Marjolein Krul

Musculoskeletal Problems in Overweight and Obese Children

PURPOSE The obesity epidemic in children is spreading at alarming rates. Because musculoskeletal problems can influence physical activity, we compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children. METHODS We performed a cross-sectional database and face-to-face interview study that included 2,459 children aged 2 to 17 years from Dutch family practices. We collected data on self-reported height and weight (body mass index), self-reported musculoskeletal problems in the 2 weeks before the interview, number of family physician consultations for musculoskeletal problems in 1 year, and age (2 age-groups were analyzed: 2 to 11 years and 12 to 17 years, because of the proxy interview in the youngest age-group). We calculated the odds ratio (OR) and 95% confidence interval (CI) for musculoskeletal problems in overweight and obese children, compared with normal-weight children. RESULTS Overweight and obese children in both age-groups (2 to 11 years and 12 to 17 years) reported significantly more musculoskeletal problems (OR = 1.86; 95% CI, 1.18–2.93; and OR = 1.69; 95% CI, 1.08–2.65, respectively) than normal-weight children. The total group of children who were overweight or obese reported more lower extremity problems than did the normal-weight children (OR = 1.62; 95% CI, 1.09–2.41); furthermore, they reported more ankle and foot problems than children who were of normal weight (OR = 1.92; 95% CI, 1.15–3.20). Overweight and obese children aged 12 to 17 years consulted their family physicians more often with lower extremity problems than did the normal-weight children (OR = 1.92; 95% CI, 1.05–3.51). CONCLUSION This study shows that overweight and obese children more frequently experience musculoskeletal problems than do normal-weight children.

Foot problems in children presented to the family physician: a comparison between 1987 and 2001

BACKGROUND In recent decades, studies on the management of common foot problems in children have suggested that in many cases, there is no indication for treatment. It is not known whether these studies have changed daily practice. OBJECTIVE Our aim was to establish and compare incidence and referral rates for foot problems in children in 1987 and 2001. METHODS A comparison was made of two large consecutive surveys in Dutch general practice performed in 1987 (86 577 children aged 0-17 years) and 2001 (87 952 children aged 0-17 years), which were carried out by The Netherlands Institute for Health Services Research. Both surveys included a representative sample of the Dutch population. Incidence and referral rates were calculated and, data were stratified for age group and gender. RESULTS Compared to 1987, in 2001 the overall incidence rate of foot problems presented to the family physician (FP) decreased substantially from 80.0 [95% confidence interval (CI) 77.0-84.7] to 17.4 (95% CI 16.5-18.3) per 1000 person-years (P < 0.0001). The incidence rate of flat feet decreased from 4.9 (95% CI 4.0-5.9) per 1000 person-years in 1987 to 3.4 (95% CI 3.0-3.8) per 1000 person-years in 2001 (P = 0.001). The distribution of referrals to other primary health care professionals and medical specialists has almost reversed in favour of primary health care professionals. CONCLUSION Total incidence rate of musculoskeletal foot problems seen by the FP has decreased substantially, between 1987 and 2001.

What is the clinical course of transient synovitis in children: a systematic review of the literature

BackgroundTransient synovitis of the hip (TS) is considered to be a self-limiting disease in childhood. However, because the etiology is unclear and some cases precede Legg-Perthes’ disease, data on follow-up are important. Our aim was to summarize the knowledge on the clinical course of TS in children.MethodsThe study design was a systematic review and a literature search was conducted in Medline and Embase. Studies describing short and/or long-term follow-up of TS in children were included. Case reports, reviews and studies describing traumatic hip pain were excluded. Study quality was scored and data extraction was performed. The main outcome measures were short-term and long-term clinical course, and recurrence of symptoms.ResultsA total of 25 studies were included of which 14 were of high quality. At two-week follow-up, almost all children with TS were symptom free. Those with symptoms persisting for over one month were more prone to develop other hip pathology, such as Legg-Perthes’ disease. The recurrence rate of TS ranged from 0–26.3%. At long-term follow-up, 0-10% of the children diagnosed with TS developed Legg-Perthes’ disease. Hip pain after intensive physical effort and limited range of motion of the hip at long-term follow-up was reported in 12-28% and in 0-18% of the children, respectively.ConclusionsThe majority of the studies indicate that children with TS recover within two weeks; recurrence was seen in 0-26% of the cases. Children with TS should be followed at least six months to increase the likelihood of not missing Legg-Perthes’ disease.

