There is very little data on physical and psychological long-term outcome after severe burn injury. The aim of the present thesis was to improve current instruments for assessment of these issues, to assess long-term outcome in a cohort of patients with burn injuries, and to explore the contribution of the individual factors of personality and coping on perceived outcome. Patients treated at the Burn Unit, Uppsala University Hospital, between 1980 and 1995 were included on a consecutive basis if they were 18 years of age or older at follow-up, had burn injuries of ten percent or more, or hospitalization times of seven days or more. A total of 350 patients fulfilled these inclusion criteria. A factor analytic approach was used to derive a 40-item instrument called the Burn Specific Health Scale-Brief (BSHS-B), resulting in nine well-defined domains. Most burn patients reported a very good perceived outcome but a subgroup reported problems years after injury. On a group level most problems were related to Heat Sensitivity, Work and Body Image. The depth of injury, gender, marital status and living conditions were all related to outcome. Neurotic personality traits were related to perceived health, and were not confined only to psychological aspects of life but also included physical aspects. A 33-item burn-specific coping scale, the Coping with Burns Questionnaire (CBQ), with six clearly separated domains with acceptable internal consistencies was developed. Coping strategies were strongly related to outcome in the subgroup of patients reporting most problems in perceived health, and coping contributed more to psychosocial than physical health. Avoidant coping and Emotional support seeking had independent effects on outcome. The observation that Neuroticism and Avoidant coping strategies are related to bad outcome after severe burn injury indicates that patients with such characteristics should be given special attention during rehabilitation.

The intertwined relationship between physical and psychological problems is a topic of much interest in the rehabilitation of severely injured patients, e.g. after a burn. The present study aims at gaining further knowledge concerning the impact of psychological factors and psychiatric morbidity on short and long-term adaptation after burn injury. Outcome was assessed for three main areas: pruritus, return to work and psychiatric health. Three separate samples of previous or current adult patients treated at the Uppsala Burn Unit during different time periods: 1980-1995 (n=248), 1996-2000 (n=86), and 2000-2005 (n=73), were assessed. Chronic burn-related pruritus is more common than previously reported and psychological factors such as anxiety-related personality traits and coping are significantly associated with its presence. Only a small group of former patients with work-related accidents were not working an average of nine years after injury. The unemployed reported more pain and worse perceived health, particularly in psychosocial domains. Returning to work was explained by both injury severity and personality characteristics. Those who were not working had lower health-related quality of life and poorer traumarelated physical and psychological health, and more pain. Preburn psychiatric morbidity is high in a lifetime perspective. Two thirds of the sample had at least one disorder according to the Structured Clinical Interview for DSM-IV Axis I disorders. Affective disorders were especially highly represented. A logistic regression showed that having a history of preburn disorders was associated with a higher risk of both PTSD and depression one year after the injury. In this material it was actually uncommon for a patient without a preburn psychiatric history to develop postburn psychiatric symptomatology. The results have strengthened the overall model for adaptation after burn injury by showing that psychological factors and psychiatric history are important moderators of the adaptation process after the injury.

