Development of International Outcomes Instrument for Hand and Upper Extremity Burn Scar Contracture Release.

Burn scar contractures remain a common source of severe disability in resource-limited countries. However, existing outcome measurements are unable to fully capture the impact of the scar contracture and surgical attempts at correction. To that end, we have developed a new outcome instrument, the Stanford-ReSurge Burn Scar Contracture Scale-Upper Extremity that can be used as a measurement of disability and reconstructive procedure outcomes. The outcome instrument was created through item generation, item reduction, and preliminary field testing. We performed a literature review using multiple databases to gather a comprehensive list of existing burn contracture metrics, removed metrics that were inapplicable in resource-limited settings, and submitted remaining items to plastic and hand surgeons for evaluation of clinical and cultural relevance, comprehensiveness, and feasibility. The remaining items were field tested to evaluate patient comprehension and ability to detect change over 1 month. A literature review found 32 unique scales that were eventually reduced to a pool of 38 potential items that were field tested with patients. Patient feedback further reduced the item pool to the final 20-item scale. Patients who underwent burn scar contracture release of the upper extremity showed an average of 14 points improvement between the preoperative and 1-month postoperative time point. The Stanford-ReSurge Burn Scar Contracture showed clinical utility for assessing outcomes in burn scar contracture release of the upper extremity. Our goal is to develop a standardized outcome instrument for burn reconstruction in the world's poorest burn patients.

Maternal risk factors for HIV infection in infants in northeastern Brazil.

INTRODUCTION: While the rate of vertically transmitted HIV infection has fallen in most regions of Brazil, there have been no similar decreases in northern and northeastern Brazil. OBJECTIVE: The objective of this study was to evaluate the risk factors associated with vertical transmission in the state of Sergipe in northeastern Brazil. METHODS: This was a retrospective cohort study. We recorded clinic and registry data for all HIV-infected pregnant women and exposed children diagnosed in Sergipe from 1990 to 2011. RESULTS: We identified 538 deliveries and 561 HIV-exposed infants (23 sets of twins). One hundred one (18.9%) infants were HIV-infected. In the multivariate analysis, infant antiretroviral prophylaxis was a significant protective factor (adjusted odds ratio (aOR) 0.07, 95% confidence interval (CI) 0.01-0.41, p=0.003). Breastfeeding was marginally associated with an increased odds of perinatal transmission (aOR 4.52, 95% CI 0.78-26.17, p = 0.092). The attributable risk percentage for breastfeeding over the study period was 91.0%. Transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following the adoption of the prevention protocol. CONCLUSION: Transmission declined over the study period. The screening of pregnant women and timely initiation of prophylaxis and therapy are issues that require further attention.