**3. Materials and methods**

In the conditions of children's department of the Samarkand State tuberculosis hospital, 90 children and adolescents aged 5–18 years subdivided into various subgroups have been examined. The quality of life was estimated by gender (2 subgroups: girls—56 and boys—34) and in various age groups (3 subgroups: adolescents aged 13–18 years—27 persons, children of school age 8–12 years—44 persons, children of preschool and younger school age 5–7 years—19 persons). Pulmonary tuberculosis has been for the first time revealed by means of various techniques: during inspection of risk groups by means of the medicine Diaskintest, the digital fluorographic device "ProScan 2000" was used as a recourse for medical care. The surveyed are divided into 3 relevant subgroups of 30 children and adolescents. For a century around the world, tuberculin was used for the diagnosis of tuberculosis and the detection of the latent tuberculosis infection. The main lack of tuberculin test is the large number of false positive reactions, in connection with cross-reactions of the antigens, which are contained in many species of mycobacterium and in strains of a bacillus of Calmette-Guerin (BCG). Diaskintest® (allergen recombinant in standard cultivation) is the recombinant protein produced by genetically modified culture of *Escherichia coli* and contains two antigens (ESAT-6 and CFP-10) that are present at virulent strains of mycobacterium of tuberculosis and absent in a vaccinal strain of BCG. With an intradermal injection of Diaskintest® for persons with a tuberculosis infection, a

**27**

*Assessing Quality of Life in Children and Adolescents Diagnosed with Pulmonary Tuberculosis*

specific skin reaction, which is a delayed-type hypersensitivity, develops. This reaction is absent in people vaccinated with BCG and not infected with MBT. Because of the outbreaks of tuberculosis that have become frequent around the world, in recent years, the value of fluorography as an identification method has increased. The main advantages of digital photofluorography are high informational content of the image, the minimum dose at inspection, convenience of archiving and extraction of data, lack of an X-ray film and chemicals, and high bandwidth of the equipment. The digital fluorography became comparable with survey radiographic pictures. It means that the ability to detect the pathology sharply increases during mass inspections. Dose loadings from the simplest digital photofluorography are 10 times less. Such small dose allows expanding the age group for X-ray prevention of tuberculosis. At the same time infiltrates and the centers come to light with big constancy in all departments of lungs and have the outlined borders; disintegration cavities, come to light always convincingly; lymph nodes distinctly are found in zones, inaccessible to an ordinary radiological research. If necessary it is possible to send pictures for expeditious consultations on computer networks, and the consultant not the subjective report of the surveying doctor, and primary diagnostic information is transferred

In terms of the clinical forms, the primary forms of tuberculosis prevailed in 50 (55.6%) patients: tuberculosis of intrathoracic lymph nodes in 34 (37.8%) patients and primary tuberculosis complex in 16 (17.8%). The secondary forms of tuberculosis prevailed in 40 (44.4%) respondents: tuberculous pleurisy in 3 (3.3%), disseminated tuberculosis in 12 (13.3%), and infiltrative tuberculosis in 25 (27.8%) patients.

On the basis of these forms, patients have been divided into two subgroups.

