Publications (52)97.97 Total impact
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Article: Erratum to: Environmental risk and protective factors of adolescents' and youths' mental health: differences between parents' appraisal and self-reports.
Quality of Life Research 11/2012; · 2.30 Impact Factor -
Article: Predictors of the use of healthcare services in children and adolescents in Spain.
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ABSTRACT: OBJECTIVE: To assess medium to long term predictors of healthcare services use in a population-based sample of children/adolescents in Spain. METHODS: A sample of children and adolescents aged 8-18 and their parents were evaluated at baseline (2003) and follow-up (2006). Total use of healthcare services and visits to specialist and dentists at the follow-up were analyzed. RESULTS: Four hundred fifty-four children/adolescents completed baseline and follow-up assessments (response rate 54 %). 90 % of respondents reported at least one visit during the 12 months previous to the follow-up. Low socioeconomic status (beta coefficient = 0.30; 95 % CI = 0.02-0.57), double healthcare coverage (0.41; 0.17-0.66), parental use of services, poor mental health and activity limitation were associated to the total number of visits. Access to specialist was associated to double healthcare coverage (OR = 1.77; 1.01-3.07) and parental primary level of education (OR = 0.51; 0.32-0.81). Age and low family affluence predicted visits to dentists (OR = 0.38; 0.19-0.73). CONCLUSION: No barriers to healthcare services use were found. Family level of education, family affluence and double healthcare coverage predicted the use of specialists and dentists.International Journal of Public Health 05/2012; · 2.54 Impact Factor -
Article: Testing the structural and cross-cultural validity of the KIDSCREEN-27 quality of life questionnaire
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ABSTRACT: ObjectivesThe aim of this study is to assess the structural and cross-cultural validity of the KIDSCREEN-27 questionnaire. MethodsThe 27-item version of the KIDSCREEN instrument was derived from a longer 52-item version and was administered to young people aged 8–18years in 13 European countries in a cross-sectional survey. Structural and cross-cultural validity were tested using multitrait multi-item analysis, exploratory and confirmatory factor analysis, and Rasch analyses. Zumbo’s logistic regression method was applied to assess differential item functioning (DIF) across countries. Reliability was assessed using Cronbach’s alpha. ResultsResponses were obtained from n=22,827 respondents (response rate 68.9%). For the combined sample from all countries, exploratory factor analysis with procrustean rotations revealed a five-factor structure which explained 56.9% of the variance. Confirmatory factor analysis indicated an acceptable model fit (RMSEA=0.068, CFI=0.960). The unidimensionality of all dimensions was confirmed (INFIT: 0.81–1.15). Differential item functioning (DIF) results across the 13 countries showed that 5 items presented uniform DIF whereas 10 displayed non-uniform DIF. Reliability was acceptable (Cronbach’s α=0.78–0.84 for individual dimensions). ConclusionsThere was substantial evidence for the cross-cultural equivalence of the KIDSCREEN-27 across the countries studied and the factor structure was highly replicable in individual countries. Further research is needed to correct scores based on DIF results. The KIDSCREEN-27 is a new short and promising tool for use in clinical and epidemiological studies.Quality of Life Research 04/2012; 16(8):1335-1345. · 2.30 Impact Factor -
Article: Environmental risk and protective factors of adolescents' and youths' mental health: differences between parents' appraisal and self-reports.
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ABSTRACT: PURPOSE: We investigated the effect of parents' mental health, life events, and home life (among other factors) on adolescents'/youths' mental health, whether such an effect varies when several variables are assessed jointly, and also whether the informant source of the mental health problem modifies the estimations. METHODS: We studied a representative sample of 454 Spanish adolescents/youths studied longitudinally (2 assessments, 3 years apart). We considered factors associated with adolescents'/youths' mental health (conduct, emotional, and hyperactivity scores [SDQ]): risk factors (parents' mental health and life events) and mediators (social and financial support). Structural equation modeling was applied. We constructed two models: (a) with parents' SDQ responses and (b) with self-reported SDQ responses (in a subsample of N = 260). RESULTS: Model fit was adequate for parents' appraisal. Parents' mental health (p < 0.05) and undesirable life events (p < 0.05) were the most important risk factors. The same model showed poorer fit when self-reported measures were used. Home life exerted a stronger protective effect on adolescents'/youths' mental health when reported by adolescents/youths. The negative effect of parents' mental health was significantly protected by home life in emotional [-0.14 (0.07)] and hyperactivity scores [-0.2 (0.08)]. CONCLUSIONS: Even in the presence of other factors, parents' mental health has an important effect on adolescents'/youths' mental health. Good levels of home life are protective, especially when adolescents'/youths' mental health is self-reported.Quality of Life Research 04/2012; · 2.30 Impact Factor -
Article: Assessing the association between low back pain, quality of life, and life events as reported by schoolchildren in a population-based study.
