H.J.M. van den Hoogen

Prevalence of urinary, fecal and double incontinence in the elderly living at home.

The aim of this study was to evaluate the prevalence of urinary, fecal and double incontinence in the elderly, through a population-based cross-sectional survey. The study included all patients aged 60 and over of nine general practices in the Nijmegen Monitoring Project. Patients living in a home for the elderly were excluded, as well as patients with dementia, patients who were too ill to participate and patients with a catheter. There were 5278 selected patients who received a postal questionnaire. Of these, 88% returned it. Nineteen percent of the respondents had involuntary loss of urine twice a month or more, 6% loss of feces and 3% both. The prevalence of urinary, fecal and double incontinence increased with age in both men and women, and especially in men in the oldest age group. Urinary incontinence was more prevalent in women than in men. The prevalence of fecal incontinence showed no sex differences, but the type of fecal incontinence did differ between men and women. In men loss of mucus was twice as common as in women. Double incontinence was also equally prevalent in men and women, except in the age group 65–74 years. In conclusion, urinary, fecal and double incontinence are common conditions in the community-dwelling population. The prevalence rates increase with age. Urinary incontinence is more prevalent in women. There were no sex differences in the prevalence of fecal incontinence but the type of fecal incontinence was different in men and women.

Can small group education and peer review improve care for patients with asthma/chronic obstructive pulmonary disease?

OBJECTIVE: To study the effectiveness of an intensive small group education and peer review programme aimed at implementing national guidelines on asthma/chronic obstructive pulmonary disease (COPD) on care provision by general practitioners (GPs) and on patient outcomes. DESIGN: A randomised experimental study with pre-measurement and post-measurement (after one year) in an experimental group and a control group in Dutch general practice. SUBJECTS AND INTERVENTION: Two groups of GPs were formed and randomised. The education and peer review group (17 GPs with 210 patients) had an intervention consisting of an interactive group education and peer review programme (four sessions each lasting two hours). The control group consisted of 17 GPs with 223 patients (no intervention). MAIN OUTCOME MEASURES: Knowledge, skills, opinion about asthma and COPD care, presence of equipment in practice; actual performance about peakflow measurement, non-pharmacological and pharmacological treatment; asthma symptoms (Dutch Medical Research Council), smoking habits, exacerbation ratio, and disease specific quality of life (QOL-RIQ). Data were collected by a written questionnaire for GPs, by self recording of consultations by GPs, and by a written self administered questionnaire for adult patients with asthma/COPD. RESULTS: Data from 34 GP questionnaires, 433 patient questionnaires, and recordings from 934 consultations/visits and 350 repeat prescriptions were available. Compared with the control group there were only significant changes for self estimated skills (+16%, 95% confidence interval 4% to 26%) and presence of peakflow meters in practice (+18%, p < 0.05). No significant changes were found for provided care and patient outcomes compared with the control group. In the subgroup of more severe patients, the group of older patients, and in the group of patients not using anti-inflammatory medication at baseline, no significant changes compared with the control group were seen in patient outcomes. CONCLUSION: Except for two aspects, intensive small group education and peer review in asthma and COPD care do not seem to be effective in changing relevant aspects of the provided care by GPs in accordance with guidelines, nor in changing patients health status.

The influence of cuff size on blood pressure measurement

The objective of the study was to determine the effect of the use of cuffs with different bladder sizes on the outcome of blood pressure (BP) measurements. Two sizes of bladders previously in common use in the study location (13u2009×u200923 cm and 16u2009×u200923 cm) were compared with the current size (13u2009×u200936 cm). A fully randomised, experimental study was carried out on a study population comprising 130 subjects (61 men, 69 women, aged between 22 and 70, mean 49) who were not undergoing special treatment for cardiovascular disease or hypertension at that time. The mean arm circumference was 32.9 cm (range 25–40 cm). BP measurements were carried out by one person, using a Hawksley random zero sphygmomanometer under standardised conditions. With the smallest bladder (13u2009×u200923 cm) the highest systolic and diastolic BP was measured (mean SBP 127.2 mean DBP 77.0 mmu2009Hg), followed by the bladder of 13u2009×u200936 cm (125.1 resp. 75.4 mmu2009Hg). The lowest BP was measured with the bladder of 16u2009×u200923 cm (123.7 resp. 74.4 mmu2009Hg). Differences between bladders were significant for all arm circumferences. Over the entire range of arm circumferences in the present study there is a small systematic difference in the BP measurements taken by the various bladder sizes. For individual readings the difference is less marked, in comparison to other factors that can affect BP measurements. However, in longitudinal studies a systematic error in BP can occur when measurements are made with different bladders during the study.

Treatment of depression related to recurrence: 10‐year follow‐up in general practice

Objectives:u2002To study outcomes related to long‐term treatment of depression and differences in treatments for first episodes of depression in patients with and without recurrences.

