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Biomedical subjects

C van Weel

Publications and source records attributed to C van Weel.

192 records · Page 11Linked to original sources
PubMed1989

Treatment of patients with airflow obstruction by general practitioners and chest physicians.

The study comprised 223 patients with airflow obstruction and/or bronchial hyperreactivity from 29 general practices in the catchment area of Nijmegen University. Fifty-six patients were treated by 19 chest physicians, the remaining 167 by their general practitioners (GPs), without specialist care. The specialists treated more allergic patients than the GP (p less than 0.05). No other relevant differences in sex, age, smoking behaviour, and severity of the disease (symptoms, lung function, and bronchial hyperreactivity) could be observed between these two groups of patients. Chest physicians prescribed almost three times as many drugs as GPs. No immediate response to the prescribed bronchodilators was found in 16% of the patients treated by the GPs, nor in 20% of the patients treated by the specialists. We could identify only a weak relationship between the severity of the disease (symptoms and pulmonary function combined) and the prescribed pharmacotherapy: with growing degrees of severity the GP seems to prescribe more bronchodilators, the specialist more inhaled corticosteroids. Prescribed pharmacotherapy should be based on the combination of symptoms, pulmonary function, bronchial hyperreactivity, and reversibility on the prescribed bronchodilators.

Adult↗
PubMed1987

Development of respiratory illness in childhood--a longitudinal study in general practice.

The prognosis of early childhood respiratory illness has been studied by analysis of historic cohorts using data recorded since 1967 in the continuous morbidity registration project of the University of Nijmegen. The characteristics of this project are discussed, including the stability of the practice (study) population, a factor which allows longitudinal analysis to be performed.The development of respiratory morbidity during the first eight years of life has been analysed and a group of 710 patients characterized on the basis of their respiratory morbidity in the first two years of life. In general the highest levels of respiratory morbidity are seen in the first years of life, with a gradual decline over the years studied. Upper respiratory tract infections are largely responsible for this morbidity. An elevated level of episodes of respiratory illness in patients aged two to seven years was observed when the following characteristics of early life respiratory morbidity were present: more than three episodes of respiratory illness, lower respiratory tract infections or catarrhal conditions. However, by the age of seven years the level of morbidity of the children with these characteristics was very similar to that of children without these characteristics. Respiratory morbidity in childhood is predominantly benign and self-limiting. Only children with atopic conditions in early childhood showed a higher prevalance of asthma and chronic bronchitis at the end of the study period.

Child↗
PubMed1985

Does labelling and treatment for hypertension increase illness behaviour?

This study looked at the possible harmful effects of detection and treatment for hypertension. Patients with borderline blood pressure (diastolic 96-109 mmHg) were randomized into two groups: an intervention group receiving treatment for hypertension and a control group not told about any problem and left untreated. The morbidity in these two groups were studied for differences. During the period studied, the patients in the investigation group saw the doctor more frequently and had a larger number of diseases classified than the control group. When consultations involving hypertension and its follow up were excluded, however, no differences were demonstrable between the groups. Problem behaviour, psychosomatic and functional affections and symptom diagnoses were evenly distributed over the two groups. The difference in blood pressure between the two groups after completion of the study was not marked: the decrease in diastolic blood pressure averaged 7.6 mmHg in the control group versus 9.1 mmHg in the intervention group. In cases where the initial blood pressure values are only slightly raised, careful monitoring of blood pressure over a long period seems to be as effective as treatment for hypertension. The general practitioner should focus especially on anticipation in this sense.

Adult↗
PubMed1980

Group-based care: does it change problem behaviour?

As a result of disappointing experiences in managing problem behaviour presented by patients in general practice, a system of team or group-based care was developed at the Ommoord Health Centre in Rotterdam, the Netherlands.However, despite all the care given by social workers, general practitioners, physiotherapists and other members of the primary health care team, the problem behaviour of about half the patients was unaltered.This report concerns the aims and methods of our group meetings and the conditions such as empathy, sincerity and non-possessive warmth which we regard as essential in dealing with problem behaviour. The conditions necessary for improvement, such as independence and responsiveness by patients, are also considered. During our group meetings the team deals with the emotions which patients are experiencing at the time, and patients are encouraged to discover as much as possible about their own possibilities for both influencing and making choices in their lives. Some examples of this type of care are given.Patients react positively to the group-based care approach and some reduction in the consultation rate and in the prescribing of tranquillizers by general practitioners has been shown.

Family Practice↗
PubMedDate not supplied

Nursing home and nursing home physician: the Dutch experience.

Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community.

Aged↗
PubMedDate not supplied

Clinicians' autonomy till the bitter end--can we learn from the extraordinary case of Harold Shipman?

Harold Shipman has attained the dubious reputation of being the greatest mass murderer of modern times. A specific feature of his murders was that these were committed during regular general practice care, over a period of 20 years. There are no grounds to assume that Shipman's case is unique in itself, or unique to British general practice and this paper analyses ways in which the medical profession can safeguard itself against future medical murderers.

