Quality of life in adolescents with cerebral palsy

670 www.thelancet.com Vol 385 February 21, 2015 Child development is dynamic and multidimensional, with genetic and epigenetic building blocks upon which the complex eff ects of environment are overlaid (ie, nurture through nature). In children with cerebral palsy and other disabilities, developmental outcome is more than the result of medical treatment, and includes the child’s communication, coping, and problem-solving skills; educational opportunities; family adaptation; and service delivery—factors all shown by quality of life (QoL). WHO’s defi nition of QoL as “the individual’s perception of their position in life in the context of the culture and value system in which they live, and in relation to their goals, expectations, standards, and concerns” represents the validation of the unique value of every person, typically developing or with a disability. The University of Toronto Centre for Health Promotion defi nes QoL as “the degree to which a person enjoys the important possibilities of his or her life”. This defi nition emphasises that the quality of a child’s life is interconnected with the nature of caregiver care and the environment in which each child lives. Increasingly, QoL is valued as an important addition to standard biomedical reports, and as a measure of clinical progress and research outcome. The large longitudinal cohort study of Allan Colver and colleagues, reported in The Lancet, examines how selfreported QoL in adolescents with cerebral palsy varies with impairment, how it compares with the perceived QoL of peers in the general population, and to what extent childhood factors amenable to intervention— pain, psychological problems, and parenting stress— predict adolescent QoL. Young people reported their QoL using KIDSCREEN, a generic QoL instrument with sound psychometric properties designed for children and adolescents. This study was done as part of the larger European SPARCLE study whose strengths include randomly selected sampling from population-based cerebral palsy registers in nine European regions. Quality of life in adolescents with cerebral palsy commonly practised after medical (but not surgical) abortion. Insertion of intrauterine contraceptives within 1 week of medical abortion, however, is safe and well tolerated and has no increased risk of expulsion or complications. Early access to aff ordable longacting contraceptives is an important component of an eff ective abortion service. Sunde Oppegaard and colleagues focus strongly on what women want, but not all women want the same things. Furthermore, although patients’ preferences are important for service design and uptake, safety and effi cacy are equally important. Follow-up after medical or surgical abortion should continue to provide individualised care.