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Biomedical subjects

C van Weel

Publications and source records attributed to C van Weel.

At least 145 records · Page 8Linked to original sources
PubMed1994

Does bronchial hyperresponsiveness precede or follow airway obstruction in asthma or COPD?

OBJECTIVE: The following hypothesis was tested: The degree of bronchial hyperresponsiveness (BHR) is a risk factor for the progression of airway obstruction in asthma, while in chronic obstructive pulmonary disease (COPD) it reflects the existing airway obstruction. METHODS: The relationships between the (annual change in) PC20 histamine and the (annual change in) FEV1 were investigated in a 2-year prospective controlled study. The FEV1 and the PC20 histamine were assessed at 6-month intervals. 183 patients (74 asthma, 109 COPD) participated. The investigated relationships were assessed by means of multiple analysis of variance (ANOVA). Patients used bronchodilator therapy alone. No steroids were permitted during the study. RESULTS: The results demonstrated that the PC20 at the start of the study was related to the subsequent annual decline of FEV1 in asthma (r = 0.32, p < 0.05) but not in COPD (r = -0.10, p = 0.89). Asthmatic patients with a PC20 value < or = 2 mg/ml had an average decline of 118 ml/yr, those with a PC20 value > 2 mg/ml of 27 ml/yr. The change in PC20 histamine during the 2-year study period was related to the annual change in FEV1 in COPD (r = 0.45, p < 0.05), but not in asthma (r = 0.06, p = 0.90). The disturbing influence of possible confounders was investigated and if necessary controlled for. CONCLUSIONS: It was concluded that BHR, assessed with PC20 histamine, is probably involved in the progression of airway obstruction in asthma. In COPD, however, the degree of BHR probably only reflects the degree of existing airway obstruction. This conclusion may contribute to the ongoing debate whether it is useful to combine the diagnosis of asthma, COPD and emphysema under the umbrella-term CARA (or CNSLD = chronic non-specific lung disease). The so-called "Dutch hypothesis" which laid the foundation for this term, suggested that bronchial hyperresponsiveness plays a central role in the pathogenesis of CNSLD. The present study supports evidence that at least BHR does not seem to play the same role in the pathogenesis of asthma and COPD.

Adult↗
PubMed1994

[Incidence and prevalence of health problems in a group of nursing home patients with dementia. A comparison with family practice].

The objective of this study was to describe the health problems of a group dementia patients on admission and during residence in a Dutch nursing home and to compare these with figures of patients of 75 years and over from general practice. In 890 nursing home patients suffering from dementia prevalence of health problems on admission and the incidence during the residence were classified by means of the ICHPPC-2-defined. The differences between men and women were studied as was the influence of the season on the incidence during the stay. Results were compared with figures of patients of seventy five year and over from the continuous morbidity registration (CMR) from 'Nijmegen'. The most frequently occurring health problems on admission were: varicose veins of legs, acquired deformation of the spine, presbyacusis, hypertension, arthrosis, COPD, cerebrovascular disorders, heart murmur, cataract and chronic ischemic heart disease. During the residence the following health problems were frequently diagnosed: urinary tract infection, side effect of medicine, constipation, pneumonia, pressure sore, feeding problem, contusion, heart failure, cold and conjunctivitis. There were clear differences between men and women. Especially the incidence of intercurrent diseases showed great differences from the patterns in general practice. Prevalence of health problems on admission to the nursing home home agreed mor with figures from general practice. Respiratory tract infections frequently occurred in winter and urinary tract infections, pressure sores and conjunctivitis seemed to occur more in the summer. Nursing home patients with dementia have a lot of chronic and intercurrent health problems. They differ clearly from patients in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

The clustering of respiratory diseases in early childhood.