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ABSTRACT: Low back pain (LBP) is prevalent in teenagers but not necessarily detrimental to their quality of life (QoL). This population-based study evaluated a global QoL score and the association between LBP and life events and/or health problems affecting QoL. Schoolchildren were investigated in Fribourg-Switzerland and Barcelona-Spain. In addition to the KIDSCREEN, a health-related QoL questionnaire, two Numerical Rating Scales were used to assess QoL in general, and the influence of LBP on QoL. Open questions explored life events and health problems affecting QoL; responses were submitted to content analysis. Adolescents were stratified: Pain-free, Other pain (OP), isolated LBP (IsoLBP), LBP + other pains (LBP + OP), and LBP + whole-body pain (LBP + WBP). Between-group comparisons were performed using Chi-squared tests and ANOVA. Linear regression analysis was performed to assess between-group differences in the impact of LBP on QoL. Schoolchildren (1,470) (mean age = 15.05 years, 52.6% = boys) completed the questionnaire. LBP lasting >1 day in the last month was reported by 39.8% (N = 560): of them, 242 (43.2%) reported IsoLBP, 268 (47.9%) LBP + OP, and 50 (9.1%) LBP + WBP. QoL was lower in LBP + WBP (mean = 6.44 vs. LBP + OP = 7.8; IsoLBP = 7.6, OP = 7.96, Pain-free = 8.1; p < 0.001). There were 18.5% who reported health problems and 15.3% life events with a perceived impact on QoL. Prevalence was higher in LBP + WBP with >30% of this group identifying life events and/or health problems vs. 10-12% in PFree or IsoLBP groups (p < 0.001). IsoLBP affected QoL marginally (mean = 2.4 ± 2.2) compared to LBP + WBP (mean = 4.9 ± 2.4) (p < 0.001). LBP affected QoL marginally. These results stress the distinction between disease and common life experience. They also indicate the potential value of global QoL assessments in clinical settings.European Journal of Pediatrics 03/2012; 171(3):507-14. · 1.88 Impact Factor -
Article: Reliability and validity of the Spanish version of the Child Health and Illness Profile Child-Edition/Child Report Form (CHIP-CE/CRF).
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ABSTRACT: To assess the reliability and validity of the Spanish version of the CHIP-CE/CRF. Cross-sectional study was conducted in a representative sample of primary school children in Spain. Children were administered the Spanish version of the CHIP-CE/CRF. The Achenbach Child Behavioral Checklist was given to parents. The overall response rate was 75% (n = 979). Internal consistency was >0.70 for 3 out of 5 domains, and the intraclass correlation coefficient for test-retest stability ranged from 0.69 to 0.80. Confirmatory factor analysis replicated the original model. Younger children scored higher in Satisfaction than older children. Girls scored lower in Comfort but higher in Risk Avoidance than boys. The Spanish version of the CHIP-CE/CRF has shown acceptable reliability and validity, similar to the properties of the original US version. Future studies should analyze the instrument's sensitivity to change.Quality of Life Research 08/2011; 21(5):909-14. · 2.30 Impact Factor -
Article: Overweight and its impact on the health-related quality of life in children and adolescents: results from the European KIDSCREEN survey.