Summaries in Afrikaans and English / A primary school child finds him or herself in the middle childhood years and it is considered to be a rich phase of life, since children have already reached important milestones. These children have the ability not only to act with empathy but also to maintain independent behaviour. As a result of the development in the cognitive and moral stage of development, these children can also distinguish between right and wrong and they show insight that social rules can be changed. As a result of this development, it is believed that this child will accept learners with different skills more confidently when the required awareness is provided. One group of learners with special skills, which I focused on during this research, are those who have been deformed by burn wounds. Statistics show that a growing number of children in South Africa are deformed by burn wounds. As a result of the changing policy on inclusive education, these children cannot be denied into the mainstream education system because of deformity or disability anymore. It is therefore believed that an increasing number of deformed or disabled children will be entering the mainstream education system. Information is gathered through various methods by using triangulation. The literature study, semi-structured interviews with children as well as teachers for experimental subjects, who completed an incomplete sentence test and open questions, added valuable information. Research indicated that children in this phase of life are indeed equipped with certain life skills, which place them in a privileged position to handle interaction with the deformed child, if they receive the required awareness. The information also indicated that the gestalt approach could be used as theoretical perspective for the compilation of the guideline. This approach recognises that play is the child's natural communication medium but also recognises that awareness is created through means of experimentation. To my knowledge, there is no program or guideline from the gestalt approach that enables education staff to address children's awareness in respect of their inherent skills in the middle childhood years. The researcher made a breakthrough in the integration of the gestalt approach with the education environment by constructing a practical guideline from the gestalt approach for education staff. Education staff should, however, receive training with regards to the gestalt approach in order to use this guideline effectively. / Laerskoolkind bevind hom- of haarself in die middelkinderjare en dit word as ryk lewensfase beskou, aangesien kinders reeds belangrike mylpale bereik het. Hierdie kinders beskik oor die vermoe om nie slegs empaties op te tree nie, maar om ook selfstandige gedrag te handhaaf. As gevolg van die ontwikkeling in die kognitiewe en morele ontwikkelingsterrein, kan hulle ook tussen reg en verkeerd onderskei en toon hulle insig dat sosiale reels verander kan word. As gevolg van hierdie ontwikkeling word daar verwag dat hierdie kind met die nodige bewusmaking, leerders wat oor verskillende bekwaamhede beskik, met meer selfvertroue sal kan aanvaar. Een groep leerders, waarop daar tydens hierdie navorsing gefokus sal word, wat oor spesiale bekwaamheid beskik, is diegene wat deur brandwonde geskend is. Statistieke toon dat toenemende aantal kinders jaarliks in Suid-Afrika, weens brandwonde geskend word. As gevolg van die veranderende beleid op insluitende onderwys, kan kinders weens geskend- of gestremdheid nie meer tot die hoofstroomonderwysstelsel geweier word nie. Die verwagting is dus dat toenemende aantal geskende of gestremde kinders die hoofstroomonderwysstelsel sal betree. Inligting is deur verskeie metodes ingesamel deur die benutting van triangulering. Die literatuurstudie, semi-gestruktureerde onderhoude met kinders asook onderwysers as proefpersone wat 'n onvoltooide sinnetoets en oop vrae voltooi het, het bruikbare inligting tot gevolg gehad. Daar is gevind dat kinders in hierdie lewensfase wei oor bepaalde lewensvaardighede beskik, wat hulle in 'n bevoorregte posisie plaas om, indien hulle die nodige bewusmaking ontvang, interaksie met die geskende kind sal kan behartig. Die inligting het verder ook daarop gedui dat die gestaltspelbenadering as teoretiese perspektief vir die samestelling van die riglyn benut kan word. Hierdie benadering erken dat spel die kind se natuurlike kommunikasiemedium is, maar ook dat bewuswording geskied deur middel van eksperimentasie. Sover bekend is daar geen program of riglyn vanuit die gestaltbenadering, wat opvoedkundige personeel in staat stel om kinders in die middelkinderjare se bewustheid ten opsigte van hulle inherente vaardighede aan te spreek nie. Die navorser het 'n deurbraak in die integrering van die gestaltbenadering met die opvoedkundige omgewing gemaak deurdat 'n praktiese riglyn vanuit die gestaltspelbenadering vir opvoedkundige personeel saamgestel is. Opvoedkundige personeel behoort egter opleiding met betrekking tot die gestaltspelbenadering te ontvang ten einde hierdie riglyn effektief te kan benut. / Social Work / M. Diac. (Play Therapy)

