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Background: Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists., Objective: To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care., Methods: A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months., Results: Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5)., Conclusions: Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Specialized Parkinson's disease (PD) care offers advantages to patients. However, specialized health care providers may be unaware of patients' personal context and comorbidity, leading to conflicting treatment regimens. Patients may benefit from a more holistic approach., Objective: To clarify the role community-dwelling PD patients see for general practitioners (GPs) in PD care and to clarify the role GPs see for themselves., Methods: Qualitative interview study with 16 community-dwelling PD patients and 12 GPs in the Netherlands, using a constant comparative approach to analysis., Results: Patients expressed a preference for self-management and autonomy in decision-making. GPs chose a limited, reactive position in early-stage PD care to stimulate patient autonomy. Moreover, GPs felt insufficiently competent to extend their role. Patients also felt GPs lack expert knowledge and skills; they focus on their neurologist for PD care. In addition, GPs observed patients might not realize what accessory role the GP could have, a role GPs described as essential in being aware of patient's well-being. Patients did not describe additional roles for the GP in more advanced disease, whereas GPs mentioned a shift towards a more proactive and extended role., Conclusion: Patients and GPs see a limited role for the GP in early-stage PD care because of patient autonomy and GP's lack of specific knowledge and skills. However, GPs should feel more confident of the added value of their generalist approach to care for patients with a complex chronic disorder as PD. If generalist and specialized care reinforce each other, PD patients benefit., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

A total of 110 women who had reported urinary incontinence to their general practitioners were randomly assigned to a treatment or control group. Treatment consisted of pelvic floor exercises in the case of stress incontinence and bladder training in the case of urge incontinence. The results were measured after 3 and 12 months by a research assistant on the basis of a constructed severity scale, an incontinence diary, and a comparison by the patients themselves of their previous and current conditions. After 3 months the control group were given the same treatment. After a further 3 and 12 months, they were assessed in exactly the same way as the treatment group. After 3 months about 60% of the patients were either dry or only mildly incontinent; the mean number of wet episodes had gone down from 20 to 7, and 74% of the women felt improved or cured. These results were later corroborated by the control group. After 12 months this successful outcome was improved slightly further. It may be concluded that the majority of women with incontinence can be successfully treated by the general practitioner. The effect of this treatment continues after one year. [ABSTRACT FROM PUBLISHER]

Background: Our clinical observations and two earlier studies indicate familial clustering to be involved in chronic chilblains. Demonstrating phenotypic familial aggregation is a next step to investigate the origin of familial clustering.Objective: This study was initiated to assess evidence for phenotypic familial aggregation in chronic chilblains.Methods: Using a case-control family design in a primary care setting, we computed the familial relative risk of at least one episode of chronic chilblains during life with 95% confidence intervals (CIs). The study population consisted of 192 relatives of 31 case probands (at least one confirmed episode of chronic chilblains). The control population consisted of 178 relatives of 31 sex- and age-matched index controls (no history of chronic chilblains).Results: The familial relative risk of chronic chilblains was 3.6 (95% CI 1.9-7.3). Additional sensitivity analysis shows similar figures.Conclusion: We demonstrate robust phenotypic familial aggregation in chronic chilblains. [ABSTRACT FROM AUTHOR]