Clinical Competence↗
PubMedDate not supplied

Occupational health and general practice: from opportunities lost to opportunities capitalised?

BACKGROUND AND AIM: Western populations are in the middle of the epidemiological transition of chronic diseases. Care of patients with chronic disease is directed at optimising life expectancy and quality of life. Daily and social functioning, including paid work are part of the treatment objectives. Yet, advice for and support in work related coping with chronic diseases, and collaboration with occupational health are not--yet--part of routine curative medical care procedures. This is also the case in general practice, where most patients with chronic conditions are treated. This 'blind spot' signals a generic lost opportunity in optimizing the care of patients with chronic disease. This paper analyses from empirical data the importance of integrating work-related advice and support in general practice and explores potential evidence of the benefits this provides for patients: the opportunities that can be capitalised through better interaction between occupational physicians (OP) and general practitioners (GP). METHODS: The paper is based on a review of three sources: (i) Epidemiology of chronic diseases: the Nijmegen Continuous Morbidity Registration; (ii) The relevant guidelines of the Dutch College of General Practitioners; (iii) Studies of work-related implications of asthma and COPD management of GPs of the Nijmegen centre of Evidence-Based Practice. RESULTS: Chronic diseases like cardiovascular disease, diabetes mellitus, COPD and asthma dominate general practice and lead annually to a large number of consultations. Although a majority of patients are 65 years or older--in particular for the first three diseases--GPs also care for a substantial number of under-65 years old. General practice guidelines for these disorders advocate care directed at normal functioning but do not systematically address functioning in the working place. Analysis of work-related functioning in case of chronic respiratory diseases, however, highlight that work-related factors and circumstances play an important role in patients' coping strategies. Patients tend to ignore negative effects of their workplace on their physical condition and as a consequence suffer undue limitations. Despite these work related risks, COPD patients who were in paid employement perceived higher quality of life than COPD patients who were disabled for work, but had similar disease severity (airway obstruction). Interestingly, a programme of patients' self-management of asthma resulted, in comparison to GP-supervised usual care in a substantial and lasting reduction of asthma related absence from work and other social-daily activities. CONCLUSIONS AND DISCUSSION: All consultations with employees with a chronic (respiratory) disease can be considered as opportunities to supervise work-related implications of the disease. Patients value their ability to work but frequently apply inefficient coping through ignoring the implications of their circumstances for their disease. A more efficient coping can probably be achieved through a more active involvement of patients in managing their own disease. Guidelines--like the Dutch College of General Practitioners'--have developed into a sophisticated and generally respected system of guidance of patient care. Explicit emphasis of management in relation to the workplace may present a logical opportunity to capitalise on.

Absenteeism↗
PubMedDate not supplied

The relationship between breast-feeding and early childhood morbidity in a general population.

This study investigated the relationship between breast-feeding and early childhood morbidity. Data on morbidity had been recorded in the Continuous Morbidity Registration of the Department of Family Medicine of the University of Nijmegen, the Netherlands, since 1967. Information on early childhood feeding was collected retrospectively by questionnaires mailed to the parents of all the children; the response rate was 94%. Exposure and outcome data of 1,347 children were available for analyses. Duration of breast-feeding was categorized as follows: 0 days (no breast-feeding), 1-14 days, 15-30 days, 31-90 days, 91-180 days, and more than 180 days. Two thirds of the children had been breast fed. Generally there was an inverse relationship between breast-feeding and morbidity. This was most prominent in the first year of life but was also present in the first three years. After adjustment for potential confounding variables, duration of breast-feeding was associated with fewer morbidity episodes and lower rates of several specific illnesses during the first three years of life. The findings suggest some modest health benefits of breast-feeding for children in the Netherlands.

Birth Order↗
PubMedDate not supplied

Is the breast best for children with a family history of atopy? The relation between way of feeding and early childhood morbidity.

BACKGROUND: Previous studies reported that breast-feeding protects children against a variety of diseases, but these studies were generally conducted on "high-risk" or hospitalized children. This paper describes the results of our study on the effects of breast-feeding on rate of illness in normal children with a family history of atopy. METHODS: A historic cohort approach of 794 children with a family history of atopy was used to assess the effects of breast-feeding on illness rates. Family history of atopy was based on allergic diseases in family members as registered by the family physician. Illness data from birth onwards were available from the Continuous Morbidity Registration of the Department of Family Medicine. Information on breast-feeding was collected by postal questionnaire. We then compared rates of illness between children with a family history of atopy who were and who were not breast-fed. RESULTS: Breast-feeding was related to lower levels of childhood illness both in the first and the first three years of life. In the first year of life they had fewer episodes of gastroenteritis, lower respiratory tract infections, and digestive tract disorders. Over the next three years of life they had fewer respiratory tract infections and skin infections. CONCLUSIONS: Our results suggest a protective effect of breast-feeding among children with a family history of atopy that is not confined to the period of breast-feeding but continues during the first three years of life. Breast-feeding should be promoted in children with a family history of atopy.

Breast Feeding↗