La lewisite est une arsine organique de la catégorie des vésicants dont l'antidote est le British Anti-Lewisite. Cet agent chimique de guerre dont la menace d'utilisation reste d'actualité, provoque après contact cutané, des lésions allant de l'érythème à la vésication plus ou moins étendue selon la dose reçue. Les données de toxicité, en particulier humaines, sont restreintes et parfois contradictoires, ce qui limite la pertinence d'une description précise des symptômes et de leur chronologie d'apparition. Les traitements actuels des brûlures cutanées sont peu spécifiques, uniquement symptomatiques, et s'inspirent généralement des approches utilisées dans le cas des brûlures thermiques. Dans ce contexte, il nous a semblé important de mieux comprendre les mécanismes lésionnels associés à une exposition cutanée à la lewisite. Ces étapes de compréhension physiopathologiques permettent d'identifier des cibles potentielles pour des interventions pharmacologiques et sont également nécessaires et préalables à l'établissement de nouvelles stratégies curatives. C'est dans ce cadre que s'est inscrit notre travail de recherche. En privilégiant une approche expérimentale chez l'animal, la souris sans poils SKH-1, le travail a consisté dans un premier temps à décrire l'évolution temporelle des lésions cutanées induites par une exposition de la peau du dos de la souris à des vapeurs saturantes de lewisite. Le processus lésionnel a été suivi pendant les 3 premières semaines après l'exposition permettant ainsi de couvrir les différentes phases de la cicatrisation cutanée. Un suivi à plus long terme sur 27 semaines a été également réalisé. L'utilisation de différentes méthodes d'exploration fonctionnelle a permis d'étudier la couleur de la peau, d'évaluer l'intégrité de la fonction barrière ainsi que les propriétés biomécaniques de la peau. Ces études ont été complétées par des analyses microscopiques des tissus lésés. Dans un deuxième temps, des cibles clés de la toxicité cutanée de la lewisite ont été identifiées par des approches génomiques et biochimiques. Sur une cinétique courte de 7 jours après l'exposition, les transcrits de gènes cibles ont été quantifiés par RT-qPCR. Ces données ont été complétées par une analyse protéique faisant intervenir différentes méthodes d'analyse complémentaires de puce à protéines, de western blot et de zymographie sur une cinétique plus longue de 14 jours. Pour terminer, l'intérêt de la détersion hydrochirurgicale associée à une thérapie matricielle a été envisagé pour traiter les lésions cutanées induites par la lewisite. / Lewisite is an organic arsenical compound ranked among the vesicating agents whose antidote is the British Anti-Lewisite. This chemical warfare agent remains a current threat and generates damage ranging from erythema to vesication, larger or smaller depending on the dose received after skin contact. Only few data are available regarding the toxicity on human and are sometimes contradictory. Therefore, the relevance of the description of the symptoms and their chronology of apparition are limited. Current treatments of skin burns are not specific, only symptomatic and are closed to those used to treat thermal burns. In such context, we consider it important to gain better understanding of the injury mechanisms associated with skin exposure to lewisite. These understanding stages of the physiopathology aim at identifying potential targets for pharmacological interventions and are necessary and prerequisites for the establishment of new curative strategies. It is within this framework that our investigations are based on. An appropriate experimental approach was conducted using the SKH-1 hairless mouse. In the first place, the aim was to describe the time course of skin lesions development induced by exposure to saturating vapors of lewisite on the dorsal skin of the mouse. The injury process was monitored throughout the first 3 weeks after exposure in order to cover the different phases of wound healing. A long term monitoring throughout 27 weeks was also performed. The use of several methods of functional exploration has enabled the study of the skin color, the evaluation of the integrity of the barrier function and the biomechanical properties of the skin. These studies were completed by microscopic analyses of the injured tissues. In a second step, key targets of the lewisite skin toxicity were identified by genomic and biochemical approaches. The transcripts of the target genes were quantified by RT-qPCR in a 7-day kinetic after exposure. Data were completed by protein analyses involving complementary analytical methods (antibody array, western blot, gel zymography in a 14-day kinetic. Lastly, a combination of hydrosurgical debridement and matrix therapy was assessed and considered in order to treat skin lesions induced by lewisite.