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ABSTRACT: To analyse the impact of overweight on HRQoL in a European sample of children and adolescents. Analyses were conducted using data on 17,159 children and adolescents aged 8-18 from 10 European countries (Germany, Spain, France, Netherlands, Austria, United Kingdom, Switzerland, Hungary, Czech Republic and Poland) participating in the KIDSCREEN Health Interview Survey. In the studied sample (N = 13,041), there were slightly more girls (52.6%) than boys (47.4%). Gender- and age-specific cut-offs of Cole et al. (BMJ 320:1240, 2000) were used to define overweight and obesity. The two groups were collapsed into one 'overweight' category. HRQoL was assessed on 10 dimensions using the KIDSCREEN-52. Univariate analysis of covariance (ANCOVA) was performed for group comparisons (normal weight vs. overweight). Partial eta squared (η (p) (2) ) was used as a measure of effect strength. Overall, 14.2% (N = 1,849) of the sample was overweight, with prevalence rates ranging between 9.4% in France and 17.6% in Spain. Across all countries, overweight children and adolescents had lower mean HRQoL scores than normal weight children and adolescents. The strongest HRQoL impairments emerged on the physical well-being (η (p) (2) = 0.012) and self-perception dimensions (η (p) (2) = 0.021), both P < 0.001. This is one of the first studies comparing the impact of HRQoL at European level using a generic and internationally valid HRQoL instrument, and the results show that, irrespective of national background, overweight children and adolescents are significantly impaired on their HRQoL, in particular on the physical well-being and the self-perception domain.Quality of Life Research 05/2011; 21(1):59-69. · 2.30 Impact Factor -
Article: Low back pain in adolescents: is quality of life poorer in those seeking medical attention?
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ABSTRACT: Paired case-control study. To assess health-related quality of life (HRQOL) and disability in adolescents with low back pain (LBP) referred to a hospital and compare it with adolescents with and without LBP from the general population. Recent studies show that the effect of LBP on HRQOL of adolescents from the general population is insignificant. Poorer HRQOL is attributed to those soliciting specialized medical attention. No study has evaluated HRQOL in adolescents with LBP who seek specialized attention. All consecutive adolescents with nonspecific LBP referred to a hospital outpatient clinic (cases-patients) between January 2006 and October 2007 were compared to two control groups: adolescents with LBP and adolescents without LBP from a representative sample of students. Two controls from each group were randomly paired with each case by city of residence, sex, and age. Cases and controls completed the same self-administered questionnaires, including a generic quality-of-life (KIDSCREEN-52) and two LBP-specific (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire) instruments. A group of teenagers with juvenile idiopathic arthritis completing the same questionnaire was used as external reference. The sample was calculated to detect a difference of more than 4.68 units in KIDSCREEN scores. Comparisons were made using t tests and effect size estimation. Patients (n = 76) had more frequent (P = 0.005) and intense (P < 0.001) LBP than adolescents with LBP in the general population (n = 152) and a poorer score on the Roland-Morris (5.5 vs. 4.3, P = .023) and Hanover (4.5 vs. 3.5, P = 0.032) questionnaires. Nonetheless, in all KIDSCREEN dimensions, patient scores and scores of adolescents with juvenile idiopathic arthritis were similar or better than those of the general adolescent population with or without LBP (n = 152). Adolescents with LBP seeking specialized medical attention have better HRQOL than symptomatic peers from the general population but report worse clinical and functional status.Spine 02/2011; 36(17):E1154-61. · 2.08 Impact Factor -
Article: Properties of a short questionnaire for assessing primary care experiences for children in a population survey.
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ABSTRACT: 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. 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. 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. 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.BMC Public Health 01/2011; 11:285. · 2.00 Impact Factor -
Article: Reliability, construct and criterion validity of the KIDSCREEN-10 score: a short measure for children and adolescents' well-being and health-related quality of life.
