S. A. Reijneveld

The impact of disabilities on quality of life in people with multiple sclerosis

Objective People with Multiple Sclerosis (MS) experience lower levels of quality of life (QOL) than people from the general population. We examined the relative impact of MS-related disabilities on QOL. Method Data were obtained from a sample of 530 patients who completed the Multiple Sclerosis Impact Profile (MSIP), a disability measure based on the International Classification of Functioning,Disabilities and Health (ICF) and two generic health-related QOL measures, the Medical Outcome study Short Form Questionnaire (SF-36) and the World Health Organization Quality Of Life-BREF (WHOQOL-BREF). The impact of disabilities on QOL was estimated using hierarchical multiple regression analyses after controlling for the clinical course of MS. Results Disabilities contributed to a unique and substantial extent to QOL variance. “Impairments in mental functions” was the most important QOL predictor. “Fatigue” showed the highest prevalence and severity scores, while the impact on QOL was limited. The estimated impact on QOL appeared to be dependent on the applied QOL measure: the WHOQOL-BREF was sensitive to disabilities related to all four ICF components, while the SF-36 was only sensitive to disabilities belonging to the body functions and ‘activities’ components. Conclusion Treatment programmes should target impairments in cognitive functioning, emotional functioning and sleep. Interventions are best evaluated using the WHOQOL-BREF.

Stability and relative validity of the Multiple Sclerosis Impact Profile (MSIP)

Objective. To examine the stability and relative validity of the Multiple Sclerosis Impact Profile (MSIP) in criterion-related groups. The MSIP is a disease-targeted health impact measure based on a selection of International Classification of Functioning, Disability and Health (ICF) aspects selected by 98 patients and medical and non-medical health professionals. Method. Data were obtained from a postal survey of 377 individuals with Multiple Sclerosis (MS) attending the MS centre of the University Medical Center Groningen (UH) and 153 subjects from the MS patients association. Stability was tested with t-tests for paired samples and intraclass correlation coefficients for repeated measures in a sample of 251 individuals from the UH sample. The Relative Validity (RV) was estimated using the Short Form Questionnaire (SF-36), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Disability and Impact Profile (DIP), the Impact on Autonomy Questionnaire (IPAQ) and the Groningen Activity Restriction Scale (GARS). Results. These indicate that the MSIP is a stable measure in time. MSIP scales showed satisfactory and strong RV. In general, the domain-specific activities and participation measures (GARS and IPAQ) performed equally or slightly better than the comparable MSIP-scales, while the MSIP performed better than the multidimensional health impact measures (SF-36, DIP and WHOQOL-BREF). Conclusion. The MSIP demonstrated good stability and RV compared to generic health impact and domain-specific measures.

Gender differences in adolescent health-related behaviour diminished between 1998 and 2006.

OBJECTIVESnMale teenagers used to smoke more than females, but this male:female ratio has reversed in several European countries over recent decades. The aim of this study was to assess whether a similar shift in gender differences in smoking and other health-related behaviours has occurred in Slovak adolescents over the last decade.nnnSTUDY DESIGNnCross-sectional study.nnnMETHODSnData were collected in 1998 (n=2616, 52.4% male, mean age 14.9±0.6 years, response rate 96.3%) and 2006 (n=1081, 47.0% male, mean age 14.3±0.6 years, response rate 93.0%). Changes in gender-specific prevalence rates for smoking, alcohol consumption and lack of physical activity were assessed for both cohorts overall and by socio-economic group using the highest educational level of the parents.nnnRESULTSnStatistically significant changes occurred in the male:female ratios for smoking and lack of physical activity but not for alcohol consumption. The prevalence of smoking in males dropped below that in females, and the physical activity of females increased substantially. However, changes in gender ratios varied strongly by socio-economic group. The greatest shift in the gender ratio for smoking occurred in the middle socio-economic group, showing an increase in the entire sample. Changes in gender ratios over time among adolescents from the highest socio-economic group were much smaller.nnnCONCLUSIONSnThe behaviour of Slovak female adolescents has become similar to that of their male peers in terms of smoking and physical activity. This shift in the gender ratio in Slovakia over the last decade mimics the shift in Western Europe from approximately two decades ago.

