Biomedical subjects

L W van Suijlekom-Smit

Publications and source records attributed to L W van Suijlekom-Smit.

At least 19 recordsLinked to original sources

PubMed2001

Quality of life in adolescents with chronic pain in the head or at other locations.

The differences in quality of life and school absence were studied in one hundred adolescents from the open population who had reported chronic headache or chronic, physically unexplained, pain at other locations. The adolescents kept a 3-week diary about their pain and completed a quality of life questionnaire. Of all chronic pain sufferers in this study, it was the adolescents with headache who showed the least frequent pain, but they reported the poorest quality of life and the largest school absence due to their pain. Adolescents with headache or adolescents with back pain showed the highest negative correlations between pain parameters and quality of life. Headache sufferers showed highly negative relationships between pain parameters and most quality of life domains (median r = -0.46), and only in headache sufferers did this involve both intensity and frequency of pain. Qualitative studies are needed to reveal the background to these differences.

Absenteeism↗

PubMed2001

Effects of sulfasalazine treatment on serum immunoglobulin levels in children with juvenile chronic arthritis.

This article describes the effects of sulfasalazine (SSZ) treatment on serum immunoglobulin (Ig) levels in 6 children with oligoarticular- or polyarticular onset juvenile chronic arthritis (JCA). None of the children who developed dysimmunoglobulinemia during treatment showed clinical symptoms of this adverse event, in particular none developed severe infections. All patients regained normal immunoglobulin levels after discontinuing SSZ treatment. One patient with a partial IgA deficiency at the start of SSZ treatment showed a slow increase in the IgA level during treatment. During follow-up (4-6 years), one patient spontaneously developed a dysimmunoglobulinemia and one patient developed diabetes mellitus. Based on these case reports and review of the literature we advocate monitoring of serum immunoglobulin levels while on SSZ treatment.

Antirheumatic Agents↗

PubMed2001

The relationship between impairments in joint function and disabilities in independent function in children with systemic juvenile idiopathic arthritis.

OBJECTIVE: Knowledge about the impact of joint impairment on functional ability is needed in planning care and setting treatment goals in children with juvenile idiopathic arthritis (JIA). We investigated the relationship between joint impairments and upper and lower limb function. METHODS: Twenty-one children with systemic JIA with an average age of 9.2 years and a mean disease duration of 4.8 years participated in this study. Joint impairments were assessed by the following variables: joint counts on swollen (JCS) and tender (JCT) joints and the loss of joint motion as determined by the Joint Alignment and Motion scale (JAM). Functional performance and functional ability were determined by the Juvenile Arthritis Functional Assessment Scale (JAFAS) and Childhood Health Assessment Questionnaire (CHAQ), respectively. The relationship between impairments and functional disabilities was studied at the level of (1) the complete instruments, (2) upper and lower limb function separately, and (3) the individual joints and items. RESULTS: Regarding complete instruments, the Spearman rank correlation between functional disabilities and loss of joint motion was moderate to good (JAM/CHAQ rs = 0.66, JAM/JAFAS rs = 0.77). A fair correlation was found between functional disabilities and the joint count on swollen joints (JCS/CHAQ rs = 0.45, JCS/JAFAS rs = 0.52), but no significant relationship was found with the number of tender joints (JCT/CHAQ rs = 0.02, p > 0.05, and JCT/JAFAS rs = 0.14, p > 0.05). At the extremity level (upper and lower limb function), the relationship between functional disabilities and the loss of joint motion appeared to be stronger in the leg than in the arm. At the level of the individual joints and questionnaire items, loss of joint motion in hip or shoulder joint appeared to be the most important factor in predicting limitation in leg or arm function. CONCLUSION: Our study shows that with respect to joint impairments, loss of joint motion is the strongest indicator of functional disability in children with systemic JIA. Loss of joint motion has a greater effect on lower limb function.

Activities of Daily Living↗

PubMed2000

Retinal vasculitis occurring with common variable immunodeficiency syndrome.

PURPOSE: To report severe retinal vasculitis causing decreased vision in three patients with the common variable immunodeficiency syndrome. METHOD: Case report. Three patients with common variable immunodeficiency syndrome developed decreased vision secondary to retinal vasculitis. Fluorescein angiography was performed in all three patients. Peribulbar injections were given in one patient, and two patients were treated with oral steroids and cyclosporin. RESULTS: All three patients were young and had classic common variable immunodeficiency syndrome. Bilateral retinal vasculitis and diffuse retinal edema were present in all three patients, and two patients had retinal neovascularization in the absence of ischemia. No evidence of intraocular infection was present, and none was detected systematically. Visual acuity decreased in five of the six eyes and was responsive to treatment in only one patient (both eyes). CONCLUSION: Retinal vasculitis may be another autoimmune manifestation of common variable immunodeficiency syndrome.