Long-term effects of a randomized, controlled, tailor-made weight-loss intervention in primary care on the health and lifestyle of overweight and obese women

BACKGROUND Maintenance of weight loss after a diet and exercise intervention is often low. Moreover, short follow-up periods and high attrition rates often impede translation of study results to clinical practice. OBJECTIVE The present study evaluated the long-term effectiveness of a randomized, tailor-made lifestyle intervention, consisting of diet and exercise, on the health and lifestyle of overweight, middle-aged women in primary care. DESIGN The intervention was part of a randomized controlled trial on the prevention of knee osteoarthritis [PROOF (PRevention of knee Osteoarthritis in Overweight Females) study]. The intervention lasted 2.5 y and consisted of visits to the dietitian and participation in physical activity classes, supervised by a physiotherapist. The outcome of main interest of the present study was weight change (in kg) 6-7 y after randomization. Additionally, the interventions effect on change in physical activity was investigated. RESULTS After 6 mo, weight loss was significantly higher in the intervention group (adjusted difference: 1.34 kg; 95% CI: 0.46, 2.22 kg). Over time, this difference decreased and became nonsignificant after 24 mo. Per-protocol analyses showed similar results. After 6 mo, change in physical activity was significantly higher in the intervention group (15.2%; 95% CI: 28.6%, 1.7%). Over time, this difference increased up to 29.8% (95% CI: 2.3%, 57.2%) after 6.6 y of follow-up. Per-protocol analyses showed no significant differences in change in physical activity. CONCLUSIONS A long-lasting intervention effect on change in physical activity was found, which increased over time. For weight change, smaller differences were found, which decreased over time. In future research, greater intervention effects on weight change are expected when higher compliance rates can be reached. The present study provides important recommendations for future research. The PROOF study was registered at http://www.isrctn.com as ISRCTN42823086.

Long-term effects of a lifestyle intervention and oral glucosamine sulphate in primary care on incident knee OA in overweight women

Objectives The present study was designed to evaluate the effect of a lifestyle intervention aimed to reduce body weight and of oral glucosamine sulphate on the incidence of knee osteoarthritis (OA) after 6-7 years in a population of middle-aged, overweight women, without knee OA at baseline. Methods The Prevention of knee Osteoarthritis in Overweight Females study, ISRCTN42823086, was a randomized controlled trial with a 2 × 2 factorial design. Four hundred and seven women aged 50-60 years with a BMI of ⩾27 kg/m 2 and free of knee OA were randomized. Results Four hundred and seventy-seven knees from 245 participants were available after a mean follow-up time of 6.6 years. Nineteen per cent of all knees showed incident knee OA. Both interventions showed no significant preventive effect on incident knee OA. Despite the fact that per protocol analyses showed greater differences between both groups for the lifestyle intervention, significance was not reached. A significant effect of losing ⩾5 kg or ⩾ 5% of baseline weight in the first 12 months on the incidence of knee OA according to the primary outcome was found (odds ratio = 0.10; 95% CI: 0.02, 0.41). Conclusion No significant preventive effect on incident knee OA of either the lifestyle intervention or the glucosamine intervention was found. As a proof of concept, the preventive effect of moderate weight loss in 1 year on the incidence of clinical knee OA is demonstrated. This trial provides important insights for future studies on the prevention of knee OA, which are currently lacking. Trial registration ISRTCN registry, http://www.isrctn.com , ISRCTN42823086.