The present investigation sought to explore the efficacy of stress inoculation in the management of pain with severely burned adults. Subjects were 16 adult burn patients randomly assigned to either the stress-inoculation or no-treatment comparison group. The focus of the analysis was the amount of change or improvement from pretreatment to posttreatment periods. The stress-inoculation group showed significant improvement on all nine dependent measures, while the no-treatment group improved significantly on only two (physical and emotional self-ratings). The overall comparison of the amount of change between groups revealed that the stress-inoculation group showed significantly greater improvement in pain management than the no-treatment group during this time. It was concluded that stress inoculation, as a flexible treatment package, was efficacious in the management of pain experience of burn patients.

With the decrease in burn mortality following improved burn care facilities and methods, burn survivors are often left with residual physical and psychosocial consequences that they have to cope with requiring adaptation and modification of lifestyle. Burn survivors habitually receive excellent treatment for their wounds while in hospital but may experience challenges due to disruption of care and rehabilitation after discharge. This aim of the study was to explore and describe the lived experiences of burn survivors’ adaptation post hospital discharge. A qualitative, hermeneutic, phenomenological design using an interpretive framework was used. A purposeful sampling was used in the selection of nine participants who were above 18 years and had been admitted to the Limpopo Burn Unit while still undergoing reviews at the Plastic and Reconstructive Surgery Clinic. Data were collected through face-to-face interviews using unstructured open-ended questions. Data were analysed using the Colaizzi’s strategy. Three main themes emerged from the data, along with sub-themes. (a)The burn survival experience involved the person in totality with reference to their internal and external environment. (b)The process of recovery was lengthy and started in hospital and continued post discharge at home. (c) Reclaiming their life and finding new meaning was a process of adaptation. The core of the participants’ needs included the need for the care and rehabilitation of the whole person in terms of their physical and psychosocial aspects, the importance of the survivor’s involvement in his/her care, and the rehabilitation. Health care personnel and family support during this difficult time should be available in order to enable the survivors to cope and adapt effectively and reclaim their lives. / Health Studies / M.A. (Nursing Science)

Submitted by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-06-27T19:07:25Z No. of bitstreams: 1 Publico-NOVO-20.pdf: 888503 bytes, checksum: 0e3c78bc6040c66cc6712fddc9beb7a9 (MD5) / Approved for entry into archive by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-06-27T19:08:15Z (GMT) No. of bitstreams: 1 Publico-NOVO-20.pdf: 888503 bytes, checksum: 0e3c78bc6040c66cc6712fddc9beb7a9 (MD5) / Made available in DSpace on 2016-06-27T19:08:15Z (GMT). No. of bitstreams: 1 Publico-NOVO-20.pdf: 888503 bytes, checksum: 0e3c78bc6040c66cc6712fddc9beb7a9 (MD5) Previous issue date: 2015 / Introdução: Queimadura extensa e profunda é um trauma complexo que necessita de cuidados intensivos no tratamento agudo. Intervenções terapêuticas para atenuar a resposta inflamatória aguda e acelerar a cicatrização podem contribuir na redução da morbimortalidade e nos custos do tratamento. Estudos demonstram a importância do fator de crescimento de queratinócito (KGF) na cicatrização de feridas. Objetivo: Avaliar a ação do KGF na expressão de 84 genes marcadores da cicatrização em cultura primária de queratinócitos humanos oriundos de pacientes com queimadura. Métodos: Após a obtenção de fragmentos de pele de quatro pacientes com queimadura (grupo queimadura) e de quatro pacientes hígidos (grupo controle), foi realizada a cultura de queratinócitos humanos primários e distribuídas em quatro grupos: GQ+ (n = 4 – queratinócitos de queimadura tratadas com KGF), GQ- (n = 4 – queratinócitos de queimadura sem tratamento), GC+ (n = 4 – queratinócitos do grupo controle tratadas com KGF) e GC- (n = 4 – queratinócitos do grupo controle sem tratamento). A análise da expressão gênica foi feita por qPCR Array, realizando seis comparações: 1) GC+ versus GC-; 2) GQ- versus GC-; 3) GQ+ versus GC-; 4) GQ+ versus GQ-, 5) GQ+ versus GC+ e 6) GQ- versus