Taakopvattingsonderzoek bij huisartsen

General practitioners have different opinions about what duties belong to their task. These opinions affect their professional behaviour. This dissertation is about research into task conceptions of general practitioners

Lower risk of atopic disorders in whole cell pertussis-vaccinated children

This study addressed whether whole cell pertussis-vaccinated children have a different risk of atopic disorders compared with children who did not receive this vaccination. Data on vaccination status, atopic disorders and child and family characteristics of the children of 700 families were collected in this retrospective study. A minority of these 700 families refused vaccinations for religious reasons. The relation between pertussis-vaccination status and atopic disorders was analysed by means of adjusted logistic regression for repeated measurements in order to account for the correlation between sibship members. The 700 families included 1,961 children. Data on vaccination status and atopic disorders were available for 1,724 children. Vaccinated children had a reduced risk of atopic disorders. Whole cell pertussis vaccination is associated with a lower risk of atopic disorders, though other vaccine components (diphtheria, tetanus, poliomyelitis) or other vaccinations may also be involved

Skin tests, T cell responses and self-reported symptoms in children with allergic rhinitis and asthma due to house dust mite allergy

Abstract BACKGROUND: In allergic responses, a distinction is made between an early-phase response, several minutes after allergen exposure, and a late-phase response after several hours. During the late phase, eosinophils and T cells infiltrate the mucosa and play an important role in inflammation. OBJECTIVE: The aim of this study was to examine the relationship between allergen-induced late-phase skin responses and in vitro T cel

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

General practice registration networks in the Netherlands: a brief report

In the Netherlands, several general practice registrations exist. Groups of general practitioners register elements of patient care according to agreed-upon criteria, and these data are collected in a central database. By means of a questionnaire the authors interviewed the managers of all nine computerized registration networks extensively about the possibilities and limitations of their registration. In addition, respondents answered some questions with data from the central database of their network. Various items are collected by nearly all the registration networks, while other items are collected by only one network. Answering questions with data from the central database turned out to be difficult. Organization and manpower are the main obstacles

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

Measuring morbidity of children in the community: a comparison of interview and diary data

BACKGROUND: Little is known about the validity of estimates of morbidity experienced at home. METHODS: In the Dutch National Survey of Morbidity and Interventions in General Practice mothers of 1630 children answered a health interview and kept a health diary for 3 weeks (only the first 2 weeks were used). Children's symptoms were recorded during the interview using a check list and monitored in the health diary through open-ended questions. RESULTS: In the interview parents reported symptoms for 65% of their children and in the diary for 54% of children. Ear problems, colds, fever and weakness and anxiety were reported more often in the interview. Mother's mental health was assessed by the General Health Questionnaire; those scoring >4 were assessed as having impaired mental health and these parents reported symptoms for more children in the interview (81%) than in the diary (65%). For similar reference periods, the least educated mothers reported fewer children with symptoms in the diary (45%) than in the interview (66%). More highly educated mothers reported similarly in the diary (67%) and the interview (70%). CONCLUSION: Both data collection methods yield different estimates of community morbidity. Explanations such as telescoping, the seriousness of the symptoms, the amount of psychological distress of the respondent, forgetfulness and literacy limitations are discussed. We recommend that diaries should not be used in less educated populations

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

Effects of outreach visits by trained nurses on cardiovascular risk-factor recording in general practice: A controlled trial

Objectives: To study the effects of outreach visits by trained nurses on cardiovascular risk-factor recording. This strategy was compared with a strategy composed of more commonly used methods to improve the quality of care in general practice such as written feedback. Methods: A controlled trial was conducted, in which 33 practices were visited by a trained nurse, 31 practices received written feedback and 31 other practices served as controls. To assess the level of risk-factor recording a chart audit was carried out before and after 18 months of intervention. A sample of medical records of patients aged 30 to 60 was evaluated looking for risk-factor entries: their presence, their combined presence, and their signal function to indicate a risk patient. Risk factors considered were: blood pressure, individual (medical) history as well as family history of cardiovascular diseases, smoking status, serum cholesterol, body weight and alcohol intake. Results: In practices visited by a trained nurse, a significant increase in the recording of most risk factors was found for the presence, the combined presence as well as the signal function. The increase in the presence of entries was consistent in all risk factors and independent of the baseline level. Changes in the group receiving written feedback were inconsistent and statistically not significant. Conclusions: Outreach visits by trained nurses is an effective tool to increase cardiovascular risk-factor recording in general practice