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Henriëtte A Moll

Publications and source records attributed to Henriëtte A Moll.

14 recordsLinked to original sources
PubMed2006

Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample.

OBJECTIVE: To evaluate feasibility, internal consistency, test-retest reliability, and concurrent and discriminative validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) for parents of pre-school children with 12 scales (103-items) covering physical and psychosocial domains and impact of child health on parents, in comparison with the TNO-AZL Pre-school Children Quality of Life Questionnaire (TAPQOL). METHODS: Parents of children from a random general population sample (2 months-4 years old; n = 500) and of an outpatient clinic sample of children with respiratory disease (5 months-[Formula: see text] years old; n = 217) were mailed ITQOL and TAPQOL questionnaires; a retest was sent after two weeks. RESULTS: Feasibility: The response was >or=80% with few missing and non-unique ITQOL-answers (<2%) in both study populations. Some ITQOL-scales (3-4 scales) showed a ceiling effect (>25% at maximum score). Internal consistency: All Cronbach's alpha >0.70. Test-retest Intraclass Correlation Coefficients (ICCs) were moderate or adequate (>or=0.50; p < 0.01) for 10 ITQOL-scales. VALIDITY: ITQOL-scales, with a few exceptions, correlated better with predefined parallel TAPQOL scales than with non-parallel scales. Five to eight ITQOL-scales discriminated clearly between children with few and with many parent-reported chronic conditions, between children with and without doctor-diagnosed respiratory disease and with a low and a high parent-reported medical consumption (p < 0.05). CONCLUSIONS: This study supported the evidence that the ITQOL is a feasible instrument with adequate psychometric properties. The study provided reference ITQOL scores for gender/age subgroups. We recommend repeated evaluations of the ITQOL in varied populations, especially among very young children, including repeated assessments of test-retest characteristics and evaluations of responsiveness to change. We recommend developing and evaluating a shortened ITQOL version.

Asthma↗
PubMed2006

Structured data entry for narrative data in a broad specialty: patient history and physical examination in pediatrics.

BACKGROUND: Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research. The aim of this project was to explore whether a previously developed generic (i.e. content independent) SDE application to support the structured documentation of narrative data (called OpenSDE) can be used to model data obtained at history taking and physical examination of a broad specialty. METHODS: OpenSDE was customized for the broad domain of general pediatrics: medical concepts and its descriptors from history taking and physical examination were modeled into a tree structure. RESULTS: An EMR system allowing structured recording (OpenSDE) of pediatric narrative data was developed. Patient history is described by 20 main concepts and physical examination by 11. In total, the thesaurus consists of about 1800 items, used in 8648 nodes in the tree with a maximum depth of 9 levels. Patient history contained 6312 nodes, and physical examination 2336. User-defined entry forms can be composed according to individual needs, without affecting the underlying data representation. The content of the tree can be adjusted easily and sharing records among different disciplines is possible. Data that are relevant in more than one context can be accessed from multiple branches of the tree without duplication or ambiguity of data entry via "shortcuts". CONCLUSION: An expandable EMR system with structured data entry (OpenSDE) for pediatrics was developed, allowing structured documentation of patient history and physical examination. For further evaluation in other environments, the tree structure for general pediatrics is available at the Erasmus MC Web site (in Dutch, translation into English in progress) 1. The generic OpenSDE application is available at the OpenSDE Web site 2.

Child↗
PubMed2006

The Generation R Study: Design and cohort profile.

The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health from fetal life until young adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioral and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Of all eligible children at birth, 61% participate in the study. Data collection in the prenatal phase included physical examinations, questionnaires, fetal ultrasound examinations and biological samples. In addition, more detailed assessments are conducted in a subgroup of 1232 pregnant women and their children. The children form a prenatally recruited birth-cohort that will be followed until young adulthood. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.

Adolescent↗
PubMed2006

Validating and updating a prediction rule for neurological sequelae after childhood bacterial meningitis.

Recently, a prediction rule for developing neurological sequelae after childhood bacterial meningitis was developed on a small derivation set. Before implementing in practice a prediction rule must first be tested in new patients (external validation). Our aim was to study the external validity of this rule and, if necessary, to update the rule. The prediction rule was tested on newly available data (validation set) by assessing the rule's calibration and discrimination. We updated the prediction rule by adding extra predictors and re-estimating the regression coefficients of the original predictors in the combined datasets. The rule showed poor agreement between predicted risks and observed frequencies. The ROC area was 0.65 (95% CI 0.57-0.72), which was statistically significantly lower than in the derivation set (0.87 (0.78-0.96)), p-value<0.01. The updated prediction rule showed adequate performance in the combined data sets; the ROC area was 0.77 (95% CI 0.72-0.82). Further study of the generalizability of this updated rule may stimulate application in clinical practice.