GC+. Resultados: A comparação 1 apresentou um gene hiporregulado e um hiperregulado. As comparações 2 e 3 apresentaram os mesmos cinco genes hiporregulados. A comparação 4 não apresentou genes diferencialmente expressos. A comparação 5 apresentou 26 genes hiporregulados e 7 hiperregulados. E a comparação 6 apresentou 25 genes hiporregulados e 11 genes hiperregulados. Conclusão: A suplementação de KGF à cultura de queratinócitos de pacientes com queimadura não determinou a expressão gênica diferencial dos genes marcadores da cicatrização. / Introduction: Severe burn injury is a complex trauma that needs intensive care in the acute setting. Therapeutic interventions that aim to attenuate the acute inflammatory response and to accelerate the healing may contribute to reducing morbidity, mortality and treatment costs. Several studies have demonstrated the importance of keratinocyte growth factor (KGF) in wound healing. Objective: Evaluate the effect of KGF in the expression of 84 wound healing genes in human primary keratinocytes cultured from patients with burn. Methods: After obtaining viable fragments of skin from four healthy (control group) and four burn patients, human primary keratinocytes was cultured and divided into 4 groups: GQ+ (n = 4 – keratinocytes of severe burn patients treated with KGF), GQ- (n = 4 – untreated keratinocytes of severe burn patients), GC+ (n = 4 – keratinocytes of control group treated with KGF) and GC- (n = 4 – untreated keratinocytes of control group). The gene expression's analysis was performed with qPCR Array, making six comparisons: 1) GC+ versus GC -; 2) GQversus GC-; 3) GQ+ versus GC-; 4) GQ+ versus GQ-, 5) GQ+ versus GC+ and 6) GQversus GC+. Results: Comparison 1 showed one down and one up-regulated genes. Comparisons 2 and 3 showed the same five down-regulated genes. Comparison 4 did not show statistically significant gene expression. Comparison 5 showed 26 downregulated and 7 up-regulated genes. And comparison 6 showed 25 down-regulated and 11 up-regulated genes. Conclusion: Supplementation of KGF to the culture of keratinocytes from patients with burn injury not determined the differential gene expression of genes markers of wound healing

Burn trauma is very stressing for patients physically due to the high level of pain, damage to the skin and risk of infection, and also from a psycho-social perspective. There are currently several facilities dedicated to burn therapy. These are staffed by quality personnel with a high level of experience, who increase the hopes of patients to achieve better living conditions. Therapy depends on the extent of the handicap as well as other factors affecting the individual. Extensive burns require treatment in specialized facilities, where the patient is subject to a demanding and long-term therapy. Such patients are subject to multiple surgical procedures in total anaesthesia. The burn trauma has many complications during the healing process. The physician together with the nurse care for the patient and play a crucial role in this process. The patient will is subject to a long-term rehabilitation and complicated reintegration into society. We carried out a quantitative examination by means of 65 questionnaires handed out to general nurses, of which 58 could be used. The objectives of the thesis were met. We defined five hypotheses: H1: Nurses observe the principles of care for patients with burn trauma. H2: Nurses are aware of the effectiveness of rehabilitation treatment when caring for clients with burn trauma. H3: It is easier for nurses to provide care to patients with burn trauma if the patient is lying on an air bed as opposed to a standard bed. H4: Nurses cooperate with a clinical psychologist when caring for a patient with burn trauma. H5: Nurses cooperate with a nutrition therapist when caring for a patient with burn trauma. All the hypotheses were confirmed except hypothesis H3, which was disconfirmed. The research examination showed that nurses adhere to the principles of hygienic care for patients with burn trauma, and that they are aware of the effectiveness of rehabilitation treatment in burn care. Care for patients on an air bed is not easier for nurses than on a standard bed. On the contrary, it is physically more demanding. It was further confirmed that nurses cooperate with a clinical psychologist as well as a nutrition therapist when caring for patients with burn trauma. The diploma thesis is elaborated in such a way so that it can be used to create and present a standard, which will help to improve care for patients with burn trauma.

