People with diabetes find it difficult to sustain adequate self-management behaviour. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of a mobile phone support intervention on top of an existing strategy in three countries, DR Congo, Cambodia and the Philippines to improve health outcomes, access to care and enablement of people with diabetes, with 480 people with diabetes in each country who are randomised to either standard support or to the intervention.The study consists of three sub-studies with a similar design in three countries to be independently implemented and analysed. The design is a two-arm Randomised Controlled Trial, in which a total of 480 adults with diabetes participating in an existing DSME programme will be randomly allocated to either usual care in the existing programme or to usual care plus a mobile phone self-management support intervention. Participants in both arms complete assessments at baseline, one year and two years after inclusion.Glycosylated haemoglobin blood pressure, height, weight, waist circumference will be measured. Individual interviews will be conducted to determine the patients' assessment of chronic illness care, degree of self-enablement, and access to care before implementation of the intervention, at intermediate moments and at the end of the study.Analyses of quantitative data including assessment of differences in changes in outcomes between the intervention and usual care group will be done. A probability of <0.05 is considered statistically significant. Outcome indicators will be plotted over time. All data are analysed for confounding and interaction in multivariate regression analyses taking potential clustering effects into account.Differences in outcome measures will be analysed per country and realistic evaluation to assess processes and context factors that influence implementation in order to understand why it works, for whom, under which circumstances. A costing study will be performed.The intervention addresses the problem that the greater part of diabetes management takes place without external support and that many challenges, unforeseen problems and questions occur at moments in between scheduled contacts with the support system, by exploiting communication technology.ISRCTN86247213.
Background and aims: Only few studies used objective respiratory health data to evaluate the potential health risk of residential proximity to livestock farms. This study aims to explore associations between proximity to livestock farms and lung function in a general, non-farming population of adults living in a rural area. Methods: We conducted a cross-sectional study in 2494 Dutch adults (20-72 yrs). A pre- and post-bronchodilator lung function test was conducted, and %predicted values were computed for FEV1, FVC, FEV1/FVC and FEF25-75%, using GLI-2012 prediction equations. Atopy was assessed in serum: specific IgE to common allergens or a total IgE ≥ 100 IU/ml. Distance to the nearest pig, poultry, cattle, or any farm, and number of farms within 500 and 1000 m of the home address were determined using a Geographic Information System. Data were analyzed using multiple linear regression and generalized additive models (smoothing). Results: Linear associations between lung function parameters and exposure to emissions of livestock farms were all non-significant. However, smoothed plots indicated a steep decrease of %predicted values of FEV1 and FEF25-75% for subjects living near a large number of farms. A lower FEV1 (-1.86, p=0.06) and FEF25-75% (-4.50, p=0.03) was found in subjects living within 1000 m of ≥17 farms (11.3% of the study population) compared to subjects living within 1000 m of <17 farms. These adverse associations were only observed in non-atopic subjects: FEV1 (-2.51, p=0.04), FEF25-75% (-6.03, p=0.03). Conclusions: Our results suggest a negative effect on respiratory health for people living in 9hotspots9 of livestock farms, possibly due to dust or endotoxin exposure.
Background. The differential diagnosis of children with acute non-traumatic hip pathology varies from quite harmless conditions such as transient synovitis of the hip to more severe problems like Perthes' disease, slipped capital femoral epiphysis (SCFE) and life-threatening conditions such as septic arthritis of the hip. Objective. To provide population-based data on symptom presentation and incidence rates of non-traumatic acute hip pathology in family practice. Methods. We analysed data from a large national survey of family practice (104 practices), which was carried out by the Netherlands Institute for Health Services Research (NIVEL) in 2001. We included all children aged 0–14 years. Incidence rates were calculated by dividing the total number of cases (numerator) by the average study population at risk (denominator). Results. Our study population consisted of 73 954 children aged 0–14 years, yielding 68 202 person-years. These children presented with 101 episodes of acute non-traumatic hip pathology. The presenting feature in 81.5% of the children was pain, in 8.6% limping and 9.9% presented with both symptoms. Only 27% of the participating family practitioners (FPs) reported whether the child had a fever. The incidence rate for all acute non-traumatic hip pathology was 148.1 per 100 000 person-years, and for transient synovitis, this was 76.2 per 100 000 person-years. Conclusion. In family practice, most children with acute non-traumatic hip pathology present with pain as the initial symptom. FPs need to be more aware that fever is the main distinguishing factor between a harmless condition and a life-threatening condition. Transient synovitis is the diagnosis with the highest incidence rate.
Purpose: To study the attitudes and working methods of general practitioners (GPs) in primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases. Methods: A questionnaire with questions about primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases in general practice was sent to a representative sample of 1100 Dutch GPs. The data were analyzed using frequency tables, chi-square and ANOVA. Results: 330 GPs completed and returned the questionnaire. Less than half of the GP’s actively invite patients for preventive measurements. Preventive measures are mainly performed by the GP when a patient asks for it or when patients visit a GP for other complaints. The main reasons for performing preventive tests were a positive family history, obesity and smoking. Most GPs consider detection of these diseases as worthwhile, but detection should particularly focus on the group of patients with the highest risk on these diseases. Conclusion: GPs have a positive attitude towards primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases, but primary prevention should be focused on patients at risk. (aut. ref.)
Background Telephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient’s ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience more difficulty in expressing their healthcare need. We aimed to assess whether income differences exist in the patient’s presented symptoms, assessed urgency and allocation of follow-up care in OPCS. Method Data were derived from Nivel Primary Care Database encompassing electronic health record data of 1.3 million patients from 28 OPCSs in 2017 in the Netherlands. These were linked to sociodemographic population registry data. Multilevel logistic regression analyses (contacts clustered in patients), adjusted for patient characteristics (eg, age, sex), were conducted to study associations of symptoms, urgency assessment and follow-up care with patients’ income (standardised for household size as socioeconomic status (SES) indicator). Results The most frequently presented symptoms deduced during triage slightly differed across SES groups, with a larger relative share of trauma in the high-income groups. No SES differences were observed in urgency assessment. After triage, low income was associated with a higher probability of receiving telephone advice and home visits, and fewer consultations at the OPCS. Conclusions SES differences in the patient’s presented symptom and in follow-up in OPCS suggest that the underlying health status and the ability to express care needs affect the telephone triage process . Further research should focus on opportunities to better tailor the telephone triage process to socioeconomically vulnerable patients.
General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance.To explore what guidance is available for GPs on managing recurrence risks for breast cancer, colorectal cancer and melanoma, and to examine whether recurrence risk management differs between these tumour types.Breast cancer, colorectal cancer and melanoma clinical practice guidelines were identified via searches on internet and the literature, and experts were approached to identify guidelines. Guidance on recurrence risk management that was (potentially) relevant for GPs was extracted and summarized into topics.We included 24 breast cancer, 21 colorectal cancer and 15 melanoma guidelines. Identified topics on recurrence risk management were rather similar among the three tumour types. The main issue in the guidelines was recurrence detection through consecutive diagnostic testing. Guidelines agree on both routine and nonroutine tests, but, recommended frequencies for follow-up are inconsistent, except for mammography screening for breast cancer. Only six guidelines provided targeted guidance for GPs.This inventory shows that recurrence risk management has overlapping areas between tumour types, making it more feasible for GPs to provide this care. However, few guidance on recurrence risk management is specific for GPs. Recommendations on time intervals of consecutive diagnostic tests are inconsistent, making it difficult for GPs to manage recurrence risks and illustrating the need for more guidance targeted for GPs.