Child↗
PubMed2006

Hospitalization for respiratory syncytial virus infection in young children: development of a clinical prediction rule.

BACKGROUND: Because passive immunization against respiratory syncytial virus (RSV) is costly, its use should be restricted to well-defined groups of high risk children. We aimed to develop a clinical prediction rule that estimates the individual monthly risk of hospitalization for RSV infection in young children. METHODS: A retrospective cohort study was conducted in the southwestern part of The Netherlands. We included children born between January 1, 1996 and December 31, 1998. Children hospitalized for proven RSV infection were compared with children not hospitalized for RSV infection. The monthly risk was estimated with a logistic regression model including 5 clinical predictors (gender, gestational age, birth weight, presence of bronchopulmonary dysplasia and age) and the mean seasonal monthly pattern of RSV infections. We compared the predictive performance of the prediction rule with the guidelines of the American Academy of Pediatrics (AAP). FINDINGS: Information was collected on 2469 hospitalized children and 140,661 children who were 1,181,790 months at risk. All predictors were statistically significant, with age and the seasonal monthly RSV pattern having the strongest effects. The clinical prediction rule that included these predictors could better discriminate between high and low risk children than the AAP guidelines and would potentially reduce the number of immunizations by 20%. INTERPRETATION: The prediction rule reliably estimates individual monthly risks of hospitalization for RSV infection in the population studied. It provides an improved index for passive immunization but further validation in other populations is required.

Age Factors↗
PubMed2005

Health-related quality of life in preschool children with wheezing and dyspnea: preliminary results from a random general population sample.

Respiratory symptoms have a high prevalence among preschool children (5-20%). This study evaluated the impact of parent-reported respiratory symptoms on health-related quality of life (HRQOL) using the TNO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire. A random general population sample of 500 parents of 3-46-month old children was mailed a questionnaire containing the TAPQOL and questions on the prevalence of respiratory symptoms. The impact of respiratory symptoms on HRQOL was analysed using the Mann-Whitney test and linear regression analysis. Response rate was 83%. The prevalence of combined "wheezing and dyspnea" during the past 4 weeks was 10%. For the sleeping, appetite, lung problems, skin problems, communication, and positive mood TAPQOL scales, HRQOL was significantly lower in the subgroup with "wheezing and dyspnea" (n = 41) than in the subgroup without symptoms (n = 321); large effect sizes were observed for lung problems (2.06) and sleeping (0.80). In multivariate analysis, adjusted for age and gender of the child, "wheezing and dyspnea" were associated with the scales sleeping, appetite, lung problems, communication, and positive mood (p < 0.05). In conclusion, decreases in HRQOL among preschoolers with parent-reported respiratory symptoms are measurable with the TAPQOL. We recommend studying the impact of doctor-diagnosed respiratory symptoms on HRQOL in future studies.

Child, Preschool↗
PubMed2004

Anticipated costs of hospitalization for respiratory syncytial virus infection in young children at risk.

BACKGROUND: Reliable estimates of hospitalization costs for severe respiratory syncytial virus (RSV) infection are necessary to perform economic analyses of preventive strategies of severe RSV disease. We aimed to develop a model that predicts anticipated mean RSV hospitalization costs of groups of young children at risk for hospitalization, but not yet hospitalized, based on readily available child characteristics. METHODS: We determined real direct medical costs of RSV hospitalization from a societal perspective, using a bottom-up strategy, in 3458 infants and young children hospitalized for severe RSV disease during the RSV seasons 1996-1997 to 1999-2000 in the Southwest of the Netherlands. We used a linear regression model to predict anticipated mean RSV hospitalization costs of groups of children at risk, based on 4 child characteristics [age, gestational age, birth weight and bronchopulmonary dysplasia (BPD)], expressed in EC Euros as of the year 2000. FINDINGS: The mean RSV hospitalization costs of all patients were 3110 Euros. RSV hospitalization costs were higher for patients with lower gestational age (5555 Euros; gestational age, </=28 weeks), lower birth weight (3895 Euros; birth weight </=2500 g), BPD (5785 Euros; with BPD) and young age (4730 Euros; first month of life). The linear regression model had an adjusted R of 0.08. This indicates a low explanatory ability for hospitalization costs of individual children. However, the model could accurately estimate the anticipated mean hospitalization costs of groups of children with the same characteristics. INTERPRETATION: RSV hospitalization costs were substantial, especially of specific high risk groups. Anticipated mean hospitalization costs of groups of children at risk for RSV hospitalization, but not yet hospitalized, could well be estimated with 4 child characteristics (age, gestational age, birth weight and BPD). These estimated costs can be used for economic analyses of preventive strategies for severe RSV disease.