Capillary Permeability↗

PubMed2000

Chronic pain among children and adolescents: physician consultation and medication use.

OBJECTIVE: The goal of this study was to assess physician consultation and use of medication in Dutch children and adolescents (0-18 years old) having chronic pain in relation to sociodemographic factors and pain characteristics. DESIGN: This was a population-based cross-sectional survey. A questionnaire was either mailed to the participants' parents or distributed at school, and it was filled out by the parents (for children aged 0-7 years) or by the participant (for children and adolescents aged 8-18 years). SETTING: The study was conducted in the Rotterdam area. PATIENTS: Participants included a random sample of 1,300 children aged 0 to 3 years taken from the register of population. In addition, 41 schools were selected to obtain a representative sample of 5,336 children and adolescents aged 4 to 18 years. OUTCOME MEASURES: Reported physician consultation and medication use were assessed. RESULTS: Of the 6,636 children and adolescents surveyed, 5,424 (82%) responded. A total of 1,358 respondents (25%) reported chronic pain. Of these, 57% had consulted a physician and 39% had used medication for the pain. Respondents with earache, more intense pain, and more frequent pain and those attending lower vocational training programs were more likely to consult a physician for the pain than the average respondent. Respondents with earache, sore throat, headache, more intense pain, and multiple pain; children aged 0 to 3 years; and girls were more likely to use medication for the pain. Logistic regression analyses showed that for physician consultation, the most significant predictive factors were the intensity of pain, age, and earache as well as the level of education for respondents aged 12 to 16 years. The use of medication was predicted by earache, headache, limb pain, intensity of pain, and age. CONCLUSIONS: Chronic pain is a common complaint in children and adolescents, frequently resulting in consultation of a physician and medication use. Regarding physician consultation, children and adolescents with a lower educational level seem to be a group at risk.

Adolescent↗

PubMed2000

Headache in adolescents in Dutch general practice.

We set out to describe the occurrence of headache in adolescents in general practice, the diagnoses made, the referrals to specialised care and the role of psychosocial problems in idiopathic headache. Data from the Dutch national survey of morbidity and interventions in general practice were used. The practice population (103 practices) comprised 37,187 children aged 12-18 years. In 650 episodes headache was a reason for encounter. The incidence of headache as presented to the GP was 69.9 per 1000 person years. The incidence in girls was twice as high as in boys. Half of the episodes with headache complaints were related to an infectious disease. The incidence rate of idiopathic headache was 18.0 per 1000 person years. Eight percent of all headache episodes were diagnosed as a psychosocial problem. Of all episodes, 25% percent were diagnosed as idiopathic headache (i.e. headache as symptom diagnosis, tension headache or migraine). Of these episodes, 21% were associated with an underlying psychosocial problem. Referrals were made by the GP in three percent of all headache episodes and four percent of idiopathic headache episodes. Headache in adolescents is a common reason for visiting a general practice. The symptom is often associated with an infectious disease. The GP is aware of underlying psychosocial problems. Only few children are referred for specialist care.

Adolescent↗

PubMed1999

Headache in children in Dutch general practice.

AIM: To describe the occurrence of headache in general practice, the diagnoses made in general practice, and the management. METHOD: Data from the Dutch national survey of morbidity and interventions in general practice were used. The practice population (103 practices) comprised 63,753 children aged 0-14 years. RESULTS: In 634 episodes, headache was a reason for encounter. The incidence of headache presented to the general practitioner was 40.2 per 1000 person years. More than half of the episodes were related to an infectious disease, among which upper respiratory tract infections predominated. The incidence rate of the diagnosis idiopathic headache was 7.3 episodes per 1000 person years. The incidence increased with age and was higher in girls than in boys. In only 12% of cases of idiopathic headache were special investigations carried out, mostly blood examinations. Medication was prescribed in 27% of all episodes of idiopathic headache. In the absence of an infectious disease, many headache episodes were associated with psychosocial problems. Family problems and school problems were mentioned most often. CONCLUSION: Headache in children as reason for encounter is a common problem in general practice, often associated with an infectious disease. When confronted with a child with idiopathic headache, the general practitioner should be aware of a possible psychosocial component.

Adolescent↗

PubMed1999

Childhood-onset Systemic Lupus Erythematosus: clinical presentation and prognosis in 31 patients.