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ABSTRACT: To assess the criterion and construct validity of the KIDSCREEN-10 well-being and health-related quality of life (HRQoL) score, a short version of the KIDSCREEN-52 and KIDSCREEN-27 instruments. The child self-report and parent report versions of the KIDSCREEN-10 were tested in a sample of 22,830 European children and adolescents aged 8-18 and their parents (n = 16,237). Correlation with the KIDSCREEN-52 and associations with other generic HRQoL measures, physical and mental health, and socioeconomic status were examined. Score differences by age, gender, and country were investigated. Correlations between the 10-item KIDSCREEN score and KIDSCREEN-52 scales ranged from r = 0.24 to 0.72 (r = 0.27-0.72) for the self-report version (proxy-report version). Coefficients below r = 0.5 were observed for the KIDSCREEN-52 dimensions Financial Resources and Being Bullied only. Cronbach alpha was 0.82 (0.78), test-retest reliability was ICC = 0.70 (0.67) for the self- (proxy-)report version. Correlations between other children self-completed HRQoL questionnaires and KIDSCREEN-10 ranged from r = 0.43 to r = 0.63 for the KIDSCREEN children self-report and r = 0.22-0.40 for the KIDSCREEN parent proxy report. Known group differences in HRQoL between physically/mentally healthy and ill children were observed in the KIDSCREEN-10 self and proxy scores. Associations with self-reported psychosomatic complaints were r = -0.52 (-0.36) for the KIDSCREEN-10 self-report (proxy-report). Statistically significant differences in KIDSCREEN-10 self and proxy scores were found by socioeconomic status, age, and gender. Our results indicate that the KIDSCREEN-10 provides a valid measure of a general HRQoL factor in children and adolescents, but the instrument does not represent well most of the single dimensions of the original KIDSCREEN-52. Test-retest reliability was slightly below a priori defined thresholds.Quality of Life Research 12/2010; 19(10):1487-500. · 2.30 Impact Factor -
Article: Reliability and validity of the Spanish version of the TAPQOL: a health-related quality of life (HRQOL) instrument for 1- to 5-year-old children.
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ABSTRACT: To evaluate the reliability, and construct validity of the Spanish version of the TNO-AZL preschool children quality of life (TAPQOL). A consecutive sample of children (3 months to 5 years old) was recruited from primary care centers and two teaching hospitals in Spain. The TAPQOL and a set of questions related to their child's health status were administered to parents. Clinical diagnoses were collected from clinical records. Principal component analysis (PCA) with varimax rotation was used to analyze the instrument's structure. Effect size (ES) and analysis of variance (ANOVA) were used to analyze differences between subgroups known to be in poor health compared to the healthy subgroup. A total of 228 children participated in the study (response rate=95%). Ten of the 12 scales showed more than 30% ceiling effect. All dimensions except one had Cronbach's alpha coefficients greater than 0.7. PCA explained 75% of the variance. Healthy children in general had better scores than the other subgroups. Children at risk of poor health outcomes and those with respiratory problems scored lower in several scales than the healthy subgroup. Although the Spanish TAPQOL shows a non-negligible ceiling effect, it seems to be a reliable and valid instrument for Spanish infants and toddlers, and with similar psychometric characteristics to the original version. Future studies should try to improve questionnaire's structure and assess its sensitivity to change.International journal of nursing studies 10/2010; 48(5):549-56. · 1.91 Impact Factor -
Article: Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey.
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ABSTRACT: To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey. Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions. All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D. The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.Quality of Life Research 03/2010; 19(6):853-64. · 2.30 Impact Factor -
Article: Quality of life and rare diseases.
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ABSTRACT: HRQOL assessment in patients with rare diseases can help to identify health needs, to evaluate the impact of disease and treatments, and to assess the evolution in health status through the natural history of disease. Several studies have shown that although some rare diseases do not necessarily affect life expectancy, the majority lead to physical, emotional and/or psychosocial limitations with a wide range of disabilities. Reliability as well as content, criterion, and construct validity, and also responsiveness should be taken into account in selecting the instrument to be used assessing individuals with rare diseases. The use of proxy-report may be essential in some cases where the patient is cognitively impaired or unable to communicate. Criteria for selecting a HRQOL instrument, as well as the more common strategies proposed help interpret scores on HRQOL instruments are addressed in the chapter. Given the impact of rare diseases on the quality of life of both patients and carers, it is likely that interest in its measurement will continue to increase among professionals, patients, and the general public. Improving the quality of life of people with rare diseases should be one of the most important goals of any health care intervention or multidisciplinary approach.Advances in experimental medicine and biology 01/2010; 686:251-72. · 1.09 Impact Factor -
Article: Reliability and validity of the Spanish version of the Child Health and Illness Profile (CHIP) Child-Edition, Parent Report Form (CHIP-CE/PRF).
