Increasing incidence of skin disorders in children? A comparison between 1987 and 2001

BACKGROUND: The increasing proportion of skin diseases encountered in general practice represents a substantial part of morbidity in children. Only limited information is available about the frequency of specific skin diseases. We aimed to compare incidence rates of skin diseases in children in general practice between 1987 and 2001. METHODS: We used data on all children aged 0–17 years derived from two consecutive surveys performed in Dutch general practice in 1987 and 2001. Both surveys concerned a longitudinal registration of GP consultations over 12 months. Each disease episode was coded according to the International Classification of Primary Care. Incidence rates of separate skin diseases were calculated by dividing all new episodes for each distinct ICPC code by the average study population at risk. Data were stratified for socio-demographic characteristics. RESULTS: The incidence rate of all skin diseases combined in general practice decreased between 1987 and 2001. Among infants the incidence rate increased. Girls presented more skin diseases to the GP. In the southern part of the Netherlands children consulted their GP more often for skin diseases compared to the northern part. Children of non-Western immigrants presented relatively more skin diseases to the GP. In general practice incidence rates of specific skin diseases such as impetigo, dermatophytosis and atopic dermatitis increased in 2001, whereas warts, contact dermatitis and skin injuries decreased. CONCLUSION: The overall incidence rate of all skin diseases combined in general practice decreased whereas the incidence rates of bacterial, mycotic and atopic skin diseases increased

Striking variations in consultation rates with general practice reveal family influence

BACKGROUND: The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21. METHODS: Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families. RESULTS: In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background. CONCLUSION: Family circumstances can easily be identified and will add to the understanding of the health complaints of the individual patient in the consulting room. Family circumstances related to health risks often cannot be changed but they can illuminate the reasons for a visit, and mould strategies for prevention, treatment or recovery. Health beliefs, on the other hand, may be influenced by providing specific knowledge

Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation-wide registration study

BACKGROUND: We aimed to investigate incidence rates of urinary tract infections in Dutch general practice and their association with gender, season and urbanisation level, and to analyse prescription and referral in case of urinary tract infections. METHOD: During one calendar year, 195 general practitioners in 104 practices in the Netherlands registered all their patient contacts. This study was performed by the Netherlands Institute for Health Services Research (NIVEL) in 2001. Of 82,053 children aged 0 to 18 years, the following variables were collected: number of episodes per patient, number of contacts per episode, month of the year in which the diagnosis of urinary tract infection was made, age, gender, urbanisation level, drug prescription and referral. RESULTS: The overall incidence rate was 19 episodes per 1000 person years. The incidence rate in girls was 8 times as high as in boys. The incidence rate in smaller cities and rural areas was 2 times as high as in the three largest cities. Throughout the year, incidence rates varied with a decrease in summertime for children at the age of 0 to 12 years. Of the prescriptions, 66% were in accordance with current guidelines, but only 18% of the children who had an indication were actually referred. CONCLUSION: This study shows that incidence rates of urinary tract infections are not only related to gender and season, but also to urbanisation. General practitioners in the Netherlands frequently do not follow the clinical guidelines for urinary tract infections, especially with respect to referral

“Clinical features of women with gout arthritis.” A systematic review

Clinically, gout is generally considered as a preferential male disease. However, it definitely does not occur exclusively in males. Our aim was to assess differences in the clinical features of gout arthritis between female and male patients. Five electronic databases were searched to identify relevant original studies published between 1977 and 2007. The included studies had to focus on adult patients with primary gout arthritis and on sex differences in clinical features. Two reviewers independently assessed eligibility and quality of the studies. Out of 355 articles, 14 were selected. Nine fulfilled the quality and score criteria. We identified the following sex differences in the clinical features of gout in women compared to men: the onset of gout occurs at a higher age, more comorbidity with hypertension or renal insufficiency, more often use of diuretics, less likely to drink alcohol, less often podagra but more often involvement of other joints, less frequent recurrent attacks. We found interesting sex differences regarding the clinical features of patients with gout arthritis. To diagnose gout in women, knowledge of these differences is essential, and more research is needed to understand and explain the differences , especially in the general population

Disease-specific comparison of the registered morbidity in four morbidity registrations in general practice: an analysis for Public Health Status and Forecast 1993

In de Volksgezondheid Toekomst Verkenning (VTV) wordt voor het beschrijven van het voorkomen van ziekten en aandoeningen onder andere gebruik gemaakt van gegevens van huisartsgeneeskundige registraties. Een probleem voor VTV is dat de registraties in Nederland, om geheel plausibele redenen, van elkaar verschillen in de doelstelling waarvoor zij zijn opgezet. De consequentie daarvan is dat gebruikte classificatiesystemen, codeerregels en rekenwijzen nogal van elkaar kunnen verschillen en dat gemeten morbiditeit niet op voorhand vergelijkbaar is. Daarom is een vergelijkende analyse tussen de vier belangrijkste huisartsenregistraties gemaakt, zodat een beter inzicht in de betekenis van cijfers uit deze huisartsenregistraties verkregen kon worden. Deze analyse bestond uit drie onderdelen. Ten eerste is een algemene beschrijving van de registratiekenmerken van de vier huisartsenregistraties gemaakt, met speciale aandacht voor prevalentie- en incidentiebepalingen ten behoeve van VTV. Een tweede onderdeel betrof het samenstellen van een tabellarisch overzicht van de empirisch aangetroffen prevalenties en incidenties. Een derde onderdeel betrof de inhoudelijke vergelijking van de registraties per ziekte. Voor de meeste ziekten kon meer inzicht verkregen worden in de betekenis van de cijfers en voor sommige ziekten konden de aangetroffen verschillen in prevalentie en incidentie min of meer verklaard worden. Soms bleken verschillen echter onverklaarbaar groot te zijn. Beschreven zijn enkele alternatieve mogelijkheden voor het presenteren van cijfers uit huisartsenregistraties in VTV. Omdat de bestaande situatie voor VTV verre van optimaal is, wordt ten slotte gepleid voor het verkennen van de mogelijkheden om ten behoeve van VTV-2001 en volgende VTV's tot een beter passende oplossing te komen.To describe the occurrence of diseases (incidence and prevalence rates) in the Public Health Status and Forecast (PHSF) report, data of morbidity registrations in general practice are used. A problem for using these in the PHSF report is that the registrations differ from each other in the aim, the design, the operationalisation of the different concepts and the classification system. The consequence is that the morbidity figures are not at once comparable. That's why an analysis of the four most important morbidity systems was made, so we can get a better understanding of the incidence and prevalence rates. This analysis consisted of three parts. First, a general description was made of the characteristics of the four morbidity registrations, with special attention for the calculation of the incidence and prevalence rates on behalf of the PHSF project. Secondly, a large table was made in which incidence and prevalence rates of the morbidity systems were brought together. Thirdly a disease-specific comparison was made. In general terms it appeared not possible to typify one of the considered registrations as the best for the aims of the PHSF project. For most of the diseases more insight was obtained about the meaning of the figures. Sometimes differences in the figures could be explained more of less. Nevertheless for a number of diseases the differences appeared to be unaccountable large. We described some alternative possibilities for presenting figures from morbidity registrations in general practice in the PHSF report. Because the existing situation in the morbidity registration in general practice is far from ideal, it is recommended to explore the possibilities for coming to a better solution for PHSF-2001 and other PHSFs.VW