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      Health-related quality of life and mental health in children and adolescents with strabismus – results of the representative population-based survey KiGGS

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          Abstract

          Background

          To estimate the effect of strabismus (squinting) on mental health and health-related quality of life aspects in children and adolescents.

          Methods

          Data from the German Health Interview and Examination Survey for Children and Adolescents KiGGS (2003–2006 baseline survey; N = 14,835, aged 3 to 17 years, 49% girls) were examined. The presence of strabismus was derived by parental questionnaire, and health-related quality of life and mental health were investigated with the KINDL-R and Strengths and Difficulties Questionnaire. Associations between strabismus and outcomes were analyzed using multivariable linear and logistic regression models.

          Results

          Of 12,989 children without missing data, 579 children (4.5% of the sample) were reported to have strabismus. Children with strabismus had lower scores in the parent-reported KINDL-R total scale (adjusted beta = − 1.02; 95%CI: -1.86 to − 0.18; p = 0.018) and sub-scale ‘friends’ (adjusted beta = − 2.18; 95%CI: -3.56 to -0.80; p = 0.002) compared to children without strabismus. The presence of strabismus was also associated with more mental health problems like ‘hyperactivity/inattention’ (adjusted OR = 1.50; 95%CI: 1.14 to 1.98; p = 0.005), and ‘peer problems’ (adjusted OR = 1.35; 95%-CI: 1.05 to 1.74; p = 0.018) as reported by parents.

          Conclusions

          Strabismus in children and adolescents is associated with lower health-related quality of life.

          Electronic supplementary material

          The online version of this article (10.1186/s12955-019-1144-7) contains supplementary material, which is available to authorized users.

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          Most cited references25

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          [The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): sample design, response and nonresponse analysis].

          From May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Aim of this nationwide interview and examination survey was to collect, for the first time, comprehensive and nationwide data on the health status of children and adolescents aged 0 to 17 years. Subject recruitment was carried out in two steps: first, 167 study locations (sample points) were chosen; second, subjects were selected from the official registers of residents of the local residents' registration offices. The percentage of quality-neutral drop-outs was comparatively low (5.3%). The participation rate was 66.6% and showed only little variation between age groups and sexes, but marked variation between resident aliens and Germans, between inhabitants of cities with a population of 100,000 or more and sample points with fewer inhabitants, as well as between the old West German states and the newly-formed German states (incl. Berlin). A total of 17,641 children and adolescents were surveyed, of whom 8,985 were boys and 8,656 were girls. The completeness of the data sets in relation to the modules was good. The main reasons for non-participation were failure to appear at an agreed appointment time (or cancellation of the appointment at short notice), the refusal of the child/adolescent himself, or lack of interest of the parents.
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            [Sociodemographic characteristics in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) - operationalisation and public health significance, taking as an example the assessment of general state of health].

            The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was conducted from May 2003 to May 2006 by the Robert Koch Institute in 167 communities representative of Germany. By collecting comprehensive and nationally representative data on the health status of children and adolescents aged 0 to 17 years, the study aimed to fill a longstanding evidence gap. Data from 17,641 study participants will be analysed in a timely and systematic manner by the Robert Koch Institute. Initially mainly descriptive analyses as presented in the current special issue on the KiGGS study, provide information on the distribution of main health characteristics according to sociodemographic key variables, including age, sex, region of residence (former East/West Germany), social status, and migrant background. We report here the rationale for a standard set of stratifying variables and the operationalisation of composite variables. Furthermore, we illustrate the public health relevance of the observed group differences using the example of an important health indicator: parents' evaluation of their children's general state of health.
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              Health-related quality of life in children and adolescents in Germany: results of the BELLA study.

              The self-perceived health or health-related quality of life of children and adolescents is increasingly recognised as a relevant outcome in medical practice and public health research. Identifying children and adolescents with particularly low health-related quality of life allows for an early detection of hidden morbidity and health care needs. The present study investigates health-related quality of life in children and adolescents in Germany. In the Mental Health Module (BELLA study) of the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents aged 7-17 years, and 1,700 children and adolescents aged 11-17 years completed the KINDL-R quality of life questionnaire. The reliability (Cronbach's alpha=0.86) and validity of the measurements using the parent-reported KINDL-R were confirmed. Means and percentiles were calculated for the total sample as well as for strata defined by age, sex, geographical region (east/west), migration status and socioeconomic status. Expected differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses were demonstrated by differences in the KINDL-R scores (effect size d up to 1.29). This study provides representative, normative data (self-report and parent-report) on the test scores of health-related quality of life (KINDL-R) for the population of children and adolescents in Germany in general, as well as in sociodemographic and socioeconomic subpopulations.
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                Author and article information

                Contributors
                alexander.k.schuster@gmx.de
                heike.elflein@unimedizin-mainz.de
                pokora@uni-mainz.de
                schlaudM@rki.de
                baumgartenF@rki.de
                urschitz@uni-mainz.de
                Journal
                Health Qual Life Outcomes
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central (London )
                1477-7525
                7 May 2019
                7 May 2019
                2019
                : 17
                : 81
                Affiliations
                [1 ]GRID grid.410607.4, Department of Ophthalmology, , University Medical Center of the Johannes Gutenberg-University, ; Mainz, Germany
                [2 ]ISNI 0000 0001 1941 7111, GRID grid.5802.f, Division of Pediatric Epidemiology, , Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, ; Mainz, Germany
                [3 ]ISNI 0000 0001 0940 3744, GRID grid.13652.33, Department of Epidemiology and Health Monitoring, , Robert Koch Institute, ; Berlin, Germany
                Article
                1144
                10.1186/s12955-019-1144-7
                6505127
                31064363
                363497ba-d665-4d97-a149-5a1bcdbce410
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 December 2017
                : 15 April 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                epidemiology,strabismus,children,adolescents,quality of life,mental health
                Health & Social care
                epidemiology, strabismus, children, adolescents, quality of life, mental health

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