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ABSTRACT: The 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. Parents 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. The 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). The 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.Health and Quality of Life Outcomes 01/2010; 8:78. · 2.11 Impact Factor -
Article: Routine care provided by specialists to children and adolescents in the United States (2002-2006).
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ABSTRACT: Specialist physicians provide a large share of outpatient health care for children and adolescents in the United States, but little is known about the nature and content of these services in the ambulatory setting. Our objective was to quantify and characterize routine and co-managed pediatric healthcare as provided by specialists in community settings. Nationally representative data were obtained from the National Ambulatory Medical Care Survey for the years 2002-2006. We included office based physicians (excluding family physicians, general internists and general pediatricians), and a representative sample of their patients aged 18 or less. Visits were classified into mutually exclusive categories based on the major reason for the visit, previous knowledge of the health problem, and whether the visit was the result of a referral. Primary diagnoses were classified using Expanded Diagnostic Clusters. Physician report of sharing care for the patient with another physician and frequency of reappointments were also collected. Overall, 41.3% out of about 174 million visits were for routine follow up and preventive care of patients already known to the specialist. Psychiatry, immunology and allergy, and dermatology accounted for 54.5% of all routine and preventive care visits. Attention deficit disorder, allergic rhinitis and disorders of the sebaceous glands accounted for about a third of these visits. Overall, 73.2% of all visits resulted in a return appointment with the same physician, in half of all cases as a result of a routine or preventive care visit. Ambulatory office-based pediatric care provided by specialists includes a large share of non referred routine and preventive care for common problems for patients already known to the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.BMC Health Services Research 12/2009; 9:221. · 1.66 Impact Factor -
Article: [Cross-cultural adaptation of the KIDSCREEN questionnaire to measure the health related quality of life in the 8 to 18 year-old Argentinean population].
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ABSTRACT: Health related quality of life (HRQOL) measures are increasingly used in research and clinical practice. The KIDSCREEN is a questionnaire developed in Europe for an 8 to 18 year-old population. To cross-culturally adapt this questionnaire for the Argentinean population, and to evaluate its cultural adequacy and semantic equivalence against the original version. Forward and backward translation according to international recommendations for cross-cultural adaptation of questionnaires, including the translation by professional linguists, cognitive interviews with people of different ages, gender and socioeconomic status to analyze cultural adequacy, and comparison of the Argentinean with the original versions to establish semantic equivalence. The language required adaptation in the use of pronouns and verb tenses. Most of the items were considered to have low translation difficulty and high semantic equivalence. Boys and girls 8-11 years (n= 7), 12-15 years (n= 7), and 16-18 years (n= 2) participated in the interviews, as well as 6 mothers. There were no major difficulties in understanding, but younger children being in the lower socioeconomic status had some difficulties to answer the questionnaire. Eight questions were modified to achieve greater semantic equivalence. The Argentinean version of the KIDSCREEN questionnaire obtained through cross-cultural adaptation process, was equivalent to the European version. Future studies should establish its reliability and validity. It provides a useful measure of HRQOL for studies in clinical, school or community settings, with the possibility to establish international comparisons.Archivos argentinos de pediatría 08/2009; 107(4):307-14. · 0.37 Impact Factor -
Article: 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.
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ABSTRACT: Health-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. A 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. The 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. The 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.Health and Quality of Life Outcomes 05/2009; 7:35. · 2.11 Impact Factor -
Article: Being bullied: associated factors in children and adolescents 8 to 18 years old in 11 European countries.
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ABSTRACT: To analyze the prevalence of bullying victims among children and adolescents aged 8 to 18 years in 11 European countries and to investigate the associated sociodemographic, physical, and psychosocial factors. Being a bullying victim was measured by using the social acceptance (bullying) scale from the Kidscreen-52, a health-related quality-of-life questionnaire administered to 16 210 children and adolescents aged 8 to 18 and their parents in postal or school-based surveys in 11 European countries. Standardized mean differences (effect size) were computed to measure the percentage of children/adolescents scoring 1 SD below the mean on the Kidscreen bullying scale. Logistic regression models were used to determine which sociodemographic, physical, and psychosocial factors were associated with being bullied. The percentage of children being bullied was 20.6% for the entire sample, ranging from 10.5% in Hungary to 29.6% in the United Kingdom. In almost all countries the factors most strongly associated with being bullied were younger age, having probable mental health problems, having a low score on the Kidscreen-52 moods and emotions dimensions, and poor social support. Using the grand mean for all countries as the reference category, there was an above-average likelihood of children or adolescents reporting that they had been victims of bullying in 5 countries (Austria, Netherlands, Spain, Switzerland, and the United Kingdom), and a below-average likelihood in 3 countries (France, Greece, Hungary). This study indicated considerable variation between countries in the prevalence of those perceiving themselves to be victims of bullying but also revealed a clear profile of those likely to be bullied. The study also suggests that the Kidscreen bullying scale could be useful in identifying potential bullying victims.PEDIATRICS 03/2009; 123(2):569-77. · 4.47 Impact Factor -
Article: Correlates of use of health care services by children and adolescents from 11 European countries.