In all subgroups, the analysis of initial level of quality of life was carried out. For a research on quality of life in pediatric practice, the questionnaire of Pediatric Quality of Life Inventory—PedsQL— proved effective. For the assessment of quality of life, all 23 criteria have been united in 6 scales: FF—physical functioning, EF—emotional functioning, SF—social functioning, SF—life in a school/garden, PSF—psychosocial functioning, and TS—a total scale. Answers to these questions open such problems for the child as the ability for independent movement and active actions, the self-service level, the emergence of pain and also experience of negative emotions, sleep disorder, and difficulties in communication with peers, problems in training, etc. The questionnaire is divided into blocks depending on age—5,–7, 8–12, and 13–18 years. The total of points pays off on a 100-mark scale after the procedure of scaling: the total size is higher, the quality of life of the child is better. Answers of children were expressed further in points. In the questionnaire for children of 5–7 years, 3 possible answers in connection with age features of these children were offered, and the graphic system of answers was used: the symbolical image of the person with a smile meaning "never," persons with the neutral expression meaning "sometimes," and persons with the negative expression meaning "often." For children of 8–12 years and adolescents of 13–18 years, each question has 5 possible answers: "no," "almost never," "sometimes," "often," and "almost always," from which it is necessary to choose one, the most suitable to a situation. All children answering the questionnaire had no mental disease according to the basic and associated diseases. Statistical processing of results of the research was carried out with the use of Microsoft Excel 2007 programs. Quantitative signs are presented in the form of average arithmetic ± a standard mistake. The statistical analysis was carried out by means of a statistical package of the SPSS program (Statistical Package for the Social Sciences Inc., USA) version 14.0 in Russian. The analysis of data included standard methods of descriptive and analytical statistics. The t-test for independent selections, t-test for dependent selections, and the one-factorial dispersive analysis (ANOVA) were used for the comparison of average values of selections. Correlation

*DOI: http://dx.doi.org/10.5772/intechopen.82672*

to any distances.

### *Assessing Quality of Life in Children and Adolescents Diagnosed with Pulmonary Tuberculosis DOI: http://dx.doi.org/10.5772/intechopen.82672*

specific skin reaction, which is a delayed-type hypersensitivity, develops. This reaction is absent in people vaccinated with BCG and not infected with MBT. Because of the outbreaks of tuberculosis that have become frequent around the world, in recent years, the value of fluorography as an identification method has increased. The main advantages of digital photofluorography are high informational content of the image, the minimum dose at inspection, convenience of archiving and extraction of data, lack of an X-ray film and chemicals, and high bandwidth of the equipment. The digital fluorography became comparable with survey radiographic pictures. It means that the ability to detect the pathology sharply increases during mass inspections. Dose loadings from the simplest digital photofluorography are 10 times less. Such small dose allows expanding the age group for X-ray prevention of tuberculosis. At the same time infiltrates and the centers come to light with big constancy in all departments of lungs and have the outlined borders; disintegration cavities, come to light always convincingly; lymph nodes distinctly are found in zones, inaccessible to an ordinary radiological research. If necessary it is possible to send pictures for expeditious consultations on computer networks, and the consultant not the subjective report of the surveying doctor, and primary diagnostic information is transferred to any distances.

In terms of the clinical forms, the primary forms of tuberculosis prevailed in 50 (55.6%) patients: tuberculosis of intrathoracic lymph nodes in 34 (37.8%) patients and primary tuberculosis complex in 16 (17.8%). The secondary forms of tuberculosis prevailed in 40 (44.4%) respondents: tuberculous pleurisy in 3 (3.3%), disseminated tuberculosis in 12 (13.3%), and infiltrative tuberculosis in 25 (27.8%) patients. On the basis of these forms, patients have been divided into two subgroups.

In all subgroups, the analysis of initial level of quality of life was carried out. For a research on quality of life in pediatric practice, the questionnaire of Pediatric Quality of Life Inventory—PedsQL— proved effective. For the assessment of quality of life, all 23 criteria have been united in 6 scales: FF—physical functioning, EF—emotional functioning, SF—social functioning, SF—life in a school/garden, PSF—psychosocial functioning, and TS—a total scale. Answers to these questions open such problems for the child as the ability for independent movement and active actions, the self-service level, the emergence of pain and also experience of negative emotions, sleep disorder, and difficulties in communication with peers, problems in training, etc. The questionnaire is divided into blocks depending on age—5,–7, 8–12, and 13–18 years. The total of points pays off on a 100-mark scale after the procedure of scaling: the total size is higher, the quality of life of the child is better. Answers of children were expressed further in points. In the questionnaire for children of 5–7 years, 3 possible answers in connection with age features of these children were offered, and the graphic system of answers was used: the symbolical image of the person with a smile meaning "never," persons with the neutral expression meaning "sometimes," and persons with the negative expression meaning "often." For children of 8–12 years and adolescents of 13–18 years, each question has 5 possible answers: "no," "almost never," "sometimes," "often," and "almost always," from which it is necessary to choose one, the most suitable to a situation. All children answering the questionnaire had no mental disease according to the basic and associated diseases. Statistical processing of results of the research was carried out with the use of Microsoft Excel 2007 programs. Quantitative signs are presented in the form of average arithmetic ± a standard mistake. The statistical analysis was carried out by means of a statistical package of the SPSS program (Statistical Package for the Social Sciences Inc., USA) version 14.0 in Russian. The analysis of data included standard methods of descriptive and analytical statistics. The t-test for independent selections, t-test for dependent selections, and the one-factorial dispersive analysis (ANOVA) were used for the comparison of average values of selections. Correlation

