18 research outputs found
Het zieke kind: een zorg voor huisarts en kinderarts
[s er een reden tot zorg over de wijze waarop de medische zorg voor kinderen in het Nederlandse
gezondheidszorgsysteem is verankerd? Ogenschijnlijk niet!
Vrijwel nergens ter wereld zijn de cijfers die een maat vormen voor de gezondheidstoestand van
kinderen gunstiger. Zou het toch nog beter kunnen2
De zorg voor het zieke kind is in ons land primair de taak van de huisarts, dit in tegenstelling tot
de situatie in veel andere landen waar zowel de curatieve als de preventieve zorg veelal door de
kinderarts wordt verleend. Specialistische zorg, ook die van de kinderarts, wordt gegeven na
verwijzing en de preventieve zorg is in handen van de jeugdgezondheidszorg.
Zijn er punten waarop de zorg door de huisarts te kort schiet, op welke wijze zou de kinderarts
kunnen bijdragen aan een verbetering van de zorg en is de wisselwerking tussen de circuits
waarin de zorg wordt verleend optimaal?
Voor de afdelingen huisartsgeneeskunde en kindergeneeskunde van de Erasmus Universiteit
Rotterdam was dit begin jaren tachtig een discussiepunt.
In 1986 werden door het Ministerie van Onderwijs en Wetenschappen gelden beschikbaar
gesteld voor projecten, gericht op onderzoek dat een bijdrage levert aan de versterking van de
extramurale gezondheidszorg. Uit het Vernieuwingsfonds Extramurale Vakken/Toponderzoek
Eerstelijn werden gelden toegekend aan de afdelingen Huisartsgeneeskunde en Kindergeneeskunde
van de Erasmus Universiteit Rotterdam om onderzoek te verrichten naar de samen~
werking tussen huisarts en kinderarts.
De doelstelling van het onderzoek was na te gaan of er knelpunten zijn in de wiize waarop de
zorg voor zieke kinderen door huisarts en kinderarts wordt gerealiseerd en op welke punten de
samenwerking tussen huisarts en kinderarts niet optimaal is. Indien problemen gesignaleerd
werden zou worden nagegaan of de werkwijze van en de interacties tussen huisarts en kinderarts
door interventies verbeterd konden worden, er van uitgaande dat dit zou bijdragen tot de
verbetering van de zorg voor het zieke kind
Molluscum contagiosum in Dutch general practice
BACKGROUND: While molluscum contagiosum is considered to be a frequently
encountered disease, few data on its incidence are known. AIM: The
objective of this study was to describe the incidence of molluscum
contagiosum in Dutch general practice and to assess the importance of
venereal molluscum contagiosum. METHOD: Data were taken from the national
survey of morbidity and interventions in general practice, drawn from 103
practices across the Netherlands, with a study population of 332300.
RESULTS: The infection appeared to be common in childhood (cumulative
incidence 17% in those aged under 15 years); the adult, sexually
transmitted, form was rare. Incidence was higher between January and June
than between July and December. Cases were unequally divided between
recording practices, which is though to have been caused by the occurrence
of small epidemics. CONCLUSION: The incidence of molluscum contagiosum in
Dutch general practice was found to be 2.4 per 1000 person years.
Molluscum contagiosum should still be considered as a mainly paediatric
disease
Ichthyosis, exocrine pancreatic insufficiency, impaired neutrophil chemotaxis, growth retardation, and metaphyseal dysplasia (Shwachman syndrome).
The Shwachman syndrome comprises exocrine pancreatic insufficiency, growth retardation, and bone marrow hypoplasia resulting in neutropenia. Clinical, morphological, and ultrastructural studies, as well as hair analysis, were performed in a patient with Shwachman's syndrome and severe ichthyosis. Clinical findings were lamellar ichthyosiform desquamation on the extremities. The hair was scanty and short on the scalp, in the eyelashes, and in the eyebrows. The nails were hyperkeratotic. Morphologic findings were slight, regular acanthosis and severe diffuse hyperkeratosis with variable parakeratosis. The granular layer was thickened. The papillary dermis showed very slight perivascular lymphocyte infiltration. The most prominent ultrastructural finding was the presence of solitary or multiple droplets of varying size in the cytoplasm of the keratinocytes. Hair analysis revealed no abnormalities; the cystine concentration in hair specimens was normal
Preschool children with asthma: Do their GPs know?