BACKGROUND: It has been suggested that early childhood respiratory morbidity is related to asthma and chronic bronchitis in later life. To understand these relations, it is necessary to know how early childhood respiratory diseases are distributed, interrelated, and clustered. This study analyzed the distribution, interrelations, and the clustering of early childhood respiratory morbidity. METHODS: We prospectively collected data of episodes of respiratory illness among 1140 children in the first five years of life, in family practice. To determine if the occurrence of respiratory illness was randomly distributed, we compared the frequency of respiratory illness to random Poisson distribution. We used factor analysis to determine if respiratory illnesses occurred in clusters or patterns according to type of illness. RESULTS: Five percent of subjects never presented a respiratory disease, and 53% presented at least six episodes. The episodes of each illness were not randomly distributed, and most conditions were associated with each other. Factor analysis showed that asthma, acute bronchitis, and pneumonia formed one cluster, and tonsillitis, otitis media, and common cold another cluster. CONCLUSIONS: Early childhood respiratory morbidity is unevenly distributed, but a clear-cut group of children with a much higher rate of more severe respiratory morbidity than other children could not be distinguished. Both upper and lower respiratory tract illnesses show clustering. In research on the long-term prognosis of early childhood respiratory morbidity, this morbidity may best be grouped into the categories identified in this research.

Child, Preschool↗
PubMed1994

Asthma in adolescents and young adults: relationship with early childhood respiratory morbidity.

AIM: This study was undertaken to examine the relationship between respiratory illness in early childhood and asthma in adolescence and young adulthood (age group 10-23 years). METHOD: The study population comprised 277 boys and 274 girls, born between 1967 and 1978 and registered from their birth to the year of study (1989) on the practice lists of the four general practices taking part in the continuous morbidity registration project (CMR) at the University of Nijmegen in the Netherlands. Details of all episodes of respiratory morbidity presented in the first five years of life and registered in the project were collected together with data on current respiratory status determined by means of a questionnaire on respiratory symptoms, spirometry and a histamine-challenge test. RESULTS: Sixteen per cent of the study group were diagnosed as having asthma. Only asthma and acute bronchitis in early childhood were significantly associated with asthma at age 10-23 years. CONCLUSION: Asthma in adolescence and young adulthood is related to asthma and acute bronchitis in early childhood. This study supports the view that this could be a causal relationship although an alternative explanation could be misclassification. The results provide no indication that upper respiratory tract infections are associated with the development of asthma in adolescence or young adulthood.

Adolescent↗
PubMed1993

Slowing the deterioration of asthma and chronic obstructive pulmonary disease observed during bronchodilator therapy by adding inhaled corticosteroids. A 4-year prospective study.

OBJECTIVE: To determine if deterioration in patients with asthma or chronic obstructive pulmonary disease (COPD) during bronchodilator therapy could be slowed by additional treatment with an inhaled corticosteroid. DESIGN: A 4-year prospective study. SETTING: Twenty-nine general practices in the catchment area of the University of Nijmegen, Nijmegen, the Netherlands. PATIENTS: The study included 56 patients (28 with asthma and 28 with COPD) who showed an annual decrease in the forced expiratory volume in 1 second (FEV1) of at least 80 mL in combination with at least two exacerbations per year during bronchodilator therapy alone. Forty-eight patients completed the study. INTERVENTION: During the first 2 years of treatment, patients received only bronchodilator therapy (salbutamol, 400 micrograms, or ipratropium bromide, 40 micrograms). During years 3 and 4, they received additional treatment with beclomethasone dipropionate, 400 micrograms two times daily. RESULTS: Prebronchodilator FEV1 increased 458 mL/y (95% CI, 233 to 683 mL/y) during the first 6 months of beclomethasone treatment; FEV1 then decreased 102 mL/y (CI, 57 to 147 mL/y) during months 7 to 24. The annual decline in FEV1 during beclomethasone treatment was less than the decline of 160 mL/y seen before beclomethasone therapy (difference, 58 mL/y; 95% CI, 2 to 87 mL/y). Only in patients with asthma did beclomethasone treatment improve bronchial hyperresponsiveness (assessed by determining the concentration of histamine that provoked a 20% decrease in FEV1 [PC20]) by 3.0 doubling doses per year (95% CI, 0.8 to 5.2 doses per year). Beclomethasone treatment was associated with improvement in peak expiratory flow rate, alleviation of symptoms, and a decrease in the number of exacerbations in both patient groups. CONCLUSIONS: Adding beclomethasone, 800 micrograms daily, slowed the unfavorable course of asthma or COPD seen with bronchodilator therapy alone. This effect was most evident in asthmatic patients.

