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BackgroundOutdoor air pollution is a known risk factor for respiratory morbidity worldwide. Compared with the adult population, there are fewer studies that analyse the association between short-term exposure to air pollution and respiratory morbidity in children in primary care.ObjectiveTo evaluate whether children in a primary care setting exposed to outdoor air pollutants during short-term intervals are at increased risk of respiratory diagnoses.MethodsA search in Medline, the Cochrane Library, Web of Science and Embase databases throughout March 2023. Percentage change or risk ratios with corresponding 95% CI for the association between air pollutants and respiratory diseases were retrieved from individual studies. Risk of bias assessment was conducted with the Newcastle–Ottawa Scale (NOS) for cohort or case–control studies and an adjusted NOS for time series studies.ResultsFrom 1366 studies, 14 were identified as meeting the inclusion criteria. Most studies had intermediate or high quality. A meta-analysis was not conducted due to heterogeneity in exposure and health outcome. Overall, studies on short-term exposure to air pollutants (carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter ≤10 µm (PM10)) were associated with increased childhood respiratory consultations in primary care. In general, exposure to ozone was associated with a reduction in respiratory consultations.ConclusionsThe evidence suggests CO, SO2, NO2, PM10and PM2.5are risk factors for respiratory diseases in children in primary care in the short term. However, given the heterogeneity of the studies, interpretation of these findings must be done with caution.PROSPERO registration numberCRD42022259279.

Background. In a small proportion of patients experiencing unspecified back pain, a specified underlying pathology is present. Objective. The purposes of this study were: (1) to identify the prevalence of physicianspecified causes of back pain and (2) to assess associations between 'red flags' and vertebral fractures, as diagnosed by the patients' general practitioner (GP), in older adults with back pain. Methods. The Back Complaints in the Elders (BACE) study is a prospective cohort study. Patients (aged >55 years) with back pain were included when consulting their GP. A questionnaire was administered and a physical examination and heel bone densitometry were performed, and the results determined back pain and patient characteristics, including red flags. Participants received a radiograph, and reports were sent to their GP. The final diagnoses established at 1 year were collected from the GP's patient registry. Results. Of the 669 participants included, 6% were diagnosed with a serious underlying pathology during the 1-year follow-up. Most of these participants (n=33, 5%) were diagnosed with a vertebral fracture. Multivariable regression analysis showed that age of [greater than or equal to] 75 years, trauma, osteoporosis, a back pain intensity score of [greater than or equal to] 7, and thoracic pain were associated with a higher chance of getting the diagnosis of a vertebral fracture. Of these variables, trauma showed the highest positive predictive value for vertebral fracture of 0.25 (95% confidence interval=0.09, 0.41) and a positive likelihood ratio of 6.2 (95% confidence interval=2.8, 13-5). A diagnostic prediction model including the 5 red flags did not increase these values. Limitations. Low prevalence of vertebral fractures could have led to findings by chance. Conclusions. In these older adults with back pain presenting in general practice, 6% were diagnosed with serious pathology, mainly a vertebral fracture (5%). Four red flags were associated with the presence of vertebral fracture., Most patients with back pain experience unspecified back pain, although in a minority of the cases, a specified underlying pathology is present. (1-3) Of these specified causes, vertebral fractures, malignancies, [...]

This article examines factors associated with ejaculatory and erectile disorders among a community-based sample of older Dutch men. Findings indicate that erectile dysfunction is correlated with age, urinary tract symptoms, obesity, heart problems, smoking, and pulmonary disease while ejaculatory dysfunction is correlated with age, prostate surgery history, and erectile difficulties.

Background: Different methods for changing blood test-ordering behavior in primary care have been proven effective. However, randomized trials comparing these methods are lacking. Objective: To compare the effect of two versions of BloodLink, a computer-based clinical decision support system, on blood test ordering among general practitioners. Design: Randomized trial. Setting: 44 practices of general practitioners in the region of Delft, the Netherlands. Participants: 60 general practitioners in 44 practices who used computer-based patient records in their practices. Intervention: After stratification by solo practices and group practices, practices were randomly assigned to use BloodLink-Restricted, which initially displays a reduced list of tests, or BloodLink-Guideline, which is based on the guidelines of the Dutch College of General Practitioners. Measurements: Average number of blood tests ordered per order form per practice. Results: General practitioners who used BloodLink-Guideline requested 20% fewer tests on average than did practitioners who used BloodLink-Restricted (mean [[+ or -] SD], 5.5 [+ or -] 0.9 tests vs. 6.9 [+ or -] 1.6 tests, respectively; P = 0.003, Mann-Whitney test). Conclusions: Decision support based on guidelines is more effective in changing blood test-ordering behavior than is decision support based on initially displaying a limited number of tests. Guideline-driven decision support systems can be effective in reducing the number of laboratory tests ordered by primary care practitioners.