Age Distribution↗
PubMed2003

Internal and external validation of predictive models: a simulation study of bias and precision in small samples.

We performed a simulation study to investigate the accuracy of bootstrap estimates of optimism (internal validation) and the precision of performance estimates in independent validation samples (external validation). We combined two data sets containing children presenting with fever without source (n=376+179=555; 120 bacterial infections). Random samples were drawn from this combined data set for the development (n=376) and validation (n=179) of logistic regression models. The models included statistically significant predictors for infection selected from a set of 57 candidate predictors. Model development, including the selection of predictors, and validation were repeated in a bootstrapping procedure. The resulting expected optimism estimate in the receiver operating characteristic (ROC) area was compared with the observed optimism according to independent validation samples. The average apparent ROC area was 0.74, which was expected (based on bootstrapping) to decrease by 0.07 to 0.67, whereas the observed decrease in the validation samples was 0.09 to 0.65. Omitting the selection of predictors from the bootstrap procedure led to a severe underestimation of the optimism (decrease 0.006). The standard error of the observed ROC area in the independent validation samples was large (0.05). We recommend bootstrapping for internal validation because it gives reasonably valid estimates of the expected optimism in predictive performance provided that any selection of predictors is taken into account. For external validation, substantial sample sizes should be used for sufficient power to detect clinically important changes in performance as compared with the internally validated estimate.

Bias↗
PubMed2003

Diagnostic research on routine care data: prospects and problems.

A diagnosis in practice is a sequential process starting with a patient with a particular set of signs and symptoms. To serve practice, diagnostic research should aim to quantify the added value of a test to clinical information that is commonly available before the test will be applied. Routine care databases commonly include all documented patient information, and therefore seem to be suitable to quantify a tests' added value to prior information. It is well known, however, that retrospective use of routine care data in diagnostic research may cause various methodologic problems. But, given the increased attention of electronic patient records including data from routine patient care, we believe it is time to reconsider these problems. We discuss four problems related to routine care databases. First, most databases do not label patients by their symptoms or signs but by their final diagnosis. Second, in routine care the diagnostic workup of a patient is by definition determined by previous diagnostic (test) results. Therefore, routinely documented data are subject to so-called workup bias. Third, in practice, the reference test is always interpreted with knowledge of the preceding test information, such that in scientific studies using routine data the diagnostic value of a test under evaluation is commonly overestimated. Fourth, routinely documented databases are likely to suffer from missing data. Per problem we discuss methods that are presently available and may (partly) overcome each problem. All this could contribute to more frequent and appropriate use of routine care data in diagnostic research. The discussed methods to overcome the above problems may well be similarly useful to prospective diagnostic studies.

Bias↗
PubMed2003

Application of a diagnostic decision rule in children with meningeal signs: a cost-minimization study.

OBJECTIVES: Recently, we developed a diagnostic rule for the diagnosis and treatment of children with meningeal signs. This rule may provide the physician with a rationale to decide on the use of diagnostic and treatment procedures in these children and to improve their care. In this study, we estimated cost savings of the rule compared with current practice. METHODS: Routine care data of 360 children visiting the emergency department of the Sophia Children's Hospital with meningeal signs between 1988 and 1998 were used. Costs of diagnostic tests and treatment were estimated by using financial accounts of an academic and a general pediatric hospital. The number of procedures actually performed and the resulting cost estimates (i.e. unit costs x volume) were compared with the estimated figures after application of the decision rule. RESULTS: The population of children with meningeal signs comprised 99 with bacterial meningitis (27%), 36 with another serious bacterial infection (10%), and 225 with a self-limiting disease (63%). Application of the rule would reduce lumbar punctures by 12% and hospitalizations for empirical treatment by 15% with the same diagnostic accuracy as current practice. Cost savings were estimated at Euro292 per patient (relative reduction 10%) and were mainly achieved in the treatment course (Euro259). CONCLUSIONS: A diagnostic decision rule for children with meningeal signs has the potential to improve the appropriate use of medical resources, to be cost-effective, and to ascertain the absence of bacterial meningitis earlier.