*Psychology of Health - Biopsychosocial Approach*

children with chronic diseases, in particular, TB patients.

factors [6]. During an economic crisis, the leading value, from the point of view of maintaining health, is on the quality of life of the child and his or her family members [7]. In recent years, the directions of studying the quality of life of children in clinical and in social pediatrics have extended [8]. WHO has suggested considering quality of life (life quality) as an optimum condition of perception by certain people and the population in general how their requirements as opportunities for achievement of well-being and self-realization are given are satisfied. Tuberculosis, influencing the physical state and psychology of behavior of an individual, changes his or her place and role in society [1]. In this regard, one of the new criteria for the evaluation of efficiency of delivery of health care is the quality of life. Today, it sounds as follows: the quality of life is a perception by an individual of his or her situation in life in the context of culture and the system of values in which the individual lives, and in connection with the purposes, expectations, standards, and the interests of this individual [9]. As quite often health depends on the level of availability of medical care, WHO considers the general availability of medical care of acceptable quality to children and adolescents mandatory at the present stage of development of society. Traditional criteria do not cover all aspects of a tuberculosis infection and do not allow estimating a condition of the sick child comprehensively. During the analysis of the quality of life parameters, there is an opportunity to define the influence of a disease on physical, psychological, and social aspects of functioning of an organism [10]. The use of this simple and reliable method will allow to improve the quality of medical care at different stages of treatment to

To carry out the analysis of initial level of quality of life at children and adolescents depending on a sex, age, when using various methods of detection of a disease, to estimate indicators of quality of life depending on a form of tubercular process.

In the conditions of children's department of the Samarkand State tuberculosis hospital, 90 children and adolescents aged 5–18 years subdivided into various subgroups have been examined. The quality of life was estimated by gender (2 subgroups: girls—56 and boys—34) and in various age groups (3 subgroups: adolescents aged 13–18 years—27 persons, children of school age 8–12 years—44 persons, children of preschool and younger school age 5–7 years—19 persons). Pulmonary tuberculosis has been for the first time revealed by means of various techniques: during inspection of risk groups by means of the medicine Diaskintest, the digital fluorographic device "ProScan 2000" was used as a recourse for medical care. The surveyed are divided into 3 relevant subgroups of 30 children and adolescents. For a century around the world, tuberculin was used for the diagnosis of tuberculosis and the detection of the latent tuberculosis infection. The main lack of tuberculin test is the large number of false positive reactions, in connection with cross-reactions of the antigens, which are contained in many species of mycobacterium and in strains of a bacillus of Calmette-Guerin (BCG). Diaskintest® (allergen recombinant in standard cultivation) is the recombinant protein produced by genetically modified culture of *Escherichia coli* and contains two antigens (ESAT-6 and CFP-10) that are present at virulent strains of mycobacterium of tuberculosis and absent in a vaccinal strain of BCG. With an intradermal injection of Diaskintest® for persons with a tuberculosis infection, a

**26**

**2. Purpose**

**3. Materials and methods**

analysis was applied to establish communication between parameters of quality of life and social factors. The probability of a mistake р < 0.05 was regarded as significant, р < 0.01—very significant, and р < 0.001—the most significant.