Hip pain in the elderly is the main feature of osteoarthritis of the hip. In this prospective followup study, we wanted to determine which patients with hip pain show disease progression, and what the incidence of total hip replacement (THR) is in this group of patients after 3 and 6 years of followup.Within general practices in the area of Rotterdam (The Netherlands), persons age ≥50 years with incident hip pain were included. After 3 and 6 years, progression of hip pain was assessed.A total of 224 patients were included. After 3 years disease progressed in 29 (15%) patients and 23 (12%) received a THR. After 6 years disease progressed in 45 (28%) patients and 36 (22%) received a THR. The prognostic variables for a THR after 3 and 6 years related to history taking were age ≥60 years, morning stiffness, and pain in the groin/medial thigh; variables related to physical examination were decreased extension/adduction, painful internal rotation, and a body mass index ≤30 kg/m2; and the variable related to radiologic findings was a Kellgren/Lawrence grade of 2 or higher.In this study population, ∼12% of patients presenting with hip pain to their general practitioner will undergo a THR within 3 years, and ∼22% after 6 years. Using the variables obtained from history taking, physical examination, and radiologic findings enables better identification of persons at high risk for a THR.

We evaluated circadian urine production and its determinants in a large population based sample of older men.

OBJECTIVE: To study whether clinical symptoms and signs can predict radiological osteoarthritis (OA) of the hip in primary care patients with hip pain. METHODS: Consecutive patients (n = 220) aged 50 years or older consulting the general practitioner for hip pain and referred for radiological investigation underwent a standardized history, radiological, laboratory, and physical examination. Radiological OA was confirmed with joint space < or = 2.5 mm. Additionally, a more stringent definition was used (< or = 1.5 mm). The relationship between radiological OA and possible clinical symptoms/signs of OA was tested. Combinations of clinical symptoms/signs that had shown an independent relationship with radiological OA in multivariate analyses were tested for their predictive value. RESULTS: Radiological OA (joint space < or = 2.5 mm) of the (more) symptomatic hip was present in 35.5% of the study population and more severe OA (joint space < or = 1.5 mm) in 11.4%. Presence of 4 specific symptoms/signs from history and examination showed a positive predictive value (PPV) of 73% (specificity 91%, sensitivity 45%) for radiological OA. When 5 specific symptoms/signs were present, the PPV for the more severe radiological OA was 82% (specificity 98%, sensitivity 72%), and when 6 or 7 specific symptoms/signs were present the PPV was 100% (specificity 100%, sensitivity 40% and 8%, respectively). Negative predictive values were high for almost all combinations. CONCLUSION: In primary care patients with hip pain, clinical symptoms and signs can to a moderate extent predict radiological OA and to a large extent more severe radiological OA.

Objective: To determine the consistency among the practice guidelines of the Dutch College of General Practitioners with respect to the use of blood tests. Methods: The authors evaluated 64 practice guidelines of the Dutch College of General Practitioners. For each guideline, they analyzed each sentence that contained a reference to a blood test to determine the clinical situation in which the test should be performed (the indication) and to determine the tests that should be performed in that situation (the recommended test). An incomplete recommendation refers to a guideline that mentioned a blood test but did not identify the indication for that test. An inconsistency refers to the situation in which one guideline recommended a certain test for a given indication whereas another guideline mentioned the same indication but did not recommend the same test. Results: Twenty-seven practice guidelines mentioned blood tests. Of these, three explicitly recommended not to request blood tests. Five guidelines contained incomplete recommendations, and the authors encountered two inconsistencies among the guidelines. Twenty-three guidelines mentioned blood tests and allowed the authors to identify indications and recommended tests. Conclusion: The identification of indications and recommended tests allows evaluation of consistency among practice guidelines. Although some incomplete recommendations and inconsistencies were discovered, the majority of the guidelines provide clear and unambiguous recommendations for blood-test ordering in primary care.

Introduction. In the Netherlands the recommendations for treatment of acute otitis media imply more restrictive use of antibiotics than in other countries. We studied nationwide data on the incidence, treatment, and short-term follow up of acute otitis media in general practice.Methods. We used data from the “Dutch National Survey of Morbidity and Interventions in General Practice”, in which 161 GPs registered every contact between patient and practice during three months. Census data of the practice population (64000 children aged below 15) were collected. We selected all contacts with the provisional diagnosis acute otitis media.The overall incidence was 101 per 1000 personyears. The incidence was highest in 3 and 4 year old children and in the months January to March. We could follow the registered contacts of 1322 children for 1 month. Antibiotics (mainly oral penicillins) were prescribed to only 21% of the in the first contact. Children with fever or respiratory complaints received antibiotics more frequenly. In the rollow up recurrent otitis media (31%), glue-ear (5%), and chronic suppurative otitis media (1%) occurred. The registered contacts of the follow up month did pot show meningitis, mastoiditis, or cholesteatoma was observed during follow up.Conclusions. These data are in agreement with local studies published in the past. The data support the idea that a relative infrequent use of antibiotics even in children < 1 year, is not associated with a high frequency of complications.