Acute niet-traumatische heupafwijkingen bij kinderen

SamenvattingKrul M, Van der Wouden JC, Schellevis FG, Van Suijlekom-Smit LWA, Koes BW. Acute niet-traumatische heupafwijkingen bij kinderen. Huisarts Wet 2010;53(10):529-32.Achtergrond Acute niet-traumatische heupafwijkingen bij kinderen kunnen het gevolg zijn van een onschuldige coxitis fugax, maar de onderliggende aandoening kan ook ernstiger zijn, zoals de ziekte van Perthes en epifysiolyse, of zelfs levensbedreigend zoals septische artritis. Om de voorafkans te kunnen inschatten is het belangrijk te weten met welke klachten deze kinderen zich bij de huisarts presenteren en hoe vaak dan welke diagnose wordt gesteld. Methoden We analyseerden de gegevens van alle kinderen van 0 tot 14 jaar uit de Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk (NS2), verzameld in 2001. Resultaten In de gegevens van 73.954 kinderen tussen 0 en 14 jaar vonden wij 101 episoden van een acute niet-traumatische heupafwijking. Van deze kinderen kwam 81,5% naar de huisarts vanwege pijnklachten, 8,6% in verband met mank lopen en 9,9% met beide symptomen. De incidentie van alle acute niet-traumatische heupafwijkingen samen was 148,1 per 100.000 persoonsjaren, die van coxitis fugax 76,2 per 100.000 persoonsjaren. In slechts 27% van de gevallen noteerde de huisarts of er sprake was van koorts. Conclusie De meeste kinderen die de huisarts bezoeken vanwege een acute niet-traumatische heupafwijking hebben pijnklachten. Gerefereerde pijn naar de knie lijkt alleen bij coxitis fugax voor te komen. Koorts is een belangrijk kenmerk om een onschuldige coxitis fugax te onderscheiden van een levensbedreigende septische artritis, maar werd weinig geregistreerd.

E-health geen effect op contactfrequentie voor luchtwegproblemen zuigelingen

SamenvattingArtsen gebruiken steeds vaker informatie op internet ter ondersteuning van het consult. Maar leidt dit ook tot efficiëntere zorg? Onderzoekers van het Julius Centrum van het UMC Utrecht onderzochten de waarde van een onlineprogramma met betrekking tot de contactfrequentie voor luchtwegproblemen bij zuigelingen. Online-informatie blijkt onvoldoende om ouders van zuigelingen gerust te stellen.

Jonge kinderen en hun ontwikkeling

SamenvattingKind in ontwikkeling is bedoeld voor iedereen die beroepshalve betrokken is bij jonge kinderen. Het beschrijft gedetailleerd de ontwikkeling van het kind op verschillende gebieden vanaf de conceptie tot het vijfde levensjaar. Aangezien dit al de zevende druk is, heeft dit boek zijn leeswaardigheid wel bewezen. In de vorige druk werden de hoofdstukken over ADHD en kindermishandeling al herzien. In deze druk is een gebruikstoelichting toegevoegd, die de uitklappagina met het ontwikkelingsschema van de kinderarts dr. Ch. Nicolic-De Kruijff verheldert.

Parachute reflex en groenhout fracturen

SamenvattingInhoud Het boek beschrijft in twintig hoofdstukken de belangrijkste orthopedische aandoeningen bij kinderen, zonder duidelijke volgorde. Het eerste hoofdstuk beschrijft gang- en standafwijkingen, gevolgd door hoofdstukken over voet-/enkelproblemen en knieproblemen, sportletsels, en heupafwijkingen. Het boek bespreekt vervolgens de wervelkolom en de bovenste lidmaat (extremiteit) en vervolgt met een hoofdstuk over de algemene aspecten van aangeboren afwijkingen, waarna de aangeboren voet- en handafwijkingen en groeistoornissen aan de beurt komen. Daarna volgen nog hoofdstukken over infecties, neuromusculaire aandoeningen, bottumoren en het boek eindigt bij fracturen en luxaties.

Vitamin E Concentration and Physical Decline in Older Persons

To the Editor: Dr Bartali and colleagues performed a longitudinal study of serum micronutrients and physical decline in older persons. Although they found an association between low serum concentrations of vitamin E and physical decline, the study had a large dropout rate, and we are concerned about the potential for selection bias. The authors report that, compared with those assessed, the 457 excluded participants (39.6% of total participants) were significantly older and had lower physical activity levels, poorer cognitive and physical function, and lower vitamin D levels, but they do not provide any information about vitamin E serum concentration (the characteristic of most interest). It would be important to know if this level were higher in the excluded group. Furthermore, we are particularly interested in the vitamin E levels and ages at baseline for the 214 participants (23.5% of baseline participants) who were lost during followup. It is very likely that these people were older and had more physical decline after baseline (because they had either died or did not participate in physical performance assessment at follow-up). This information would help in judging whether the study findings may actually be due to a selection bias before investing in expensive clinical trials to determine whether optimal vitamin E levels reduce functional decline, as was suggested by the authors.