Baar, M.E. van

Quality of life after burns in childhood (5-15 years): Children experience substantial problems (Article)

2011-09-01T00:00:00Z

The aim of our study was to assess prevalence and correlates related to sub optimal outcome after pediatric burns and to make a comparison with pediatric injuries not related to burns. We conducted a cross-sectional study on quality of life (QOL) after burns in a sample (n = 138; median 24 months post-burn) of Dutch and Flemish children (5-15 years) with an admission to a burn center. QOL was assessed with the Burn Outcomes Questionnaire (BOQ). The generic EuroQol-5D was used to allow for a comparison with children after injuries not related to burns. More than half of the children had long-term limitations. According to the BOQ, children frequently (>50%) experienced sub optimal functioning on 5 out of 12 dimensions, concerning 'appearance', 'parental concern', 'itch', 'emotional health' and 'satisfaction with current state'. Children with a high total burned surface area (TBSA ≥10%) showed significantly more sub optimal functioning on 'upper extremity function' (OR = 5.3; ≥20% TBSA), 'appearance' (OR = 5.5; ≥10-20% TBSA), 'satisfaction with current state' (OR = 3.4; ≥10-20% TBSA) and 'parental concern' (OR = 3.4; ≥10-20% TBSA), compared to children with less than 10% TBSA. Burn victims at 9 months post-injury appeared to be worse off at several health dimensions. After 24 months generic quality of life of in pediatric burns was more comparable to pediatric injuries not related to burns. Children after burns experience substantial problems, mainly on itch and appearance and several psychosocial dimensions. More extensive burns are related to sub optimal functioning. These problems are in part specific for burns and not picked up by generic measures.

Accuracy of burn size assessment prior to arrival in Dutch Burn centres and its consequences in children: A nationwide evaluation (Article)

2011-07-07T00:00:00Z

Background: Total body surface area (TBSA) burned, expressed as percentage is one of the most important aspects of the initial care of a burn victim. It determines whether transfer to a burn centre is necessary as well as the need for, and amount of, intravenous fluid resuscitation. Numerous studies, however, have highlighted inaccuracies in TBSA assessment. Therefore, the differences in burn size estimates between referrers and burn centre's in children and its consequences in terms of transfer and intravenous fluid resuscitation were investigated. Methods: This study involved two time periods from January 2002 until March 2004 and January 2007 until August 2008. All referred children admitted to a Dutch Burn centre within 24 h post burn were eligible. Data were obtained from patient records retrospectively and in part prospectively. Results: A total of 323 and 299 children were included in periods 1 and 2, respectively. Referring physicians overestimated burn size with a factor two (mean difference: 6% TBSA ± 5.5). About one in five children was referred to a burn centre without fulfilling the criteria for referral with regard to burn size (assessed by burn specialists) special localisation or inhalation trauma. Proportions of children receiving intravenous fluid resuscitation regardless of indication increased from 33% to 49% (p < 0.01). The received volumes tended to be higher than necessary. Conclusions: Referring physicians overestimate burn size in children admitted to Dutch burn centres. This has little negative consequences, however, in terms of unindicated transfers to a burn centre or unnecessary fluid resuscitation.

Health-related quality of life in preschool children in five health conditions (Article)

2011-06-01T00:00:00Z

Objective: To test the responsiveness of the Infant/Toddler Quality of Life Questionnaire (ITQOL) to five health conditions. In addition, to evaluate the impact of the child's age and gender on the ITQOL domain scores. Methods: Observational study of 494 Dutch preschool-aged children with five clinical conditions and 410 healthy preschool children randomly sampled from the general population. The clinical conditions included neurofibromatosis type 1, wheezing illness, bronchiolitis, functional abdominal complaints, and burns. Health-related quality of life (HRQoL) was assessed by a mailed parent-completed ITQOL. Mean ITQOL scale scores for all conditions were compared with scores obtained from the reference sample. The effect of patient's age and gender on ITQOL scores was assessed using multi-variable regression analysis. Results: In all health conditions, substantially lower scores were found for several ITQOL scales. The conditions had a variable effect on the type of ITQOL domains and a different magnitude of effect. Scores for 'physical functioning', 'bodily pain', and 'general health perceptions' showed the greatest range. Parental impact scales were equally affected by all conditions. In addition to disease type, the child's age and gender had an impact on HRQoL. Conclusions: The five health conditions (each with a distinct clinical profile) affected the ITQOL scales differently. These results indicate that the ITQOL is sensitive to specific characteristics and symptom expression of the childhood health conditions investigated. This insight into the sensitivity of the ITQOL to health conditions with different symptom expression may help in the interpretation of HRQoL results in future applications.

Socio-economic inequalities in injury incidence in the Netherlands (Article)

2009-08-15T00:00:00Z

Background: Interventions to reduce socio-economic inequalities in injury incidence should be tailored to specific priority areas that may be identified by descriptive studies. We aimed to provide an overview of existing socio-economic inequalities in injury incidence in the Netherlands and to assess the potential influence of methodological choices on the relationships found. Methods: Self-reported medically treated injuries (all injuries versus fractures) were derived from a survey among a random sample of 59 063 persons. Injuries resulting in hospital admissions (all injuries versus fractures) were derived from a prospective cohort study of 18 810 participants, linked to the National Hospital Discharge Register for a follow-up period of 7 years. Logistic regression was used to calculate the odds ratios of self-reported medically treated injuries and fractures by level of education, occupation and income, and of hospital-admitted injuries by level of education and occupation. Results: Socio-economic inequalities in injury incidence in the Netherlands were dependent on the indicator of non-fatal injury incidence, indicator of socio-economic status (SES) and studied cause of injury. In the majority of specific relations analyzed, injury risks were not or only moderately elevated in lower SES-classes. Analyses focusing on injury with higher severity levels (admitted injuries and/or admitted fractures) revealed the steepest SES gradient with odds ratios of injury of 1.5 or more of the lowest socio-economic (educational) groups compared to persons with higher SES (education). In hospital admitted traffic injuries, we found the most striking difference with a threefold higher risk in the lowest educational groups. Conclusion: Future descriptive research into socio-economic differences in injury incidence should include all three core indicators of SES and separate analyses on the more severe injuries should be conducted.

Influence of obesity on the development of osteoarthritis of the hip: a systematic review (Article)

2002-01-01T00:00:00Z

OBJECTIVE: To evaluate the evidence for the influence of obesity as a risk factor for the occurrence of osteoarthritis (OA) of the hip. METHODS: A bibliographical search of Medline, EMBASE and the Cochrane library until April 2000 was carried out. Articles describing studies of the relationship between obesity and the occurrence of hip OA were selected. The quality of the studies was assessed with a standardized set of criteria. The outcome of the studies was compared with respect to study characteristics and the quality score for the study. A best-evidence synthesis was used to summarize the results of the individual studies. RESULTS: Five longitudinal and seven cross-sectional studies were included in this review. There was no association between outcome and study design or methodological quality. The associations between obesity and hip OA were, however, stronger in studies in which the diagnosis of hip OA was based not only on radiological criteria but also on clinical symptoms. Overall, moderate evidence was found for a positive association between obesity and the occurrence of hip OA, with an odds ratio of approximately 2. CONCLUSION: The evidence for a positive influence of obesity on the development of hip OA is moderate.