Administration, Inhalation↗
PubMed1993

[Differences between family physicians and pulmonary specialists in the treatment of COPD patients].

This cross-sectional study comprised 223 patients with moderate asthma or chronic bronchitis (FEV1 > 50% of the predicted value) from 29 general practices in the catchment area of Nijmegen University. Fifty-six patients were treated by 19 chest physicians, the remaining 167 by 29 general practitioners, without specialist care. In the study population no relevant differences in sex, age, smoking behaviour or severity of the disease (symptoms, lung function, and bronchial hyperreactivity) could be observed between the two groups of patients, except for allergy. Chest physicians prescribed on average almost three times as much medication as general practitioners. We could identify only a weak relationship between the severity of the disease (symptoms and pulmonary function combined) and the prescribed pharmacotherapy: with rising degrees of severity the general practitioner prescribes more bronchodilators, the specialist more inhaled corticosteroids. No relationship could be observed between bronchial hyperreactivity and the prescribed pharmacotherapy. No response to prescribed bronchodilators was found in 16% of the patients treated by the general practitioner and in 20% of the patients treated by the specialist. On the basis of this cross-sectional study no well-defined treatment policy of patients with moderate asthma or chronic bronchitis either by the general practitioner or by the lung specialist could be found.

Administration, Inhalation↗
PubMed1993

Validity of diagnoses of chronic diseases in general practice. The application of diagnostic criteria.

Certainty of a diagnosis is not only important for the patient but also for morbidity studies. In the absence of a gold standard, agreement with diagnostic criteria is often the best approach in measuring the certainty of a diagnosis. The agreement with diagnostic criteria has been studied for 5 chronic diseases (hypertension, chronic ischemic heart disease, diabetes mellitus, chronic nonspecific lung disease and osteoarthritis) in 7 general practices with a total practice population of 23,534 persons. Agreement with diagnostic criteria is operationalized into 3 categories. For each chronic disease a diagnostic quality measure per general practitioner is computed. Retrospective data have been collected in the practices on 2295 diseases in 1989 patients. Two-thirds of the diagnoses were made in general practice. The agreement with the diagnostic criteria for the cases diagnosed in general practice is high, ranging from 96% true positive cases in diabetes mellitus to 58% in chronic nonspecific lung disease. The highest rate of false positive cases is 4%. On the level of general practitioners diagnostic qualities vary from 62 to 96% true positive cases for the different diseases. The variation in diagnostic quality between general practitioners is substantial. The prevalence rates for the 5 chronic diseases are lower after adjustment by only including true positive cases. Diagnoses of the 5 chronic diseases recorded in general practice are generally valid with low numbers of false positive cases.

Adolescent↗
PubMed1993

Comorbidity of chronic diseases in general practice.

With the increasing number of elderly people in The Netherlands the prevalence of chronic diseases will rise in the next decades. It is recognized in general practice that many older patients suffer from more than one chronic disease (comorbidity). The aim of this study is to describe the extent of comorbidity for the following diseases: hypertension, chronic ischemic heart disease, diabetes mellitus, chronic nonspecific lung disease, osteoarthritis. In a general practice population of 23,534 persons, 1989 patients have been identified with one or more chronic diseases. Only diseases in agreement with diagnostic criteria were included. In persons of 65 and older 23% suffer from one or more of the chronic diseases under study. Within this group 15% suffer from more than one of the chronic diseases. Osteoarthritis and diabetes mellitus are the diseases with the highest rate of comorbidity. Comorbidity restricts the external validity of results from single-disease intervention studies and complicates the organization of care.

Adolescent↗
PubMed1993

Diabetes and its long-term complications in general practice: a survey in a well-defined population.