Background. Intimate partner violence (IPV) against women is a major health problem and negatively affects the victim’s mental and physical health. Evidence-based interventions in family practice are scarce. Objective. We aimed to evaluate a low threshold home-visiting intervention for abused women provided by trained mentor mothers in family practice. The aim was to reduce exposure to IPV, symptoms of depression as well as to improve social support, participation in society and acceptance of mental health care. Methods. A pre–post study of a 16-week mentoring intervention with identified abused women with children was conducted. After referral by a family doctor, a mentor mother visited the abused woman weekly. Primary outcomes are IPV assessed with the Composite Abuse Scale (CAS), depressive symptoms using the Symptom Checklist (SCL 90) and social support by the Utrecht Coping List. Secondary outcomes are analysed qualitatively: participation in society defined as employment and education and the acceptance of mental health care. Results. At baseline, 63 out of 66 abused women were referred to mentor support. Forty-three participants completed the intervention programme. IPV decreased from CAStotal 46.7 (SD 24.7) to 9.0 (SD 9.1) (P ≤ 0.001) after the mentor mother support programme. Symptoms of depression decreased from 53.3 (SD 13.7) to 34.8 (SD 11.5) (P ≤ 0.001) and social support increased from 13.2 (SD 4.0) to 15.2 (SD 3.5) (P ≤ 0.001). Participation in society and the acceptance of mental health for mother and child improved. Conclusions. Sixteen weekly visits by trained mentor mothers are a promising intervention to decrease exposure to IPV and symptoms of depression, as well as to improve social support, participation in society and the acceptance of professional help for abused women and their children. [ABSTRACT FROM PUBLISHER]

Objective. To explore the prevalence of intimate partner violence (IPV) of women (aged >18 years) attending general practice and to assess the association between IPV and depression.Methods. A cross-sectional survey was conducted within 15 general practices across Rotterdam. The study population was all women older than 18 years of age attending general practice. Women were screened for sociodemographic factors, IPV and depression using the Composite Abuse Scale and the Beck Depression Inventory.Results. This study had a response rate of 63% (221 of 352 women). Two hundred and fourteen women were included in the study of whom 41% were migrants. Thirty per cent of the women attending general practise ever experienced IPV. Migrants experienced IPV 1.5 times more often compared to Dutch women. A significant association between IPV and depression was found. Half of the abused women were suffering from a depression. More than three-quarter of depressed women ever experienced IPV.Conclusions. IPV is common in women attending general practice and it is significantly associated with depression. To improve recognition of abused women, doctors should ask depressed women if they ever experienced IPV. [ABSTRACT FROM AUTHOR]

Background: The selection process of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice.Objective: The objective of this study was to use female urinary incontinence as a model in an attempt to provide empirical support for selection bias.Method: The analyses are based on three populations of incontinent women: community level (epidemiological survey, 535 women), primary care level (general practice, prospective clinical study, 105 women), and secondary care level (university hospital, prospective clinical study, 228 women).Results: The general practice patients were older and the hospital patients younger than those in the community. From community via general practice to hospital, there was an increase in duration, frequency of leakage, amount of leakage, severity and perceived impact of incontinence. Help-seeking at the primary care level was associated with increasing age and severity, and with urge symptoms and substantial impact. Referral from general practice to hospital level was only associated with age and urge symptoms.Conclusion: The study provides empirical evidence to support the existence of selection bias. This phenomenon must not be overlooked when recommendations developed at the consultant level are presented at a level with a significantly different clinical picture of a condition. [ABSTRACT FROM AUTHOR]

The objective was to study explanatory factors for help-seeking among incontinent women, and what was the outcome of the treatment. A questionnaire was mailed to all 2366 women aged 20 or over in the rural community of Rissa, Norway. Women confirming incontinence gave information about duration, precipitating factors, frequency, amount of leakage, and impact. Questions about doctor consultation or planned consultation, treatment and results were included. Women with incontinence which had resolved without treatment were also recorded. A total of 77% answered the questionnaire. Twenty per cent of women with incontinence ( = 535) had consulted a doctor, 18% had planned to consult. Increasing age and duration, and urge/mixed type of incontinence were determinative factors for doctor consultation, while increasing severity and impact were determinative for planned consultation. Drugs, exercises, pads, and electrostimulation were all important treatment options: 21% were cured, 40% much better after treatment. Of all the women, 8% reported that they had been incontinent in the past, and only 18% of these had consulted a doctor. [ABSTRACT FROM PUBLISHER]