Objective: To answer the following question: Are children with asthma known to their GP? Methods: Parents of all 464 children, 1-3 years of age and registered with five general practices, received a postal questionnaire asking about asthma symptoms of the child, and past and present asthma medication. Thus, children were classified as having no, mild, moderate or severe asthma. The GPs' records were checked for recorded asthma symptoms, medication and asthma-related diagnoses. The presence of these items was compared with asthma severity. Results: Eighty-seven percent of parents responded to the questionnaire (mean age of children 30.1 months). For all classes of severity, 75% of children with asthma were known to their GP. Although all children with severe asthma were known to their GP, the proportion of asthmatic children known to their GP fell with decreasing severity. Symptoms and medication were recorded more often than asthma-related diagnoses. Conclusions: Most preschool children with asthma are known to their GP. The diagnosis is recorded less often than asthma symptoms and medication
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
A cognitive-behavioural program for adolescents with chronic pain - A pilot study
The purpose of this pilot study is to evaluate the feasibility of a cognitive-behavioural training program for adolescents with chronic pain irrespective of pain localisation. A secondary aim was to give an impression of the effect of the program on pain and quality of life. Eight adolescents (14-18 years) with chronic non-organic pain recruited from the general population (and their parents) participated in this pilot study. The intervention included five group meetings alternated with four telephone contacts (during the self-management weeks) over a period of 9 weeks. The training aimed to change pain behaviour through pain education, relaxation strategies, problem-solving techniques, assertiveness training, cognitive restructuring and by stimulating the adolescent's physical activity level. The training further addresses the social context of pain by inviting parents to attend two meetings for the parents only, and by asking the adolescents to bring a peer to one of the meetings. Adolescents and their parents were positive about the program. Adolescents felt they were more in control of their pain and parents valued the support they experienced in helping their children to master the pain. The training was considered to be feasible in daily life. Further, the preliminary data showed an effect on pain and quality of life in the expected direction. The results underline the need for a definitive study with a larger sample size and a random controlled design
Development and psychometric properties of a pain-related problem list for adolescents (PPL)
Instruments for measuring pain-related problems in adolescents with chronic pain are sparse, especially those based on the personal experiences of these adolescents. This study aimed to develop and test such an instrument, the pain-related problem list for adolescents (PPL). A sample of 129 adolescents with chronic pain without documented physiological etiology completed the 57-item problem list, which was based on interviews with a similar group of adolescents with chronic pain. Principal components analysis yielded four domains: problems related to (1) concentration; (2) mobility; (3) adaptability; and (4) mood. The questionnaire was shortened to 18 items and has good reliability (total α = 0.82; concentration α = 0.86; mobility α = 0.77; adaptability α = 0.71; and mood α = 0.78); the validity also proved to be adequate, especially in the general population sample. The PPL provides a tool to assess the impact of chronic pain in adolescents. Future research should focus on further validation of the PPL in a large clinical population and establishing its test-retest reliability
Randomised placebo-controlled trial of inhaled sodium cromoglycate in 1-4-year-old children with moderate asthma
BACKGROUND: Inhalation therapy with sodium cromoglycate is recommended as the first-line prophylactic treatment for moderate asthma in children. The availability of spacer devices with face-masks has extended the applicability of metered-dose inhalers to younger children. We studied the feasibility and effects of this therapy compared with placebo in children aged 1-4 years.
METHODS: 218 children aged 1-4 years with moderate asthma were recruited through 151 general practitioners between March, 1995, and March, 1996. They were randomly assigned sodium cromoglycate (10 mg three times daily) or placebo, given by inhaler with spacer device and face-mask for 5 months. Rescue medication (ipratropium plus fenoterol aerosol) was available during the baseline period of 1 month and the intervention period. Parents completed a daily symptom-score list. The primary outcome measure was the proportion of symptom-free days in months 2 to 5. Analysis was by both intention to treat and on treatment.
FINDINGS: 167 (77%) children completed the trial. 131 (78%) of these children used at least 80% of the recommended dose. Of the 51 children who stopped prematurely, 23 had difficulties with inhaled treatment. The mean proportion of symptom-free days for both groups was greater for the treatment period than for the baseline period (95% CI for mean difference 5.1 to 17.5 cromoglycate, 11.9 to 23.3 placebo). However there were no differences between the sodium cromoglycate and placebo groups in the proportion of symptom-free days (mean 65.7 [SD 25.3] vs 64.3 [24.5]%; 95% CI for difference -8.46 to 5.70) or in any other outcome measure.
INTERPRETATION: Our study in a general practice setting shows that inhalation therapy with a spacer device and face-mask is feasible in a majority of children below the age of 4 years. However, long-term prophylactic therapy with inhaled sodium cromoglycate is not more effective than placebo in this age-group
Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial
OBJECTIVE: To test the hypothesis that fusidic acid would not increase the
treatment effect of disinfecting with povidone-iodine alone in children
with impetigo. DESIGN: Randomised placebo controlled trial. SETTING:
General practices in Greater Rotterdam. PARTICIPANTS: 184 children aged
0-12 years with impetigo. MAIN OUTCOME MEASURES: Clinical cure and
bacterial cure after one week. RESULTS: After one week of treatment 55% of
the patients in the fusidic acid group were clinically cured compared with
13% in the placebo group (odds ratio 12.6, 95% confidence interval 5.0 to
31.5, number needed to treat 2.3). After two weeks and four weeks the
differences in cure rates between the two groups had become smaller. More
children in the placebo group were non-compliant (12 v 5) and received
extra antibiotic treatment (11 v 3), and more children in the placebo
group reported adverse effects (19 v 7). Staphylococcus aureus was found
in 96% of the positive cultures; no strains were resistant to fusidic
acid. CONCLUSIONS: Fusidic acid is much more effective than placebo (when
both are given in combination with povidone-iodine shampoo) in the
treatment of impetigo. Because of the low rate of cure and high rate of
adverse events in the placebo group, the value of povidone-iodine in
impetigo can be questioned
Comparison between children and adolescents with and without chronic benign pain: consultation rate and pain characteristics
The aim of the study was to determine whether children with chronic benign
pain are in contact with their general practitioner (GP) more frequently
than those without chronic benign pain. A random sample of children and
adolescents aged between 0 and 18 years of age was drawn from the records
of ten general practices. According to their responses to a pain
questionnaire, subjects were assigned to the chronic benign pain group (n
= 95) if they had pain of more than three months' duration, or to the
control group (n = 105) if they had pain of less than three months'
duration or no pain at all. All the subjects had an average GP
consultation rate of 2.6 contacts per year. No significant age and sex
differences were found. Chronic benign pain in childhood and adolescence
is not related to increased use of healthcare services, suggesting that
somatisation does not play a major role in children with chronic benign
pain