Respiratory Diseases in Children: studies in general practice

The work presented in this thesis covers various aspects of the epidemiology, diagnosis and management of various respiratory symptoms and diseases in children frequently encountered in general practice. These respiratory tract symptoms and diseases can be categorized into symptoms and diseases of the upper respiratory tract (ENT problems, including cough, earache, sore throat, otitis media, tonsillitis), and symptoms and diseases of the lower airways (e.g. cough, wheezing, dyspnoea, pneumonia, bronchitis, asthma). The general aim of this work was to provide information for optimizing the care for children with respiratory symptoms and diseases in general practice. We have provided epidemiological data about respiratory symptoms and diseases in children, and examined the general practitioners' (GPs) management with respect to medication prescribing and referring these children to specialist care. The study aims were achieved by examining data from the second Dutch National Survey of General Practice, the Netherlands Information Network of General Practice, the Dutch National Medical Registration, and the Cochrane Central Register of Controlled Trials

Neel Temperature for Quasi-Two-Dimensional Dipolar Antiferromagnets

We calculate the N\'eel temperature $T_N$ for two-dimensional isotropic dipolar Heisenberg antiferromagnets via linear spin-wave theory and a high temperature expansion, employing the method of Callen. The theoretical predictions for $T_N$ for K$_2$MnF$_4$, Rb$_2$MnF$_4$, Rb$_2$MnCl$_4$ and (CH$_3$NH$_3$)$_2$MnCl$_4$ are in good agreement with the measured values.Comment: 12 pages, REVTEX, TUM-CP-93-0

Adequate use of asthma inhalation medication in children: more involvement of the parents seems useful

Background. Asthma and other chronic airway diseases can be effectively treated by inhaler therapy. Inhaler therapy depends on appropriate use of the inhaler. This study evaluates the knowledge among Dutch children and their parents regarding asthma inhaler therapy and appropriateness of its use. Findings. Five general practices selected all children aged 0 to 12 years on asthma inhalation medication. Children demonstrated inhaler use and were interviewed with their parents. 46 subjects were enrolled; mean age 5.5 years (SD 3.4) years; 26 (57%) were boys. Of the children using one inhaler only, 70% used the inhaler as indicated and of those using more than one inhaler 46%. On average 2.6 mistakes were made during demonstration of the technique, and 2 mistakes were reported in the interview. In total, 87% of the parents decided when and how the inhaler had to be used. Spacer cleaning was performed correctly by 49%; 26% reported a correct way of assessing how many doses were remaining. Conclusion. Dutch children make essential mistakes related to inhaler use that are easy to avoid. We recommend a better explanation and demonstration of the technique, and recommend involvement of the parents during instruction

Sex differences in the trajectories to diagnosis of patients presenting with common somatic symptoms in primary care:an observational cohort study

Objective: Little insight exists into sex differences in diagnostic trajectories for common somatic symptoms. This study aims to quantify sex differences in the provided primary care diagnostic interventions for common somatic symptoms, as well as the consequences hereof for final diagnoses. Methods: In this observational cohort study, we used real-world clinical data from the Dutch Family Medicine Network (N = 34,268 episodes of care related to common somatic symptoms; 61,4% female). The association between patients' sex on the one hand, and diagnostic interventions and disease diagnoses on the other hand, were assessed using multilevel multiple logistic regression analyses. Structural equation modelling was used to estimate a mediation model with multiple parallel mediators to assess whether the fewer disease diagnoses given to female patients were mediated by the fewer diagnostic interventions female patients receive, compared to male patients. Results: Women received fewer physical examinations (OR = 0.84, 95%CI = 0.79-0.89), diagnostic imaging (OR = 0.92, 95%CI = 0.84-0.99) and specialist referrals (OR = 0.85, 95%CI = 0.79-0.91) than men, but more laboratory diagnostics (OR = 1.27, 95%CI = 1.19-1.35). Women received disease diagnoses less often than men for their common somatic symptoms (OR = 0.94, 95%CI = 0.89-0.98). Mediation analysis showed that the fewer disease diagnosis in female patients were mediated by the fewer diagnostic interventions conducted in women compared to men. Conclusion: This study shows that sex inequalities are present in primary care diagnostic trajectories of patients with common somatic symptoms and that these lead to unequal health outcomes in terms of diagnoses between women and men. FPs have to be aware of these inequalities to ensure equal high-quality care for all patients

Sex Differences in Incidence of Respiratory Symptoms and Management by General Practioners

Background: Differences between women and men play an important role in lung physiology and epidemiology of respiratory diseases, but also in the health care processes. Objective: To analyse sex differences in patients encountering their general practitioner (GP) with respiratory symptoms with regard to incidence, GP's management and final diagnoses. Methods: Retrospective cohort study, using data of the Dutch Practice Based Research Network. All patients who encountered their GP from 01-07-2013 until 30-06-2018 with a new episode of care starting with a reason for encounter in the respiratory category (R) of the ICPC-2 classification were included (n = 16 773). Multi-level logistic regression was used to analyse influence of patients' sex on management of GPs with adjustment for possible confounders. Results: We found a significant higher incidence of respiratory symptoms in women than in men: 230/1000 patient years [95% confidence interval (CI) 227-232] and 186/1000 patient years (95% CI 183-189), respectively. When presenting with cough, GPs are more likely to perform physical examination [odds ratio (OR) 1.22; 95% CI 1.11-1.35] and diagnostic radiology (OR 1.25; 95% CI 1.08-1.44), but less likely to prescribe medication (OR 0.88; 95% CI 0.82-0.95) in men. When visiting the GP with dyspnoea, men more often undergo diagnostic imaging (OR 1.32; 95% CI 1.05-1.66) and are more often referred to a specialist (OR 1.35; 95% CI 1.13-1.62). Conclusions: Women encounter their GP more frequently with respiratory symptoms than men and GPs perform more diagnostic investigations in men. We suggest more research in general practice focussing on sex differences and possible confounders

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