[Urticaria in general practice]. / Urticaria i almen praksis.

The vast majority of cases of urticaria and angio-edema are diagnosed and treated by general practitioners. Epidemiologic investigations have shown that 2.5 percent of the population annually seek medical advice for urticaria, and of these 95 percent consult a general practitioner. The available literature, however, is mainly based on materials from specialist clinics, and outpatients hospital departments. The clinical picture of urticaria as seen by the general practitioner differs, however, is essential features from that observed in selected patient groups. Recent studies from the primary health care services have confirmed this observation.

A two-year follow-up of children with urticaria in general practice.

A questionnaire was sent in 1984 to 97 children with urticaria, who had previously been seen in Danish general practice during a period of three months in 1982. The questionnaire included questions about provoking factors and the course of the disease. Replies were received from 79 children, 46 of whom had experienced one attack only, and 33 had had several attacks. Fifteen percent of the former and 48% of the latter suggested a variety of provoking agents, which were mainly food and food additives in the recurrent group. Previous infections were not suspected, though 20% had signs or symptoms of infection at the registration in 1982. It is suggested that a first episode of urticaria should be investigated by the practitioner only, with simple questioning and perhaps symptomatic treatment, because the first attack is often the sole one.

Susceptibility testing performed in general practice by urinary tract infections.

Demonstration of significant bacteriuria by quantitative culture of a urine specimen by use of dip-slides is a well proved diagnostic procedure in general practice. Susceptibility testing from urine specimens by use of dip-slides or agar-plates seems likewise easy to perform in general practice, but commercial methods, modified for use in general practice by simplification of the standard disc diffusion method involve possible sources of errors. In a multipractice study, the predictive values of results from susceptibility testing in general practice from urine specimens, by use of two commercial methods are calculated. A considerable number of errors were found, mainly because susceptible bacteria were classified as resistant. The consequence of this is certainly that patients are treated with a drug, which is effective against the infecting organism, but the clinician possibilities for choice of drugs will be limited more than necessary.

Urticaria among Danish children in general practice.

During a three month period 186 Danish general practitioners recorded 97 children with urticaria. No significant difference in frequency relating to sex was found. In 88 per cent of the cases the reason for contact was pruritus and exanthema. Patients did not appear to attend the practitioner on account of fear of serious disease. In 15 out of 21 children the disease had persisted for less than 24 months. Ninety-four per cent were questioned about provoking factors, but in only 17% was the aetiology elucidated. Only five patients revisited their general practitioner during a 14 day follow-up period. This confirms that most cases in general practice belong to the acute urticaria type in contrast to cases of urticaria in dermatology out-patient clinics. Seventy-five per cent were treated with drugs, in most cases with antihistamines.

A longitudinal study of serum TSH, and total and free iodothyronines during normal pregnancy.

Serum T4, T3, rT3, free T4, free T3 and TSH were measured during and after normal pregnancy in 20 women. Special methodological precautions were taken to avoid interference of other hormones and protein alterations in the assays. Serum T4 and T3 were steadily increasing during the last part of the 1st trimester, and remained high and nearly stable during the 2nd and 3rd trimester of the gestation period. The high levels were approximately 1.5 times the values measured 10 weeks post-partum. Serum rT3 was elevated already during the last part of the 1st trimester and remained high throughout pregnancy, compared to the post-partum value. Serum free T4 and free T3 were slightly elevated in early pregnancy. The values decreased gradually during pregnancy and were slightly depressed during the 3rd trimester. A gradual increase in serum TSH was observed during pregnancy and the 2nd and 3rd trimester values were significantly higher than the post-partum value. The mean values for serum TSH, free T4 and free T3 remained always well within the normal range. Thus small variations in serum free iodothyronines and TSH occur during normal pregnancy, the alterations observed in the last trimester of the gestation period resembling those of a slight thyroid insufficiency. These trends in variation of the reference values are worth to remember in the diagnosis of borderline hypo- or hyperthyroidism and in the balanced treatment of pregnant women with thyroid dysfunction.

[Withdrawal of high estrogen containing oral contraceptives and the demand for medical service]. / Hljlstrogene p-pillers tilbagetraekning og eftersplrgsel på laegelig service

PIP: The results of a survey are presented conerning the effectiveness of mass media publicity with the public. After oral contraceptives containing high levels of estrogen were prohibited in Denmark, a telephone survey of 23 doctors was taken to determine the fluctuation in demand for medical information from patients, and the reason for the fluctuation. The reasons were divided into 3 groups: 1) resulting from mass media publicity, 2) resulting from the unavailability of a particular contraceptive, and 3) other. 3 surveys were conducted of the frequency of demand for information on the high estrogen contraceptives, 1 for each of the 2 weeks after the prohibition and withdrawal of the contraceptives took place, and 1 1 month after the prohibition. 2-3% of the inquiries received by the doctors concerned the prohibited contraceptives, and half of these could be attributed directly to the mass media publicity. The number of requests in categories 1 and 2 dropped sharply in the 2nd and 3rd surveys, indicating that the effect of the mass meida publicity and the withdrawal of the contraceptive from the market had only a very immediate effect. It is also shown that the telephone can be used successfully to ascertain the effects of a short-term social phenomenon on the public.^ieng