Childhood morbidity in Dutch general practice : epidemiology and management

With the ageing of the population, children's health tends to become a neglected area in health research and health care research. And this is unjustified, considering that the children of today are tomorrow's adults and that their health is originated in childhood. Measurement of child's health over time will identify the emergence of new childhood health problems and morbidity trends. The recognition of such trends may lead to a shift in priorities in child health care. The aims of this thesis are to present an overview of children's morbidity in Dutch general practice and general practitioners' management, and to evaluate changes therein over the past decades. Moreover, determinants of morbidity or changes in general practitioners' management are assessed in order to provide tools for prevention of morbidity or for the improvement of clinical practice. To investigate these issues, data of 0-17 year old children of two successive national surveys in Dutch general practice were used (1987-2001). Both surveys were designed and performed by the Netherlands Institute for Health Service Research (NIVEL). In both surveys, general practitioners registered all contacts with patients during the study period. Among others, they recorded the diagnosis and if a referral or prescription was made, this was linked to the corresponding diagnosis. Characteristics of the practices and study population were obtained by mailed questionnaire, and the response rate was 70-90% dependant on different variables

Epidemiology of unintentional injuries in childhood: a population-based survey in general practice

This study aimed to assess the incidence of unintentional injuries presented in general practice, and to identify children at risk from experiencing an unintentional injury. We used the data of all 0-17-year-old children from a representative survey in 96 Dutch general practices in 2001. We computed incidence rates and multilevel multivariate regression analysis in different age strata and identified patient and family characteristics associated with an elevated injury risk. Nine thousand four hundred and eighty-four new injury episodes were identified from 105 353 new health problems presented in general practice, giving an overall incidence rate of 115 per 1000 person years (95% confidence interval [CI] = 113 to 118). Sex and residence in rural areas are strong predictors of injury in all age strata. Also, in children aged 0-4 years, a higher number of siblings is associated with elevated injury risk (> or =3 siblings odds ratio [OR] = 1.57, 95% CI = 1.19 to 2.08) and in the 12-17-year-olds, ethnic background and socioeconomic class are associated with experiencing an injury (non-western children OR = 0.67, 95% CI = 0.54 to 0.81; low socioeconomic class OR = 1.39, 95% CI = 1.22 to 1.58). Unintentional injury is a significant health problem in children in general practice, accounting for 9% of all new health problems in children. In all age groups, boys in rural areas are especially at risk to experience an injury

Diagnosis of early stage knee osteoarthritis based on early clinical course

Background: Early diagnosis of knee osteoarthritis (OA) is important in managing this disease, but such an early diagnostic tool is still lacking in clinical practice. The purpose of this study was to develop diagnostic models for early stage knee OA based on the first 2-year clinical course after the patient’s initial presentation in primary care and to iden