Injuries in children have been undoubtedly a threat for all parents, healthcare professionals and the children themselves for many years, but the children often do not have the possibility to even realize this threat. Just in moment too fast, they enter the turmoil of prehospital care and become patients, victims of their own play or due to the lack of attention of others, or even victims of adults. Burns or the so called thermal injuries are very common mechanisms of injuries in children. In our diploma thesis, we decided to focus on thermal injuries from the viewpoint of those who are the first to come in contact with the patients, and who must evaluate the given trauma and initiate treatment based on the evaluation. In particular, this applies to the personnel of emergency medical services, and also to the graduates of the Faculty of Health and Social Studies, University of South Bohemia in České Budějovice (USB FHSS). These persons should also be the ones to be aware of how burn injuries are evaluated in children - given among others that many of them are often found in the position of healthcare personnel at children´s camps or nurse at offices of general practitioners for children and adolescents. The following hypothesis was formulated based on consultations with the professional public (MUDr. Robert Zajíček, Burn Medicine Department, University Hospital Královské Vinohrady): ?Education of healthcare personnel of emergency medical services and USB FHSS graduates is inadequate, being a potential source of errors in the provision of prehospital care?. Based on this hypothesis, objectives of the diploma thesis were set as follows: Objective 1: Determine the knowledge status and practical skills in respect of evaluating 6 essential burn factors amnog emergency medical service personnel and USB FHSS graduates. Objective 2: Develop an educational material on prehospital care in children with burns.

Made available in DSpace on 2014-06-11T19:22:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2005Bitstream added on 2014-06-13T20:09:57Z : No. of bitstreams: 1 mendesjunior_ecs_me_botfm.pdf: 5579459 bytes, checksum: 8669f77056518f9187d25fceedc26900 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O estudo avaliou o efeito da membrana de silicone no tratamento de área cruenta de ferimento. Método: O estudo experimental foi realizado com 30 ratos Wistar, machos, divididos igualmente em três grupos: no grupo GG a área cruenta foi tratada com gazes, no grupo GH com homoenxerto e no grupo GS com membrana de silicone. Após quatorze dias de pós-operatório, os animais foram sacrificados. Os atributos estudados foram a variação da massa corporal dos animais; o estudo histológico quantificado por análise morfométrica avaliando o número de neovasos, fibroblastos, fibras colágenas, leucócitos, monócitos; e a medida da espessura da área cruenta através de régua micrométrica. Os dados foram submetidos à análise estatística. Resultados: Não houve diferença significativa entre as massas dos animais. Observou-se um predomínio de neovasos, fibroblastos e a espessura de área cruenta nos animais do grupo GS. Houve predomínio de leucócitos e monócitos nos animais do grupo GH. Também foi observado que não houve diferença significativa entre os grupos quanto às fibras colágenas. Conclusão: A membrana de silicone proporcionou tecido de granulação com maior número de neovasos, fibroblastos e maior espessura. / The purpose of this study was to evaluate effects of the silicone membrane on treatment of wound healing base. Methods: The experimental study was with thirty Wistar male rats equally divided into three groups. Group GG the would healing base was treatment with rayon gauz, group GH with homograft and group GS with silicone membrane. The animals were sacrificed 14 postoperative day. This study evaluated weigh of rats; histological and morphometric analysis of the number of neovessels, fibroblasts, collagen fibers, leucocytes and monocytes; and measurement of wound healing base thickness was done with micrometer straight edge . The data were submitted to statistical analysis. Results: The weight of rats was similar among groups. The analysis showed considerable increased number of neovessels, fibroblasts and the measurement of would healing base thickness on the group GS; considerable increased number of leucocytes and height increased number of monocytes on the group GH. Similar pattern was observed in number of collagen fibers among three groups. Conclusion: The silicone membrane supportered wound healing base with considerable increased number of neovessels, fibroblasts and enlarging measurement of thickness.