The aim of this study was to assess the prevalence of long-term complications in all patients with non-insulin-dependent diabetes mellitus, who were known to their general practitioners (GPs). During one year 19 GPs in the area of Hoogeveen in the Netherlands examined their non-insulin-dependent (NIDDM) patients, including those under specialist's care. A detailed protocol was used; the GPs were trained in the diagnostic procedures. Complications were either already known from the records or newly discovered during screening. In a population of 41,940 14.5/1000 patients with diabetes were identified: 12/1000 NIDDM and 2.5/1000 insulin-dependent diabetes mellitus (IDDM). Of the 509 NIDDM patients, 387 (76%) could be screened for late complications. Signs and symptoms of late complications were found in many patients: retinopathy (14%), nephropathy (57%), neuropathy (68%) and macroangiopathy (53%). The prevalence of serious complications was: proliferative retino- and maculopathy (3.3%); diabetic foot (2.6%); renal failure (2.5%). The systemic screening revealed a high number of previously unknown cases. It is concluded that many patients with NIDDM develop signs and symptoms of late complications. Most cases are identified by systemic screening only. More long-term studies of the prognosis of late complications in NIDDM are needed.

Aged↗
PubMed1993

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP's opinion.

Thus far, the response to the nationwide screening programme for cervical cancer in The Netherlands, which was started in 1989, has been disappointing. One way to improve response is to involve general practitioners in the call system. A postal survey was conducted to review the implementation of the current screening programme in general practice and to examine the willingness of general practitioners to participate in a general practice-based call system. The response rate to the survey was 90%. The general practitioners were dissatisfied with follow-up, cost and time spent and compliance of women. Of all respondents 60% had already set up a call system within the practice or were willing to do so; another 31% were willing to participate in a regionally organized practice-based call system. On the basis of the results of this study a centralized general practice-based call system is recommended. The next step is to study the applicability of this system in a pilot programme.

Adult↗
PubMed1993

[Use of psychotropic drugs in a group of nursing home patients with dementia: many users, long-term use but low dosages].

Of 890 nursing home patients with dementia, admitted between 1980 en 1989 to Dutch nursing home 'Joachim en Anna' in Nijmegen, each episode of psychotropic drug use was retrospectively registered. Drugs were coded by means of the Anatomical Therapeutic Chemical (ATC)-classification system and the daily dose was expressed as the ratio of the prescribed daily dose and the internationally agreed defined daily dose. Side effects were analysed as were changes in prescription patterns throughout the years of patient admittance. A total of 3090 episodes were registered. Neuroleptics, benzodiazepines and antidepressants accounted for 58, 32 and 9% of the prescriptions. In almost every drug-prescription the prescribed daily dose was lower than the defined daily dose. More than 75% of the patients had at least one prescription for a psychotropic drug during institutionalization. Half of those patients who used a neuroleptic showed one or more side effects. Neither the total amount of patients with psychotropics nor the duration of usage changed throughout the years of patient admittance. It is concluded that a majority of these nursing home patients got at least one prescription of a psychotropic drug during institutionalization. Psychotropics were prescribed for long-term usage, but in low doses. Side effects were frequently observed in determining the right dose.

Aged↗
PubMed1993

Prevalence of left ventricular hypertrophy as assessed by electrocardiogram in treated hypertensive persons in general practice.

Many studies have paid attention to the prevalence of left ventricular hypertrophy (LVH) as assessed by electrocardiogram (ECG) in hypertensive patients. Patients with ECG-LVH show a considerably higher risk of cardiovascular morbidity and mortality than patients without ECG-LVH. This paper describes the prevalence of LVH and the relation between LVH, age, sex and BP. ECG, BP, treatment, duration of hypertension, body mass index and total serum cholesterol were recorded. The dimension of LVH was computed in accordance with the Minnesota Code. One of five hypertensive patients (21%) had LVH with or without repolarisation abnormalities. LVH based on high QRS voltages only was found more often in men. LVH with repolarisation abnormalities was more frequent in elderly patients. LVH was found more often in the highest SBP categories (SBP > 160 mmHg) and in the highest DBP categories (DBP > 105 mmHg). A logistic regression analysis showed the influence on the occurrence of LVH of the following parameters: being male, age > 65 years, SBP > 160 mmHg and DBP > 105 mmHg.

Aged↗
PubMed1993

Preliminary results of a general practice based call system for cervical cancer screening in The Netherlands.

