Systematic review: accuracy of symptom-based criteria for diagnosis of irritable bowel syndrome in primary care.

Background: Despite the trend towards making a positive diagnosis of irritable bowel syndrome (IBS), many health care providers approach IBS as a diagnosis of exclusion.

Aim: To summarize available evidence on the diagnostic performance of symptom-based IBS criteria in excluding organic diseases, and of individual signs and symptoms in diagnosing IBS and to additionally assess the influence of sources of heterogeneity on diagnostic performance.

Methods: We searched PubMed and EMBASE and screened references.

Determinants of regional differences in the incidence of impetigo.

Background And Objective: Impetigo is a common contagious skin infection, mostly seen in children and caused by Staphylococcus aureus and/or group A B-hemolytic Streptococcus. Two surveys performed in general practice showed a strong geographical gradient in the incidence rates among children in the Netherlands. The incidence in the south was approximately twice as high as in the rest of the Netherlands.

Management of urinary incontinence in general practice: data from the Second Dutch National Survey.

Objective: The aim of this study was to provide insight into the referral pattern of newly diagnosed patients with urinary incontinence in general practice and into the prescription of medication and incontinence pads by general practitioners (GPs). We also examined the influence of gender and age of patient/GP on these patterns.

Methods: Data were obtained from the Second Dutch National Survey of General Practice.

Foot problems in children presented to the family physician: a comparison between 1987 and 2001.

Background: In recent decades, studies on the management of common foot problems in children have suggested that in many cases, there is no indication for treatment. It is not known whether these studies have changed daily practice.

Objective: Our aim was to establish and compare incidence and referral rates for foot problems in children in 1987 and 2001.

Development of a diagnostic protocol for dizziness in elderly patients in general practice: a Delphi procedure.

Background: Dizziness in general practice is very common, especially in elderly patients. The empirical evidence for diagnostic tests in the evaluation of dizziness is scarce. Aim of our study was to determine which set of diagnostic tests should be part of a diagnostic protocol for evaluating dizziness in elderly patients in general practice.

Does age modify the relationship between morbidity severity and physical health in English and Dutch family practice populations?

Purpose: To investigate the co-influences of age and morbidity severity on physical health in adult family practice populations.

Methods: Morbidity data in a 12-month period for 7,833 older English consulters aged 50 years and over and 6,846 Dutch consulters aged 18 years and over was linked to their physical health status obtained from cross-sectional health surveys. Individual patients were categorised using 78 consulting morbidities classified by a chronicity measure (acute, acute-on-chronic and chronic) into an ordinal scale of morbidity severity ranging from single to multiple chronicity groups.

Inter-practice variation in diagnosing hypertension and diabetes mellitus: a cross-sectional study in general practice.

Background: Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adjusting for patient and practice characteristics. Therefore, in the present study inter-practice variation of diagnosed hypertension and diabetes mellitus prevalence rates was calculated by 1) using a multi-level design and 2) adjusting for patient and practice characteristics.

Allergic rhinitis in children: incidence and treatment in Dutch general practice in 1987 and 2001.

Allergic rhinitis is a common chronic disorder in children, mostly diagnosed in primary health care. This study investigated the national incidence and treatment of allergic rhinitis among children aged 0-17 yr in Dutch general practice in 1987 and 2001 to establish whether changes have occurred. A comparison was made with data from the first (1987) and second (2001) Dutch national surveys of general practice on children aged 0-17 yr.

Reduced risk of next exacerbation and mortality associated with antibiotic use in COPD.

The long-term risk of a subsequent exacerbation of chronic obstructive pulmonary disease (COPD) after treatment with oral corticosteroids without (OS) or with antibiotics (OSA) was compared in a historical general practice-based cohort. Eligible patients were >/=50 yrs of age, had a registered diagnosis of COPD, were on maintenance respiratory drugs, and had experienced at least one exacerbation defined as a prescription OS or OSA. Times to second and third exacerbations were assessed using Kaplan-Meier survival analysis; the risk of a subsequent exacerbation was assessed in a Cox proportional hazards analysis; and all-cause mortality was assessed using Kaplan-Meier survival and Cox proportional hazards analyses.

The impact of laboratory characteristics on molecular detection of respiratory syncytial virus in a European multicentre quality control study.

The performance of nucleic acid amplification techniques for detecting respiratory syncytial virus (RSV) was evaluated in 25 laboratories across Europe by an external quality assessment study. In addition, factors related to the diagnostic performance of laboratories were explored. The results of this quality control study show that the performance of laboratories for RSV diagnosis in Europe is good, with an overall correct score of 88%.

Prescribing of pain medication in palliative care. A survey in general practice.

Purpose: To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands.

Methods: In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1-year study period.

What factors explain the differences in morbidity estimations among general practice registration networks in the Netherlands? A first analysis.

Background: Information on the incidence and prevalence of diseases is a core indicator for public health. There are several ways to estimate morbidity in a population (e.g.