Adolescent↗
PubMed2002

Prediction of duration of hospitalization in respiratory syncytial virus infection.

Identification of variables that predict duration of RSV-associated hospitalization may be useful in the identification of preventive and therapeutic strategies. A recently published prediction model (Michigan model) for the duration of hospitalization in RSV infection demonstrated good discrimination between children with and without an increased likelihood of a hospital stay >or= 7 days, based on variables such as log weight, congenital heart disease, failure to thrive, premature birth, bronchopulmonary dysplasia, other pulmonary diseases, miscellaneous conditions, early mechanical ventilation, and early ribavirin treatment (receiver operating characteristic (ROC) area, 0.89). Validation of this model is of particular interest for Europe, since the mean duration of hospitalization in The Netherlands is approximately twice that in the USA. The objective of the current study was 1) to validate the Michigan model for RSV hospitalized patients in a large university hospital in The Netherlands, and 2) to develop our own prediction model for a prolonged hospital stay. Data from 177 children younger than 12 months of age admitted with confirmed RSV infection to the Sophia Children's Hospital Rotterdam between 1992-1995, were used for valiation of the Michigan model and derivation of the Rotterdam model. Mean duration of hospitalization for the Rotterdam database was 10.3 (+/-6.3) days, with a median of 9 days; 138 (78%) patients had a hospital stay >or= 7 days. The Michigan model performed poorly when applied to the Rotterdam database, with an ROC area of 0.65 (95% CI, 0.57-0.73). The Rotterdam prediction model (hospital stay >or= 9 days, the median in our database) considered weight and need for oxygen supplementation. The ROC area was 0.65 (95% CI, 0.57-0.73). When using data from patients for the 1995-1996 season, the ROC area was 0.52 (95% CI, 0.34-0.72). The Michigan and the Rotterdam models failed to identify a considerable number of patients who had a prolonged hospital stay, with a low false-positive rate. We conclude that neither the Michigan, nor the Rotterdam model reliably predicted the duration of hospitalization based on demographic and clinical variables.

Female↗
PubMed2002

Sequelae after bacterial meningitis in childhood.

The neurological outcome of bacterial meningitis in children was evaluated retrospectively. Data were obtained from a large study on children aged between 1 month and 15 y who initially visited the emergency department of Sophia Children's Hospital, Rotterdam, The Netherlands with meningeal signs. This study presents data from 103 patients in whom bacterial meningitis was diagnosed. Neisseria meningitidis was the dominant pathogen of meningitis. We found a 2% case-fatality rate in children with bacterial meningitis and a 13% rate of sequelae among survivors: 7% hearing impairment and 7% neurological sequelae. Children with bacterial meningitis caused by Streptococcus pneumoniae and those with acute focal neurological symptoms tended to have the worst prognosis.

Adolescent↗
PubMed2002

Cost-utility analysis of patient care in children with meningeal signs.

OBJECTIVES: We designed a model of diagnostic and therapeutic interventions applied in children with meningeal signs. Using this model, we determined in a cost-utility analysis the consequences for society of different diagnostic strategies in terms of quality-adjusted life-years (QALYs) and costs. METHODS: Data were used from 360 children (0.1-15 years) visiting the pediatric emergency department of the Sophia Children's Hospital Rotterdam, The Netherlands (1988-98) with meningeal signs. Model inputs included probabilities of meningitis and adverse outcome, QALYs for years lived with long-term sequelae, and costs of tests and treatments. Mean outcome measures were costs and effects of diagnostic and therapeutic interventions in children suspected of bacterial meningitis, key determinants of the model outcomes, and evaluation of alternative diagnostic strategies and two vaccination programs in an analysis. RESULTS: The population comprised 99 children with bacterial meningitis (adverse outcome in 10), 36 with serious other bacterial infections, and 225 with self-limiting diseases. Key determinants were the risk of bacterial meningitis or sequelae, costs of treatment, and long-term morbidity. Minimizing lumbar punctures and empirical treatments using a diagnostic decision rule, without missing a single case of meningitis, was a dominant strategy to actual practice. Vaccination strategies of Streptococcus pneumoniae and Neisseria meningitidis resulted in our model in incremental cost-utility ratios of 401,965 Euro dollar ([symbol: see text])/QALY and [symbol: see text]22,635/QALY, respectively. CONCLUSIONS: Costs of long-term morbidity of bacterial meningitis largely outweigh diagnostic and treatment costs. Modeling interventions in children at risk of bacterial meningitis should include long-term consequences in terms of costs and QALYs.

Child, Preschool↗