Marcus Klein

Background: Monosymptomatic nocturnal enuresis (MNE) affects 10–15% of children at school age. Influences on psychological well-being and self-confidence were repeatedly described, but effects on health-related quality of life (HRQoL) have been rarely reported. The aim of this study is to examine the HRQoL under therapy by using KINDL-R and to compare it with three recognized chronic diseases. Methods: Questionnaires were sent to all patients with MNE of the special outpatient clinic for enuresis (age 7–17 years; groups: I: 7–13, II: 14–17 years; at least 3 months of therapy, no achieved dryness). Simultaneously, patients from special outpatient clinics for allergic bronchial asthma (ABA), diabetes mellitus type I (DMI), and juvenile idiopathic arthritis (JIA) were asked to take part in the study. Results: Included patients: 47 MNE (I:41/II:6)/59 ABA (I:34/II:25)/57 DMI (I:31/II:26)/37 JIA (I:18/II:19). Patient reports showed no significant differences between the cohorts in both age groups examined with regard to the total score and six individual dimensions. In the additional “chronic-generic” module, patients with MNE in the age of 7–13 years showed significantly lower values than all other study cohorts ( p < 0.001). Conclusions: Patients under therapy for MNE without achieving dryness showed no significant differences in overall HRQoL or individual dimensions compared to the reference groups, but a significantly lower HRQoL in the chronic-generic module in children and parents (group 7–13 years) and in adolescents (14–17 years of age). This result is consistent with reported limitations in self-esteem and HRQoL before therapy and supports the need and importance of adequate therapy for MNE. Graphical

Zusammenfassung Hintergrund Die primäre Enuresis nocturna (PNE) betrifft einen relevanten Anteil von Kindern (10–15 % bei Einschulung). Es wird ein großer Einfluss auf das psychologische Wohlbefinden und Selbstbewusstsein der betroffenen Kinder beschrieben, die Auswirkungen auf die HRQoL („health related quality of life“) sind jedoch bisher wenig untersucht. Ziel dieser Untersuchung ist es, die Lebensqualität unter Therapie mittels eines etablierten Fragebogens zu untersuchen. Methode Der KINDL‑R als HRQoL-Fragebogen mit 24 Items in 6 Dimensionen wurde an alle Patienten der Enuresissprechstunde (Alter 7–17 Jahre, mindestens 3 Monate Therapie, keine Trockenheit) versandt. Aus den Ambulanzdaten wurden aktuelle Einnässfrequenz und evtl. Begleiterkrankungen ermittelt. Ergebnisse Von 57 versandten Fragebögen kam es zu einem Rücklauf von 47 Kinder- und Elternbögen (82,5 %). Die Befragungen der Patienten zeigten keine Korrelation zwischen HRQoL und Alter, lediglich eine negative Korrelation des körperlichen Wohlbefindens mit zunehmendem Alter (r = −0,259, p < 0,05). Eine deutliche negative Korrelation (r = −0,372, p < 0,05) ergab sich zwischen Einnässfrequenz und Gesamt-HRQoL, insbesondere in den Dimensionen „Selbstwert“ (r = −0,399, p < 0,005) und „chronisch-generisch“ (r = −0,383, p < 0,05). Diskussion Die Patienten im Therapieprozess ihrer PNE ohne erreichte Trockenheit zeigten keine systematische Einschränkung der HRQoL im Vergleich zu Referenzkollektiven. Dies steht im Kontrast zu berichteten Einschränkungen von Selbstwertgefühl und HRQoL vor Therapie, wird jedoch möglicherweise durch die Korrelation dieser Dimensionen mit der Einnässfrequenz in dieser Studie und die in anderen Studien berichtete Besserung unter Therapie erklärt. Beides unterstützt die Notwendigkeit und Bedeutung einer adäquaten Therapie der PNE.

Introduction: To achieve optimized blood glucose concentrations (assessed by HbA1c) and high health-related quality of life (HRQL), children and adolescents with diabetes mellitus type 1 (T1DM) must follow strict disease management strategies. This study aims to investigate HRQL of children and adolescents with T1DM and its association with HbA1c values over the course of 6 months. Methods: Patients aged 7–17 years (n = 203) with T1DM provided HRQL data on a monthly basis. HRQL was measured using the Kids-CAT, a computer-adaptive test (CAT) comprising five generic HRQL domains. HbA1c concentrations were assessed at baseline, at 3 and 6 months. We explored the trajectory of HRQL at the domain level using linear mixed effects models. Further, we investigated the association between HRQL and HbA1c concentrations over time using path analysis models. Results: Children and adolescents with T1DM reported high scores across all HRQL domains over time. However, those with an HbA1c concentrations of >9.0% reported significantly lower scores in physical well-being and parent relations compared with those with an HbA1c concentration of 9.0% reported lower scores in selected HRQL domains. Thus, special attention should be drawn to HRQL of children and adolescents with higher HbA1c concentrations. The minimal relationship between HbA1c and HRQL indicates that the two therapy goals, i.e., achievement and maintenance of glycemic targets and high HRQL, should be considered and evaluated independently in clinical routine. Trial Registration: DRKS00006326 (German Clinical Trial Register), date of registration: August 1st, 2014.