Familiarity between patient and general practitioner does not influence the content of the consultation.

Background: Personal continuity in general practice is considered to be a prerequisite of high quality patient care based on shared knowledge and mutual understanding. Not much is known about how personal continuity is reflected in the content of GP - patient communication. We explored whether personal continuity of care influences the content of communication during the consultation.

A clinical prediction rule for urinary tract infections in patients with type 2 diabetes mellitus in primary care.

We aimed to develop a prediction rule for urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (DM2). A 12-month prospective cohort study was conducted in patients with DM2 aged > or = 45 years to predict the occurrence of recurrent UTIs in women and lower UTIs in men. Predictors for recurrent UTI in women (n=81, 2%) and lower UTIs in men (n=93, 3%) were age, number of general practitioner (GP) visits, urinary incontinence, cerebrovascular disease or dementia.

Raising positive expectations helps patients with minor ailments: a cross-sectional study.

Background: Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs). As medical interventions are not always available, specific communication strategies, such as active listening and positive communication, might help GPs to handle these problems adequately. This study examines to what extent GPs display both strategies during consultations for minor ailments and investigates how each of these relate to the patients' perceived health, consultation frequency and medication adherence.

Comorbidity, limitations in activities and pain in patients with osteoarthritis of the hip or knee.

Background: This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity.

Methods: A cross-sectional cohort study was conducted, in which 288 elderly patients with hip or knee osteoarthritis were included.

Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly.

Objective: The aim of the study was to investigate how settings and registry characteristics affect the prevalence and nature of multimorbidity in elderly individuals.

Study Design And Setting: We used data from three population-based studies, two general practitioner registries, one hospital discharge register, and one nursing home registry to estimate the prevalence of multimorbidity. Individuals aged 55 years and over were included.

Characteristics of children consulting for cough, sore throat, or earache.

Background: GPs are often consulted for respiratory tract symptoms in children.

Aim: To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache.

Design Of Study: Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire.

Morbidity severity classifying routine consultations from English and Dutch general practice indicated physical health status.

Objective: To investigate the construct validity of morbidity severity scales based on routine consultation data by studying their associations with sociodemographic factors and physical health.

Study Design And Setting: Study participants were 11,232 English adults aged 50 years and over and 9,664 Dutch adults aged 18 years and over, and their consulting morbidity data in a 12-month period were linked to their physical health data. Consulters with any of 115 morbidities classified on four ordinal scales of severity ("chronicity," "time course," "health care use," and "patient impact") were compared to all other consulters.

Changes in the prevalence of chronic disease and the association with disability in the older Dutch population between 1987 and 2001.

Background: most studies of older populations in developed countries show a decrease in the prevalence of disabilities, and an increase in chronic diseases over the past decades. Data in the Netherlands, however, mostly show an increase in the prevalence of chronic diseases and mixed results with regard to the prevalence of disability. This study aims at comparing changes in the prevalence, as well as the association between chronic diseases and disability between 1987 and 2001 in the older Dutch population using data representative of the general population.

Prescribing patterns for upper respiratory tract infections in general practice in France and in the Netherlands.

Background: France and the Netherlands are often presented as two contrasting countries with regard to drug prescriptions and consumption. This study aimed to analyse general practitioners' (GP's) prescription patterns for upper respiratory tract infections (URTI).

Methods: Data on diagnoses and prescriptions were derived from two databases recording daily electronic medical patient files: the 'Société Française de Médecine Générale' database (SFMG-DB) and the Dutch Landelijk Informatie Netwerk Huisatsenzorg database (LINH-DB).

Impact of preexisting depression on length of stay and discharge destination among patients hospitalized for acute stroke: linked register-based study.

Background And Purpose: There exists limited knowledge regarding the relation between depression and healthcare utilization in stroke patients. The objective of this register-based study was to examine the impact of having preexisting depression at the time of hospital admission for acute stroke on length of hospital stay and discharge destination.

Methods: Data from a general-practice database were linked to those of a hospital database to identify patients hospitalized for stroke and were used to categorize these patients into 3 groups based on preexisting mental health (MH) status at admission, ie, those with preexisting depression, those with another preexisting MH condition, and those without any preexisting MH condition.

Recently enlisted patients in general practice use more health care resources.

Background: The continuity of care is one of the cornerstones of general practice. General practitioners find personal relationships with their patients important as they enable them to provide a higher quality of care. A long-lasting relationship with patients is assumed to be a prior condition for attaining this high quality.

Changes in the sociodemographic composition of the lowest socioeconomic group over time, 1987-2001.

Background: When comparing health differences of groups with equal socioeconomic status (SES) over time, the sociodemographic composition of such a SES group is considered to be constant. However, when the periods are sufficiently spaced in time, sociodemographic changes may have occurred. The aim of this study is to examine in which respects the sociodemographic composition of lowest SES group changed between 1987 and 2001.