Change in disability profile and quality of life in multiple sclerosis patients: a five-year longitudinal study using the Multiple Sclerosis Impact Profile (MSIP):

Background: Evidence on the progress of disease severity in Multiple Sclerosis (MS) is generally limited in scope. Objectives: To examine the course of a broad spectrum of MS-related disabilities and quality of life (QOL) in relation to disease severity, and responsiveness of the Multiple Sclerosis Impact Profile (MSIP). Methods: The mortality rate was calculated after checking the national population register for vital status of the initial cohort. We performed a longitudinal study among 245 patients with MS attending the Groningen MS Center in the Netherlands. We assessed these patients in 2004 and 2009 using a postal survey including the MSIP to evaluate disabilities, the World Health Organization Quality of Life-Abbreviation version (WHOQOL-BREF) to evaluate QOL, and the ambulation question of the Expanded Disability Status Scale (EDSS) to evaluate disease severity. Responsiveness of the MSIP was estimated using standardized response mean (SRM). Results: Increase of disability in the MSIP disability domains and loss of QOL were most prevalent and pronounced in patients with EDSS 0 to < 4.5 in 2004. MSIP and QOL scores were remarkably stable in the higher disease severity groups. Mortality rates were highest (24%) in patients with EDSS ≥ 7 to < 10 in 2004. SRM indices for the MSIP ranged between 0.26 and 0.56. Conclusions: Prominent increases in multiple aspects of disability and loss of QOL occur especially in the early stages in MS. Health care interventions may lead to health and QOL gains, in particular when offered to patients in the first stage of the MS process. Responsiveness was sufficient for nine of the 11 MSIP domains.

Adding a subjective dimension to an ICF-based disability measure for people with multiple sclerosis: development and use of a measure for perception of disabilities

Objective. The subjective dimension of disability, the perception of disability, is a dimension missing from the International Classification of Functioning, Disability and Health (ICF), and from health-related quality of life (HRQOL) instruments. However, it is a highly relevant dimension for clinical practice as perceived disability may identify care needs. We therefore developed a measure for this subjective dimension of disability in multiple sclerosis (MS) and examined the contribution of this dimension to QOL. Method. A measure named the Multiple Sclerosis Impact Profile-Disability Perception (MSIP-DP) was developed to reflect a persons perception of disabilities reported using the original MSIP-disability (MSIP-D) items. MS patients (n = 530) completed both MSIP sections, the medical outcome study short form questionnaire (SF-36), the World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and questions concerning disease severity. The contribution of disability perception (DP) to QOL in MS was estimated using hierarchical multiple regression analyses after controlling for MS severity. Results. Confirmative factor analysis confirmed the hypothesised disability perception domains that correspond with the related disability domains in the MSIP. DP scales yielded sufficient reliability. DP explained a unique and substantial part of the variance in QOL, particularly the perception of impairments in mental functions. Discussion. Results indicated that the subjective dimension of functioning and health operationalised in the MSIP-DP is a relevant concept in explaining QOL in MS. In clinical practice psychological interventions addressing a patients perception of disability, particularly of impairments in mental functioning, may contribute to QOL.

Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender

Background Roma people are commonly described as having an unhealthy lifestyle—for example, an unhealthy diet, intensive smoking, frequent alcohol consumption and a lack of physical activity. However, data about such health-endangering behaviours among Roma adolescents are scarce and of poor quality. The aim of our study is to assess the occurrence of health-endangering behaviours among Slovak Roma adolescents in comparison to non-Roma adolescents, and to assess the impact of parental education and social desirability on the differences found. Methods A cross-sectional study among Roma from separated and segregated settlements in the eastern part of Slovakia (n=330; mean age 14.50u2005years; interview) and non-Roma adolescents (n=722; mean age 14.86u2005years; questionnaire) was conducted. The effect of ethnicity and parental education on smoking, drunkenness, drug use and physical activity was analysed separately for boys and girls using logistic regression and adjusted for social desirability. Results Among girls, Roma adolescents had lower rates of smoking, drunkenness and drug use than non-Roma (ORs from 0.14 to 0.60 compared to non-Roma), but had higher rates of physical inactivity. Among boys, drug use was less frequent among Roma adolescents (OR 0.12, 95% CI 0.03 to 0.46); differences for the other health-endangering behaviours were small and statistically insignificant. The effects of parental education and social desirability were small. Conclusions In contrast to the scarce evidence, Roma had lower rates of substance abuse, especially among girls. Only physical inactivity rates were higher among Roma girls. A challenge in health promotion among Roma is to maintain their relatively low substance use and to promote physical activity.