Introduction: The improvement—or at least maintenance—of health-related quality of life (HRQoL) in children and adolescents is one of the main aims of chronic disease care. This study examines HRQoL of children and adolescents with three different chronic conditions (i.e., diabetes mellitus, asthma, juvenile arthritis) using the computer-adaptive test Kids-CAT, comprising five HRQoL domains: physical well-being, psychological well-being, parent relations, social support and peers, and school well-being. Further, associations between HRQoL and distinct clinical data and medical assessments are investigated to explore how much variability of the five domains can be explained by these variables. Methods: Cross-sectional data of the Kids-CAT study was analyzed. The Kids-CAT was used in two outpatient clinics in northern Germany gathering data on self-reported HRQoL in n = 309 children and adolescents aged 7–17 years. Additionally, general patient information, clinical data, and pediatrician-reported medical assessments were measured. Multiple regression analyses were conducted to explore associations between HRQoL and selected variables (i.e., disease duration, co-morbidity, disease control, overall health status). Results: Overall, self-reported HRQoL in all five domains were comparable to data of an age- and sex-matched reference population. Results of regression analyses indicated that the investigated variables only minimally explain variance in the five Kids-CAT domains. Sociodemographic, clinical data, and medical assessments explained 18.4% of the variance in physical well-being, 10.7% in psychological well-being, and < 10% of the variance in parent relations, social support and peers, and school well-being. Conclusion: Sociodemographic data, disease duration, co-morbidity, and medical assessments, such as disease control or pediatrician-assessed overall health status show low association with HRQoL of children and adolescents with chronic conditions. Data on self-reported HRQoL delivers valuable information on children's well-being and can improve healthcare professionals' understanding of the subjective well-being of their young patients. The implementation of tools like the Kids-CAT can facilitate the identification of potential problem areas, which should enable healthcare professionals to better address specific healthcare needs. Clinical Trial Registration: identifier: DRKS00006326 (retrospectively registered); Date of registry: August 1st, 2014.

In einer prospektiven, randomisierten, einfach blinden Studie wurden 48 Jugendliche zwischen 13 und 17 Jahren am Morgen nach stationärer Aufnahme mit Alkoholintoxikation mithilfe eines standardisierten Fragebogens zum bisherigen Trinkverhalten befragt. Während bei einem Teil der Jugendlichen eine psychologische Intervention (HaLT-Präventionsprojekt) erfolgte (A: n=28), wurde bei dem anderen Teil der Studienteilnehmer auf das Gespräch verzichtet (B: n=20). 6 und 12 Wochen nach dem stationären Aufenthalt wurden die Jugendlichen telefonisch zum aktuellen Trinkverhalten befragt. Insgesamt tranken 58% (n=28) der Studienteilnehmer im Untersuchungszeitraum weniger und/ oder seltener Alkohol als vor der Alkoholintoxikation. 17% (n=8) verzichteten während der 12 Wochen komplett auf den Konsum alkoholischer Getränke. 54% (n=26) der Jugendlichen behaupteten, nicht wieder betrunken gewesen zu sein. 38% (n=18) haben ihr Trinkverhalten nicht verändert und 6% (n=3) tranken mehr und/oder häufiger als zuvor Alkohol. Es gab keinen statistisch signifikanten Unterschied in der Entwicklung des Trinkverhaltens zwischen den beiden Gruppen: 58% (A) bzw. 65% (B) der Jugendlichen mit bzw. ohne Gespräch tranken nach dem Ereignis weniger und/ oder seltener (χ²=0,6269, p=0,4285). Ein Einfluss der Gespräche im Rahmen des HaLT-Präventionsprojektes bei stationär aufgenommenen Jugendlichen nach Alkoholintoxikation konnte nicht nachgewiesen werden. Weitere Untersuchungen müssen Interventionen bei Eltern und peers mit einbeziehen. Individual Motivational Interventions after alcohol-related event treated in Hospital – Effective Option for Secondary Prevention in Adolescence? In a prospective, randomized, single-blind study 48 adolescents between 13 and 17 years answered a standardized questionnaire about their behavior of alcohol-consumption after an alcohol-related event with hospitalization. They were divided in 2 groups by randomization: Group A (n=28) took part in an individual motivational intervention (HaLT-Präventionsprojekt), Group B (n=20) did not get any intervention. Six and 12 weeks after the hospitalization the same questionnaire was answered again by telephone-based interviews. The interviewer did not know to which group the interview-partner belonged. 58% (n=28) of all adolescents drank less alcohol or in a lower frequency than before the alcohol-related event. 17% (n=8) did not drink any alcohol in that period of 12 weeks. 54% (n=26) explained, that they had no events of drunkenness in that period. 38% (n=18) did not change their behavior in consumption of alcohol. 6% (n=3) drank more or in higher frequency than before. We could not find any significant difference in the behavior of alcohol-consumption of both groups: 58% (A) resp. 65% (B) drank less than the time before the alcohol-related event (χ²=0,6269; p=0,4285). An influence of the individual motivational intervention could not be shown. Further studies should include interventions for parents and peers.

Health-related quality of life (HRQoL) is an important patient-reported outcome in clinical and health research. The EQ-5D-Y assesses child and adolescent HRQoL by five items on mobility, self-care, usual activities, pain/discomfort, and anxiety/depression as well as a visual analogue scale (VAS) on the current health state. This study investigates predictors of self-reported HRQoL according to the EQ-5D-Y in chronically ill children and adolescents using longitudinal data.

Recently, we developed a computer-adaptive test (CAT) for assessing health-related quality of life (HRQoL) in children and adolescents: the Kids-CAT. It measures five generic HRQoL dimensions. The aims of this article were (1) to present the study design and (2) to investigate its psychometric properties in a clinical setting.