OBJECTIVE: To determine the clinical features at onset, the disease course, and prognostic factors in children with SLE. METHODS: The medical records of 31 patients with childhood-onset SLE were reviewed. Signs and symptoms at onset and during the course of the disease were documented as well as survival and SLICC/ACR damage index. The disease course was compared to 135 consecutive adult-onset SLE patients. RESULTS: Childhood-onset SLE most frequently presented with fatigue, arthritis, fever, weight loss, and malar rash. During follow-up, the frequency of the presence of malar rash, anemia, leukocytopenia, and anti-dsDNA antibodies was significantly higher in childhood-onset than in adult-onset patients. Mean SLICC/ACR damage index was 2.6 after 4.7 years of follow-up. The presence of arthritis, anemia, and seizures at the onset of disease resulted in a 2.6 to 3.9 times higher chance of a severe disease course. CONCLUSION: Patients with childhood-onset SLE suffer from substantial morbidity. Arthritis, anemia, and seizures at onset may be indicators of poor prognosis.

Adolescent↗

PubMed1998

[Linear morphea].

Explore the source record for details and available documents.

Calcitriol↗

PubMed1998

Sulfasalazine in the treatment of juvenile chronic arthritis: a randomized, double-blind, placebo-controlled, multicenter study. Dutch Juvenile Chronic Arthritis Study Group.

OBJECTIVE: To assess the efficacy, tolerability, and safety of sulfasalazine (SSZ) in the treatment of juvenile chronic arthritis (JCA). METHODS: We conducted a 24-week randomized, placebo-controlled, double-blind, multicenter study of patients with active JCA of both oligoarticular and polyarticular onset. Patients were treated with a dosage of 50 mg/kg/day of SSZ (maximum 2,000 mg/day) or placebo. The efficacy variables were joint scores, physician's, parents', and patient's overall assessments, and laboratory parameters of inflammation. RESULTS: Of the 69 patients enrolled, 52 (75%) completed the trial. Six patients (18%) withdrew from the placebo group, and 11 (31%) withdrew from the SSZ group (P = 0.18). In the intention-to-treat analysis of end point efficacy, between-group differences were significant for the overall articular severity score (P = 0.02), all global assessments (P = 0.01), and the laboratory parameters (P < 0.001). Adverse events occurred more frequently in the SSZ group and were the main reason for withdrawal (P < 0.001), but in all instances, these events were transient or reversible upon cessation of treatment. CONCLUSION: The results of this first placebo-controlled study show that SSZ is effective and safe in the treatment of children with oligoarticular- and polyarticular-onset JCA, although it was not well tolerated in one-third of the patients.

Adolescent↗

PubMed1997

Randomised placebo-controlled trial of inhaled sodium cromoglycate in 1-4-year-old children with moderate asthma.

BACKGROUND: Inhalation therapy with sodium cromoglycate is recommended as the first-line prophylactic treatment for moderate asthma in children. The availability of spacer devices with face-masks has extended the applicability of metered-dose inhalers to younger children. We studied the feasibility and effects of this therapy compared with placebo in children aged 1-4 years. METHODS: 218 children aged 1-4 years with moderate asthma were recruited through 151 general practitioners between March, 1995, and March, 1996. They were randomly assigned sodium cromoglycate (10 mg three times daily) or placebo, given by inhaler with spacer device and face-mask for 5 months. Rescue medication (ipratropium plus fenoterol aerosol) was available during the baseline period of 1 month and the intervention period. Parents completed a daily symptom-score list. The primary outcome measure was the proportion of symptom-free days in months 2 to 5. Analysis was by both intention to treat and on treatment. FINDINGS: 167 (77%) children completed the trial. 131 (78%) of these children used at least 80% of the recommended dose. Of the 51 children who stopped prematurely, 23 had difficulties with inhaled treatment. The mean proportion of symptom-free days for both groups was greater for the treatment period than for the baseline period (95% CI for mean difference 5.1 to 17.5 cromoglycate, 11.9 to 23.3 placebo). However there were no differences between the sodium cromoglycate and placebo groups in the proportion of symptom-free days (mean 65.7 [SD 25.3] vs 64.3 [24.5]%; 95% CI for difference -8.46 to 5.70) or in any other outcome measure. INTERPRETATION: Our study in a general practice setting shows that inhalation therapy with a spacer device and face-mask is feasible in a majority of children below the age of 4 years. However, long-term prophylactic therapy with inhaled sodium cromoglycate is not more effective than placebo in this age-group.

Administration, Inhalation↗

PubMed1997

Measuring chronic pain in children, an exploration.