A study was undertaken in Nijmegen, in the Netherlands, to compare the attendance rate following a call system for cervical cancer screening organized by general practitioners, with the attendance rate resulting from the Dutch national call system. Women are invited for screening on a three yearly basis and in 1990 1616 women were identified by nine practices as being in the appropriate age group (35 to 54 years) to attend for cervical cancer screening while 10,387 women were identified by the national call system. The attendance rate among the 1101 women in the rural general practices was 58%, compared with 49% of 4154 women in the matched group receiving an invitation from the national call system. The attendance rate among the 515 women in the urban general practices was 55%, compared with 41% of 6233 women in the matched group receiving an invitation from the national call system. Invitations from general practitioners resulted in similar percentages of women in all age groups attending for screening. Four general practices sent a reminder letter or made a telephone call to non-attenders. A reminder increased the attendance rate from 58% to 70%. It is concluded that a general practice based call system for cervical screening produces a higher attendance rate than the national call system.

Adult↗
PubMed1993

Morbidity in early childhood: family patterns in relation to sex, birth order, and social class.

BACKGROUND AND OBJECTIVES: This study investigated family patterns of morbidity in early childhood related to different degrees of severity of morbidity, sex, birth-order position, and social class. METHODS: The study was performed using data collected by the Continuous Morbidity Registration Project of the Department of Family Practice of the Nÿmegen University in the Netherlands. All recorded morbidity and a number of sociodemographic data (sex, birth order, and social class) were available. The study population included children (783 boys, 730 girls) born in the four practices from 1971 to 1985 and their parents. The children were followed until age five. Morbidity of children during the first five years of life and their parents during the same five years was categorized into three levels of seriousness and 10 morbidity groups. RESULTS: Correlations between morbidity of children and their mothers were high, particularly for nonserious morbidity (0.45-0.49). Correlations between morbidity of fathers and their children were similar for moderate and nonserious morbidity (0.30). Logistic regression analysis showed that the morbidity of the mother was the most important factor in predicting childhood morbidity. CONCLUSIONS: Although morbidity in early childhood was associated with sex, birth order, and social class, the morbidity of the parents, in particular the mother, was by far the most important factor.

Adult↗
PubMed1993

Euthanasia in The Netherlands. General practice facts.

The recent survey of the way general practitioners act in case of euthanasia, did point to the fact that procedural requirements were not always observed. This concerned particularly the issuing of an appropriate death certificate. It is important that the practice of euthanasia be prudently surveyed in order to safeguard the standard of euthanasia that general practitioners are able to provide. Fear in the community for unwanted medical practice is understandable when the history of Hitler Germany is used as a frame of reference. Stories of mercy killing in nursing homes or elsewhere will as well increase anxiety. This fear is, however, based on a wrong understanding of euthanasia. The formulated requirements and prudent surveillance offer the best protection against the fear of the community.

Euthanasia↗
PubMed1993

Migraine in family practice: prevalence and influence of sex hormonal status.

BACKGROUND: The objective of this study was to determine the prevalence of migraine headache in a family practice patient population. In addition, this study evaluated the simultaneous presence of Raynaud's phenomenon (RP) and migraine and examined the influence of sex hormonal status on migraine symptoms. METHODS: Data from the Continuous Morbidity Registration Project (CMR) of Nijmegen, the Netherlands, were used to identify all patients in the registration who had migraine headache and a comparison group of patients with nonvasospastic tension headache. Questionnaires were used to verify the diagnosis and to determine signs and symptoms of both headaches. RESULTS: There was an average annual prevalence of migraine headache of four per 1,000 men and 16 per 1,000 women. Eighty-five percent of patients diagnosed by family physicians as having migraine were found to fulfill the International Classification of Health Problems in Primary Care (ICHPPC) criteria for migraine headache. Migraine differed from tension headache with regard to the duration of the attacks, concomitant photo- and phonophobia, provoking factors, and the need to use analgesic medications. RP was present in 15% of the migraine group and in 16% of the tension headache group and occurred almost exclusively in women. The headaches were worse during and before menstruation in both groups and improved during pregnancy and menopause in the migraine group to greater extent than in the tension headache group. CONCLUSIONS: The use of the ICHPPC criteria for migraine headache is reliable in morbidity surveys in family practice. Although there was an overlap, migraine differed in various aspects from tension headache. Digital vasospasm and the influence of female hormonal changes were present in both headache groups.

Adolescent↗