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ABSTRACT: 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. Cross-sectional surveys in representative samples included using phone or school-based sampling. 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. Any visit to ("access") and number of visits ("intensity of use") to health care professionals during the previous 12 months. 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. 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.Medical care 03/2009; 47(2):161-7. · 3.24 Impact Factor -
Article: Prevalence of low back pain and its effect on health-related quality of life in adolescents.
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ABSTRACT: To assess the prevalence of low back pain (LBP) in adolescents and the clinical features of LBP in 2 European countries and to evaluate the effect of LBP on health-related quality of life (HRQOL) using standardized validated generic and disease-specific instruments. Cross-sectional study. Secondary schools of Barcelona, Spain, and Fribourg, Switzerland. Representative sample of adolescents from the 2 cities. Intervention Selected adolescents completed a questionnaire including a generic HRQOL (KIDSCREEN-52) and 2 LBP-specific instruments. Results of KIDSCREEN-52, the Roland-Morris Disability Questionnaire, and the Hanover Functional Ability Questionnaire. A total of 1470 adolescents (52.6% male) with a mean (SD) age of 15.05 (1.17) years completed the questionnaires (response rate, 85.1%). Low back pain was reported by 587 adolescents (39.8%): isolated LBP in 250 (42.6%), LBP plus other pain in 271(46.2%), LBP plus whole-body pain in 50 (8.5%, and unclassifiable LBP in 16 (2.7%). Five hundred adolescents (34.7%) reported no pain, and 369 (25.6%) reported other pain without LBP. In those with isolated LBP, the percentage of adolescent boys was higher (54.6%; P < .001) and the LBP was mildest. In those with LBP plus whole-body pain, the percentage of adolescent girls was higher (62%; P < .001) and LBP was most severe. All KIDSCREEN scores in the group with LBP plus whole-body pain were significantly lower than in the other groups (effect size, 0.52-1.24). No differences were found between the groups who reported isolated pain, no pain, or other pain with no LBP. On the LBP-specific instruments, adolescents who reported LBP plus other pain had significantly poorer scores (P < .001) compared with those with isolated LBP but better scores (P < .001) than those with LBP plus whole-body pain. Low back pain in adolescents is a prevalent symptom with overall low associated disability and little effect on health-related quality of life. A subset of adolescents in whom LBP is associated with whole-body pain report significant impairment and deserve more attention.Archives of pediatrics & adolescent medicine 01/2009; 163(1):65-71. · 3.73 Impact Factor
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Institutions
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2012
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Hospital del Mar Medical Research Institute
Barcelona, Catalonia, Spain
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2011
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Universität Hamburg
- Department of Child and Adolescent Psychiatry and Psychotherapy
Hamburg, Hamburg, Germany
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2009–2011
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Hospital Universitari Vall d'Hebron
Barcelona, Catalonia, Spain
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2010
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University Medical Center Hamburg - Eppendorf
Hamburg, Hamburg, Germany
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2007–2010
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Agència de Salut Pública de Barcelona
Barcelona, Catalonia, Spain -
Universität Bielefeld
Bielefeld, North Rhine-Westphalia, Germany -
Institut Català de la Salut
Cerdanyola del Vallès, Catalonia, Spain
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2008
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University Pompeu Fabra
Barcelona, Catalonia, Spain -
The University of Manchester
Manchester, ENG, United Kingdom
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2006
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Robert Koch Institut
Berlin, Land Berlin, Germany
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