The bacterial growth in patients presenting with a sore throat was assayed and four clinical features were tested in order to reliably differentiate between beta-haemolytic streptococci group A (GABHS) and other micro-organisms. For 2 years, 53 general practitioners (GPs) in The Netherlands took throat swabs from all patients, aged 4–60, presenting with a sore throat lasting 14 days or less. Four clinical features: fever (history), (tonsillary) exudate, anterior cervical lymphadenopathy and absence of cough were registered. In 70% of the 598 patients one or more micro-organisms were cultured from throat specimens. In 48% of the patients beta-haemolytic streptococci were found (32% group A, 7% group C, 4% group G, 5% others). Enterobacteriaceae were cultured in 5%, in 5%, in 4%, various others in 8% of the patients. In 30% of the patients cultures remained negative. Of the 270 patients with three or four clinical features, 46% (95% Cl, 40–52%) harboured GABHS in their throats, while in 328 patients with less than three features 21% (95% Cl, 16–25%) were GABHS positive. However, this relationship between presence or absence of clinical features and culture result was not found in the youngest age category (4–14 years old). Culture results were not related to sex, smoking habits or the insurance mode of the patient. The clinical relevance of several micro-organisms, other than beta-haemolytic streptococci, remains to be determined. The four mentioned signs and symptoms were helpful in predicting the probability of GABHS in patients aged 15 years and older. More negative cultures were seen in the group with less than three clinical features. [ABSTRACT FROM PUBLISHER]

Cataract is a slowly developing eye disease, the prevalence of which rises with age. Although patients often adapt to the diminished visual acuity accompanying the development of cataracts, their functional health may be impaired by poor vision. An index for visual functioning was derived from the literature. As older people often have additional chronic diseases, vision, visual functioning index and chronic co-morbidity were measured. Functional health was measured with different validated instruments. Eighty cataract patients participated in this study and were visited at home. Results showed statistically significant correlations between vision and co-morbidity on the one hand and visual functioning and functional health on the other. As in most participants vision was only slightly impaired, these results might even be more pronounced in patients with mature cataract. We conclude that indications for cataract surgery might not only be derived from visual acuity, but also from visual functioning and functional health. [ABSTRACT FROM PUBLISHER]

The article discusses various reports published within the issue, including one on clinical prevention services, one on behavioral research in disease prevention and one on medical screening and treatment research.

Background. A multiple intervention targeted to reduce antibiotic prescribing with an educational outreach programme had proven to be effective in a randomized controlled trial in 12 peer review groups, demonstrating 12% less prescriptions for respiratory tract infections. Objective. To assess the effectiveness of a multiple intervention in primary care at a large scale. Methods. A controlled before and after study in 2006 and 2007 was designed. Participants were from general practices within a geographically defined area in the middle region of The Netherlands. Participants were GPs in 141 practices in 25 peer review groups. A control group of GP practices from the same region, matched for type of practice and mean volume of antibiotic prescribing. The multiple intervention consisted of the following elements: (i) group education meeting and communication training; (ii) monitoring and feedback on prescribing behaviour; (iii) group education for GPs and pharmacists assistants and (iv) patient education material. The main outcome measures are as follows: (i) number of antibiotic prescriptions per 1000 patients per GP and (ii) number of second-choice antibiotics, obtained from claims data from the regional health insurance company. The associations between predictors and outcome measurements were assessed by means of a multiple regression analyses. Results. At baseline, the number of antibiotic prescriptions per 1000 patients was slightly higher in the intervention group than in the control group (184 versus 176). In 2007, the number of prescriptions had increased to 232 and 227, respectively, and not differed between intervention and control group. Conclusions. The implementation of an already proven effective multiple intervention strategy at a larger scale showed no reduction of antibiotic prescription rates. The failure might be attributed to a less tight monitoring of intervention and audit. Inserting practical tools in the intervention might be more successful and should be studied. [ABSTRACT FROM AUTHOR]