The study focused on the feasibility and validity of pain instruments and the optimal period of diary registration for measuring chronic pain intensity of 13 children. Highly positive associations were found between the registration of pain on a Visual Analogue Scale and on the Postoperative Pain Measure for Parents. For children under medical treatment for chronic limb pain a one-week dairy registration suffices.

Adult↗

PubMed1997

Children referred for specialist care: a nationwide study in Dutch general practice.

BACKGROUND: Insight into referral patterns provides general practitioners (GPs) and specialists with a frame of reference for their own work and enables assessment of the need for secondary care. Only approximate information is available. AIM: To determine how often, to which specialties and for what conditions children in different age groups are referred, as well as how often a condition is referred given the incidence in general practice. METHOD: From data of the Dutch National Survey of Morbidity and Interventions in General Practice, 63,753 new referrals (acute and non-acute) were analysed for children (0-14 years) from 103 participating practices (161 GPs) who registered. Practices were divided into four groups. Each group of practices participated for three consecutive months covering a whole year altogether. We calculated referral rates per 1000 children per year and referability rates per 100 episodes, which quantifies the a priori chance of a condition being referred for specialist care. RESULTS: The referral rate varied by age from 231 for children under 1 year old to 119 for those aged 10-14 years (mean 159). The specialties mainly involved were ENT, paediatrics, surgery, ophthalmology, dermatology and orthopaedics. Referrals in the first year of life were most frequently to paediatricians (123); among older children the referral rate to paediatricians decreased (mean 36). Referrals to ENT specialists were seen particularly in the age groups 1-4 (71) and 5-9 (53). For surgery, the referral rate increased by age from 19 to 34. Differences between boys and girls were small, except for surgery. The highest referral rates were for problems in the International Classification of Primary Care (ICPC) chapters: respiratory (28); musculoskeletal (25); ear (24) and eye (21). Referability rates were, in general, low for conditions referred to paediatrics and dermatology and high for surgery and ophthalmology. The variation in problems presented to each specialty is indicated by the proportion of all referrals constituted by the 10 most frequently referred diagnoses: from 35% for paediatrics to 81% for ENT; for ophthalmology, five diagnoses accounted for 83% of all referrals. CONCLUSIONS: The need for specialist care in childhood is clarified with detailed information for different age categories, specialties involved and variation in morbidity presented to specialists, as well as the proneness of conditions to be referred.

Adolescent↗

PubMed1996

[No difference in frequency of family practitioner consultation by Turkish, Surinam and Moroccan 0-14-year-old children from Dutch children, but difference in reason for contact].

OBJECTIVE: To determine whether consultation behaviour of Turkish, Surinam and Moroccan children (0-14 years old) with a GP differs from that of a comparable group of Dutch children. DESIGN: Cohort study with comparison of matched groups. SETTING: 103 general practices in the Netherlands. METHODS: Data on 63.753 children collected in the Dutch National Survey were used. 161 GPs registered all contacts between patient and practice during 1 year (in 4 parts of each 3 months). Sociodemographic characteristics of all 103 practice populations were gathered. For each Turkish, Surinam and Moroccan child a Dutch child was selected with similar age, gender, socio-economic status, degree of urbanisation, season of registration and sickness insurance coverage. Consult frequency, number of encounters per episode of care, morbidity presented, duration of encounter and percentages of encounters during evening, night and weekend were registered. RESULTS: There were no significant differences in consult frequency between the three ethnic groups and their Dutch reference group, nor were there any differences in number of encounters during an episode of care. The morbidity presented did vary compared with Dutch children. Turkish children consulted the GP more often for gastrointestinal problems (relative risk (RR): 1,81) and respiratory problems (RR: 1,27), but less often for ear problems (RR: 0,54). Surinam children consulted the GP less often for musculoskeletal problems (RR: 0,65), but more often for respiratory problems (RR: 1,20). Moroccan children consulted the GP less often for ear problems (RR: 0,51). For a larger percentage of ethnic children the duration of encounter was less than ten minutes. CONCLUSION: Turkish, Surinam and Moroccan children do not consult a GP more often than a comparable group of Dutch children. The morbidity presented differed.

Adolescent↗

PubMed1995

[For which health problems in children is the family physician consulted and how often?].