Psychotropic drug use in a group of Dutch nursing home patients with dementia: many users, long-term use, but low doses.

The aim of this study was to describe the use of psychotropic drugs in a psychogeriatric nursing home, “Joachim en Anna”, in Nijmegen, the Netherlands. To this end the medical records of 890 nursing home patients with dementia, admitted between 1980 and 1989, were analysed retrospectively. Each time pattern of psychotropic drug use was registered. Drugs were coded by means of the Anatomical Therapeutic Chemical classification system. The daily dose was expressed as the ratio of the mean prescribed daily dose and the defined daily dose. Side-effects and changes in prescription patterns throughout the years patients were admitted were analysed. A total of 3,090 time patterns of exposure to psychotropics were registered. Neuroleptics, benzodiazepines, and antidepressants accounted for 58, 32, and 9% of the time patterns, respectively. For almost every drug prescription the prescribed daily dose was lower than the defined daily dose. More than 75% of these nursing home patients had at least one prescription for a psychotropic drug during institutionalization. One or more side-effects were observed in 50% of the patients who used a neuroleptic. The total number of patients receiving psychotropics did not change throughout the study. Psychotropics were prescribed for long-term use, but in a low dose. Side-effects were frequently observed while the correct individual dose was being determined.

The long-term perspective: A study of psychopathology and health status of patients with a history of depression more than 15 years after the first episode

This article examines psychopathology, functioning, well-being, social support, and coping-behavior of family practice patients with a history of depressive illness, both with and without recurrences. Results of depressive patients were compared with each other and with those of normal controls. The patients belonged to the four practices of the Continuous Morbidity Registry of the University of Nijmegen, Netherlands. Their first episode of depression for each patient was more than 15 years ago. Data were collected with the Symptom Checklist (SCL-90) the RAND-36, the Social Support List (SSL-12), and the short Utrecht Coping List (UCL-k). Psychopathology scores of patients without recurrences were higher than normal controls and lower than patients with recurrences. The same pattern was found concerning health status. No significant differences were found between the groups in social support but patients with recurrences had a lower score of emotional coping than patients without recurrences or normal patients. That even a long time after an episode of depression, patients have higher levels of a variety of psychopathology than controls has implications for every-day practice as it calls for a longer and more critical follow-up of depression by clinicians.

Microalbuminuria in patients with Type 2 diabetes mellitus from general practice: course and predictive value.

SUMMARY

Diagnosing Diabetic Retinopathy by General Practitioners and by a Hospital Physician: The use of fundus photos

Five non-ophthalmologists (four general practitioners and a hospital physician) assessed the retinal status of 62 patients with diabetes mellitus, using fundus photos. They had no particular interest in diabetic retinopathy, nor did they receive special training. Their diagnoses were compared with the diagnostic opinion of two ophthalmologists, whose diagnoses served as the standard. The use of reference charts (photos of normal retinas and retinas with diabetic retinopathy) reduced the number of false negative assessments. The sensitivity of the non-ophthalmologists varied between 100 per cent and 88 per cent, depending on the standard (diagnosis of one ophthalmologist or consensus between two ophthalmologists). The specificity was 55 percent, indicating the potentially high rate of inappropriate referral. The coefficient of agreement of diagnosis between the non-ophthalmologists and the ophthalmologists was kappa 0.54. All but one patient put on treatment by the ophthalmologists had been identified by the non-ophthalmologists. The possibility of fundus photography in patient management (consultation on photo reading instead of a referral of the patient) is discussed. It is concluded that the assessment of fundus photos to detect diabetic retinopathy by general physicians seems to be a promising strategy in the surveillance of patients with diabetes mellitus.

The relationship between respiratory symptoms and bronchial hyperresponsiveness in a population-based sample of adolescents and young adults

OBJECTIVESnto study the relationship between chronic respiratory symptoms and bronchial hyperresponsiveness (BHR) in adolescence and young adulthood and to assess the possible predictive value of these symptoms for BHR.nnnMETHODSna cross-sectional analysis: in a population sample of 551 subjects aged 10-23 years, data collected with a standardized questionnaire on respiratory symptoms were compared with the results of a histamine challenge test.nnnRESULTSn43% of the subjects reported one or more chronic respiratory symptoms; of these subjects 54% did not show BHR. Forty-two per cent of the subjects had a PC20 < or = 8.0 mg ml-1 histamine, of which 53% reported no chronic respiratory symptoms. Wheezing and breathlessness were related to the level of BHR, but only breathless when walking on the flat was independently related to BHR; however, its predicted value for BHR was negligible.nnnCONCLUSIONSnin adolescents and young adults the relationship between chronic respiratory symptoms and BHR is incomplete. A standardized questionnaire on respiratory symptoms does not provide adequate information to discriminate between those with and without BHR.