Parental Divorce and Adolescent Drunkenness: Role of Socioeconomic Position, Psychological Well-Being and Social Support

Background: The aim of this cross-sectional study was to explore the association between parental divorce and adolescent drunkenness in the last 4 weeks and the contribution of socioeconomic position, family structure, social support from family and well-being to this association. Methods: We obtained data on 3,694 elementary school students from several cities in Slovakia (mean age 14.3, 49.0% males; response rate 93%). Respondents completed questionnaires on how often they had been drunk in the last 4 weeks, whether their parents were divorced, their socioeconomic position (education of parents, family affluence), the composition of the household (one or two parents/step-parents), social support from the family and their own well-being. Results: Parental divorce was found to have an effect on adolescent drunkenness in the last 4 weeks, as well as high socioeconomic position, low social support from the family and high depression/anxiety. The effect of divorce on drunkenness decreased only slightly after adding social support into the model. Conclusion: Our findings indicate that parental divorce has a persistent influence on risk behavior independent of the influence of socioeconomic position and well-being. Parental divorce may increase the likelihood of drunkenness more than other factors such as low parental support and poor socioeconomic position.

Socio-economic status and physical activity among adolescents: the mediating role of self-esteem.

OBJECTIVESnPhysical activity is an essential part of a healthy lifestyle in adolescence. Previous studies have shown physical activity to be associated with socio-economic status and self-esteem; the latter association may mediate the former, but evidence on this is lacking. The aim of this study was to explore the associations of socio-economic status and the self-esteem of adolescents with physical activity, and their joint effects.nnnMETHODSnA sample of 3694 elementary-school students from Slovakia (mean age 14.3 years, 49% boys) completed the Rosenberg Self-esteem Scale and answered questions about the frequency of their physical activity and their parents educational level.nnnRESULTSnAdolescents with higher socio-economic status were significantly more likely to report physical activity on ≥5 days/week and to report higher self-esteem. In logistic regression, the association between socio-economic status and physical activity decreased after including self-esteem, suggesting that at least a part of this association is mediated by self-esteem.nnnCONCLUSIONSnTo conclude, youths from lower socio-economic groups have already been identified as a target group, for intervention. These findings suggest that it is important for promotion programmes to focus not only on the enhancement of their physical activity, but also on their self-esteem as a possible mediator.

Does the influence of peers and parents on adolescents' drunkenness differ between Roma and non-Roma adolescents in Slovakia?

Background. Roma adolescents have been shown to use less alcohol than non-Roma adolescents. This could be due to the protective influences of peers and parents. Objective. The purpose of this study was to explore differences in the levels of peer and parental influence and their effects on drunkenness between Roma and non-Roma adolescents. Design. Data were obtained in Eastern Slovakia from 330 Roma (mean age=14.50; 48.5% boys) and 722 non-Roma (mean age=14.86; 53.2% boys) primary school pupils. We analysed data on adolescent drunkenness (being drunk at least once in the past four weeks), parental monitoring (parents knowing with whom their children are when they go out) and peer influence (best friend drinking alcohol at least once a week) using logistic regression. Results. Roma adolescents self-reported more parental monitoring and less peer influence when compared with their non-Roma counterparts (p<0.001). Less parental monitoring contributed to the probability of drunkenness only among girls (OR/CI: 4.17/2.00–8.69). This effect of parental monitoring was not modified by ethnicity. Peer influence affected drunkenness in both boys (OR/CI: 3.34/1.91–5.85) and girls (4.84/2.55–9.19), but there was no significant interaction of ethnicity with peer influence. Conclusion. While both boys and girls seem to be sensitive to peer influence, only girls appear to be sensitive to parental monitoring in regard to drunkenness. Stronger parental monitoring and weaker peer influence partially explain the lower prevalence of drunkenness among Roma adolescents, whereas the effects of these factors per level do not vary between Roma and non-Roma adolescents.

Changes in socio-economic differences in adolescent self-reported health between 15 and 19 years of age : a longitudinal study

The period of adolescence maybeparticularlyimportantintheshapingofthesocio-economicgradient. However, despite its importance, only a few follow-up studies of adolescents have investigated changes in socio-economic differences in health during adolescence.Patterns of socio-economic inequalities may vary bygender, although findings have been inconsistent. Mustardand Etches