OBJECTIVE: To determine how often and for what health problems in children general practitioners (GPs) are consulted, and whether this is affected by age, gender, season, socioeconomic status and degree of urbanisation. DESIGN: Descriptive. SETTING: 103 general practices (161 GPs) in the Netherlands. METHOD: Data from 63,753 children (0-14 years of age) collected in the framework of the Dutch National Survey were used. A random sample of 161 GPs registered all contacts between patient and practice during 3 months. Sociodemographic characteristics of all practice populations were gathered. Health problems were coded according to the International Classification of Primary Care (ICPC). Consultation frequency, morbidity presented, age and gender specific incidence rates were determined, as well as relative risks of presented morbidity relative to sociodemographic characteristics and season. RESULTS: Children consulted a GP on average 2.8 times per year. Problems from the respiratory tract (upper respiratory tract infection, acute bronchitis, coughing and acute tonsillitis) and acute otitis media were presented most. The morbidity varied strongly with age. Children from low socioeconomic strata and children living in larger cities presented more problems (in particular respiratory and ear problems). CONCLUSION: The GP is confronted with a great diversity of health problems in children. The variation in consultation frequency and morbidity according to selected sociodemographic characteristics showed that presentation of information in more detail by age is necessary in order to obtain optimal insight.

Adolescent↗

PubMed1995

Musculoskeletal disorders in children: a study in Dutch general practice.

OBJECTIVE: This study focuses on the occurrence of musculoskeletal disorders in children presented in general practice. Known epidemiological studies addressing musculoskeletal diseases in childhood are scarce and based on a low number of episodes. DESIGN AND SETTING: Prospective study of all patient contacts in general practice. A total number of 161 general practitioners participated, divided into four groups, registering during four consecutive three-month periods. PATIENTS: All children younger than 15 years of age who visited their GP during the registration period. All diagnoses and working hypotheses concerning musculoskeletal disorders were selected. RESULTS: The total number of children in the study was 64,198. Disorders of the musculoskeletal system accounted for 3,699 (7.5%) of all 49,309 contacts and for 3,046 (7.5%) of all 40,340 episodes. Of the 3,046 episodes registered for ICPC-chapter L (musculoskeletal), 2,562 (84%) were new episodes, i.e. not presented to the GP before. Fifty-four percent of all new episodes were acute injuries. In 22% of the new episodes the general practitioner made a symptom diagnosis. Differences by age and sex were found for a limited number of diagnosis categories. CONCLUSION: Children present disorders of the musculoskeletal system less often than adults; they also present different disorders to their general practitioners. The majority of disorders presented by children are acute injuries, mostly sprains and strains.

Adolescent↗

PubMed1994

Molluscum contagiosum in Dutch general practice.

BACKGROUND: While molluscum contagiosum is considered to be a frequently encountered disease, few data on its incidence are known. AIM: The objective of this study was to describe the incidence of molluscum contagiosum in Dutch general practice and to assess the importance of venereal molluscum contagiosum. METHOD: Data were taken from the national survey of morbidity and interventions in general practice, drawn from 103 practices across the Netherlands, with a study population of 332300. RESULTS: The infection appeared to be common in childhood (cumulative incidence 17% in those aged under 15 years); the adult, sexually transmitted, form was rare. Incidence was higher between January and June than between July and December. Cases were unequally divided between recording practices, which is though to have been caused by the occurrence of small epidemics. CONCLUSION: The incidence of molluscum contagiosum in Dutch general practice was found to be 2.4 per 1000 person years. Molluscum contagiosum should still be considered as a mainly paediatric disease.

Adolescent↗

PubMed1993

[Infants who cry a lot: incidence and management of this problem in family practice].

OBJECTIVE: To determine how frequently general practitioners (GPs) are consulted because of excessively crying infants and how such infants are managed. SETTING: A stratified sample of 103 GP practices throughout The Netherlands. DESIGN: Descriptive. METHOD: 161 GPs from 103 practices for one year (in four groups, each for three months) recorded all their contacts with patients as a part of the National Study of Diseases and Items of Service in General Practice, conducted by the Netherlands Institute for Primary Health Care Research. An inventory was made of the infants who fulfilled the criteria of the 'colic syndrome' as to age, symptomatology and diagnosis. RESULTS: Of the infants seen by the GPs, 10% displayed symptoms of excessive crying, colic or restlessness. In over one-third of this group a colic-like diagnosis was made; of the children from zero to four months this proportion was two-thirds. The probability of a child in the age group of 0 to 4 months being seen by the GP with colic-like symptoms and diagnosis amounted to 7.1% (cumulative incidence). The majority of the GPs were certain of their (mostly somatic) diagnoses. The GPs were consulted more often about these children, apart from the colic problem, than about their contemporaries, the difference being statistically significant. In only 30% of the cases did the GPs prescribe medication or a diet, or made a referral.

Colic↗