ABSTRACT
- The guideline entitled 'Functional abdominal pain in children' has been developed by a multidisciplinary working group on behalf of the Dutch Pediatric Association in 2015. - History and physical examination are essential in diagnosing pediatric functional abdominal pain. Additional diagnostic testing is of limited value when alarm symptoms are absent. - Reassurance and education of both the child and parent(s), are the cornerstones in the treatment of pediatric functional abdominal pain. - In case of persisting symptoms, hypnotherapy or cognitive behavioral therapy can be started. There is no evidence for any pharmacological treatment.
Subject(s)
Abdominal Pain/diagnosis , Abdominal Pain/therapy , Cognitive Behavioral Therapy , Physical Examination , Practice Guidelines as Topic , Abdominal Pain/psychology , Child , Diagnosis, Differential , Diagnostic Tests, Routine , Humans , ParentsABSTRACT
OBJECTIVE: To assess changes in incidence and in antibiotic prescription rates for infections of the lower respiratory tract (LRTI) and urinary tract (UTI) in patients with diabetes (DM) over the years 1995 to 2003. METHODS: This was a retrospective cohort study as part of the University Medical Center Utrecht General Practitioners Research Network. We included patients with DM aged > or = 45 years. We assessed incidence and antibiotic prescription rates for LRTI and UTI. Incidence rates were calculated as episodes per 1000 person-years. Antibiotic prescription rates were calculated per 100 episodes of LRTI and UTI. RESULTS: The study population increased over the years 1995 to 2003. The male-to-female ratio and mean age of the study population remained constant over these years. The incidence rate for LRTI remained stable (13%; p=0.442), and for UTI the incidence rate increased by 40% (p=0.037). Antibiotic prescription rates increased in LRTI by 60% (p<0.001) and in cystitis by 15% (p=0.029). CONCLUSIONS: Incidence rates for UTI and antibiotic prescription rates for LRTI in diabetes have increased over the years 1995 to 2003. In particular, attention should be paid to the increasing use of antibiotics in DM patients with LRTI.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Diabetes Complications , Practice Patterns, Physicians'/statistics & numerical data , Respiratory Tract Infections , Urinary Tract Infections , Diabetes Complications/drug therapy , Diabetes Complications/epidemiology , Drug Utilization , Female , Humans , Incidence , Male , Middle Aged , Netherlands/epidemiology , Primary Health Care , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiologyABSTRACT
We aimed to develop a prediction rule for urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (DM2). A 12-month prospective cohort study was conducted in patients with DM2 aged > or = 45 years to predict the occurrence of recurrent UTIs in women and lower UTIs in men. Predictors for recurrent UTI in women (n=81, 2%) and lower UTIs in men (n=93, 3%) were age, number of general practitioner (GP) visits, urinary incontinence, cerebrovascular disease or dementia. In women, renal disease was an additional predictor. The optimism [corrected] corrected area under the receiver-operating curve (AUC) was 0.79 (95% CI 0.74-0.83) for women and 0.75 (95% CI 0.70-0.80) for men. Using a cut-off score of 4, women with a lower risk assignment had a probability of 0.3% for the outcome. For a cut-off score of 6, women with a higher risk assignment had a probability of 5.8%. For men these figures were 0.8 and 7.1 for a cut-off score of 2 and 4, respectively. Simple variables can be used for the risk stratification of patients.
