in Thailand with Perinatally Acquired HIV Infection Taking Antiretroviral Therapy

Neurocognitive outcome is an essential aspect of treatment for HIV-infected children. This study is aimed at assessing cognitive functioning in school-aged HIV-infected children and the change after receiving antiretroviral therapy (ART). We conducted a prospective cohort study of HIV-infected Thai children from 6-12 years of age compared with HIV-affected (children of HIV-positive mothers who were not infected with HIV), and normal control groups. Wechsler Intelligence Scale for Children-III (WISC-III) was administered at enrollment and 30 months of follow-up. Semistructured interviews of primary caregivers were performed. From April to October 2003, 121 children were enrolled; 39 HIV-infected, 40 HIV-affected, and 42 control children with a median age of 9.3 years. The HIV-infected group had a mean (standard deviation [SD]) CD4 percentage of 13.8% (5.3), 87% of whom had been receiving ART for a median of 35 weeks. At the first cognitive assessment, the mean (SD) of full-scale intelligence quotient (FSIQ) was 79 (13) and 88 (10) among HIV-infected and HIV-affected children, which was statistically lower than that of the control group at 96 (13; p < 0.01). The proportion of children with average intelligence level (FSIQ > 90) among 3 groups were 21%, 49%, and 76%, respectively (p < 0.01). At 30 months of follow-up, the HIV-infected group had a mean (SD) CD4 percentage of 25.6% (5.6); 77% had undetectable viral load. The mean (SD) FSIQ of children among three groups were 75 (12), 85 (12), and 91 (12), respectively. Compared with the baseline assessment, the verbal scale score significantly decreased in all groups, including the controls, whereas the performance scales did not change. In conclusion, school-aged HIV-infected children have lower cognitive function than HIV-affected and normal children. Cognitive function was not improved after receiving ART. Further study to address whether early ART can preserve cognitive functioning among HIV-infected children should be explored.

Quality of Life Among HIV-Infected Children in Thailand

The aim of the study was to measure quality of life in human immunodeficiency virus-infected children. This is a cross-sectional study among main caregivers of human immunodeficiency virus-infected children. The questionnaire consisted of 5 main domains: general health, physical functioning, symptoms, psychological well being, and social and role functioning. A total of 131 main caregivers (21% males, average age 42.5 years) of human immunodeficiency virus-infected children (28% male, average age 10.1 years) answered the questionnaires. Four out of 5 domains showed that children without immune suppression had a significantly higher quality of life than children with immune suppression. There was a significant correlation between health care utility and physical functioning, symptoms, and social and role functioning. The instrument had acceptable internal consistency and was a feasible measure of quality of life among human immunodeficiency virus-infected children. The information obtained will enable health care providers to establish comprehensive health care services to serve the needs of these children and their families.

Psychosocial Functioning in Adolescents with Perinatal HIV Infection Receiving Highly Active Antiretroviral Therapy

Background: With effective highly active antiretroviral therapy (HAART), perinatally HIV-infected children are living longer through adolescence. Methods: We conducted a cross-sectional study of perinatally HIV-infected adolescents, aged 11 to 18 years. Demographically matched controls were also enrolled. The adolescents completed the Youth Self-Report (YSR), while the caregivers filled out the Child Behavior Checklist (CBCL), to determine emotional and behavioral problems. Results: The sample included 50 HIV-infected adolescents and 56 controls. The internalizing problem scores from the YSR were significantly higher in the HIV-infected group than those in the control group (13.76 versus 9.95, P = .02). The total competence scores, from both the self-report and the caregiver report in the HIV-infected group, were significantly lower than those of the control group (P = .005 and .001). Conclusion: Although HAART has prolonged the survival of HIV-infected children, they remain at increased risk of psychosocial problems as well as impaired social functioning.

Psychosocial functioning of children with systemic lupus erythematosus.

Aims:  Systemic lupus erythematosus (SLE) is a chronic illness in children. Involvement of multiple systems; the chronicity, as well as the treatment, has had great impact on children and their families. The objective of this study was to assess emotional and behavioural problems in childhood lupus during disease remission.

Health-Related Quality of Life in Adolescents with Thalassemia.

Children and adolescents with thalassemia suffer from chronicity of the disease and its treatment, including transfusion dependence and complications of iron overload. This study aimed to assess the health-related quality of life of adolescents with thalassemia compared with healthy controls. Sixty-four adolescents with thalassemia aged 13 to18 years and their parents were enrolled in this cross-sectional study, as well as their age- and gender-matched those of the healthy controls (64 participants and their parents). The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) self-report form was administered to the adolescents in both groups. Parents were also asked to complete the PedsQL 4.0, parent proxy-report form. The self-reported total, psychosocial, and school functioning scores of the thalassemia patients were significantly lower than those of the healthy controls (p = 0.03, 0.04, and <0.001, respectively). The parent-reported psychosocial and school functioning scores of the thalassemia group were also significantly lower than those of the controls (p = 0.03 and 0.003, respectively). Among adolescents with thalassemia, the serum ferritin level and comorbidity were the only variables associated with quality of life scores. This study showed that thalassemia negatively affected quality of life. For a better quality of life, thalassemia patients should be monitored for serum ferritin levels and treated for comorbidity as part of their comprehensive health care.

Family Functioning in Adolescents with Perinatal HIV Infection

This study aimed to assess family functioning in adolescents with perinatal HIV infection receiving antiretroviral therapy compared with healthy controls. Correlations between self-reported and caregiver-reported family functions were also evaluated. A sample of 195 participants including 65 perinatally HIV-infected adolescents and 130 healthy controls were enrolled. The total family functioning score in HIV-infected adolescents was significantly lower than that in healthy controls by self-report (105.86 vs 115.41; P ≤ .001). Caregivers of HIV-infected adolescents also reported lower scores of family functioning than those of controls (109.91 vs 114.98; P ≤ .001). Among the HIV-infected group, there was no or minimal correlation between the self-reported and caregiver-reported total scores of family functioning. However, there were moderate correlations between self-reported and caregiver-reported family functioning total scores in the control group. Overall, HIV-infected adolescents reported lower family functioning than healthy controls. Improved functioning in the family may help with better adjustment in perinatally HIV-infected adolescents.

Media use and psychosocial adjustment in children and adolescents

Currently, television and new forms of media are readily available to children and adolescents in their daily lives. Excessive use of media can lead to negative physical and psychosocial health effects. This study aimed to describe childrens media use, including media multitasking, as well as the associations between media use and their psychosocial adjustment.

Screen viewing time and externalising problems in pre-school children in Northern Thailand

Objectives: There are increasing reports of younger children accessing media and screen. This study aims to describe screen use in pre-school children and its association with externalising problems. Methods: A cross-sectional study of pre-schoolers aged two to five years was conducted. Their caregivers were asked to provide data regarding screen use by their children and themselves. The Child Behaviour Checklist (CBCL) was completed by caregivers to assess their child’s behaviour. Results: Participants included 200 caregivers of pre-school children. There were 47% of pre-schoolers who had used at least three types of media. When comparing the 0–1, >1 to 2, and >2 hours per day of screen viewing time groups, the children who had experienced more screen time also had significantly more background media and their caregivers had more screen time (p < 0.001). The externalising problem scores increased with more screen viewing time, although the relationship was not statistically significant. However, age and gender of the child were factors associated with externalising problems from the multiple linear regression analysis (p = 0.03). Conclusion: Pre-schoolers with more screen viewing time did not have a significantly greater externalising problem score than those with less screen time. A longitudinal study with a larger sample size would provide more information.