Febrile Children in Primary Care

Fever in children is a common symptom. Frequently,the underlying illness is self-limiting and medical intervention is seldom needed. However, general practitioners need to be alert on those children who are at risk for serious infections. In this thesis, we studied the natural course of fever in children, how general practitioners manage febrile children, and which improvements can be incorporated to achieve better health care for febrile children in primary care

Study on consumers’ attitudes towards Terms and Conditions (T&Cs): Final Report

This report was produced under the EU Consumer Programme (2014-2020) in the frame of a service contract with the Consumers, Health, Agriculture and Food Executive Agency (Chafea) acting under the mandate from the European Commission.Previous research has shown that when buying products and services online, the vast majority of consumers accept Terms and Conditions (T&Cs) without even reading them. The current research examined effects of interventions aimed at making consumers aware of the quality of such T&Cs. This was done by 1) shortening and simplifying the T&Cs and 2) adding a quality cue to an online store, such as the presence of a logo of a national consumer organisation accompanied by the statement “these terms and conditions are fair”. The main study consisted of three experiments and was conducted in 12 Member States with 1000 respondents in each Member State. In each experiment, consumers visited an online store and went through all the steps of an ordering process. One of these steps was accepting the T&Cs. Key findings are that shortening and simplifying the terms and conditions results in improved readership of the T&Cs, a slightly better understanding of the T&Cs, and a more positive attitude towards the T&Cs. Moreover, adding a quality cue to an online store increases trust and purchase intentions. Which quality cue is trusted the most depends on what type of online store consumers are visiting. For domestic online stores, a quality cue by a national consumer organisation is trusted most; for foreign online stores, a quality cue by a European consumer organisation is trusted most. The patterns were similar across Member States

Www.airqualitynow.eu, a common website and air quality indices to compare cities across europe

International audienceAir quality is a public concern. This is partly due to the "right to know" principle embodied in European legislation. Despite this common legislation, the way air quality is being interpreted and communicated differs considerably. For specialists raw monitoring data for Europe are available but these are not usable by the general public. Easy to understand and internationally comparable air quality information from one city to another is scarce: there are almost as many air quality indices as air quality monitoring networks. The CITEAIR II project (Common information to European Air, INTERREG IVc) facilitates the comparison of urban air quality in near real-time by introducing common air quality indices at hourly, daily and annual scales and by developing a forecast for those indices for D+0 and D+1.The implementation was based on a common website www.airqualitynow.eu using readily available simple IT-solutions. This paper describes those tools which both aimed at presenting the air quality of the participating cities in a comparable way and not to replace more targeted local information. Their added value is to provide, for the first time, a European and comparable picture of the air quality in near real-time easily accessible through a common platform and presentation of the results. The website is designed to receive and display data from any city wanting to join. The main part is dedicated to compare the cities index values using different time scales (hourly, daily or annual) and two types of exposure thanks to a background and a traffic index. In addition, space is offered to cities for presenting themselves according to a common template, providing background information on their specific air pollution situation and associated reduction measures. Participating is easy: cities upload their data through ftp and the indices calculations are automatically made. The website provides a dynamic picture of the air quality and is updated each hour enticing viewers to make repeated visits. However, participation with only a daily update or with yearly data is feasible as wel

The development of a questionnaire on metacognition for students in higher education

Background Interest in the role of metacognition has been steadily rising in most forms of education. This study focuses on the construction of a questionnaire for measuring metacognitive knowledge, metacognitive regulation and metacognitive responsiveness among students in higher education and the subsequent process of testing to determine its validity. Purpose The aim of the study was to construct an original instrument for measuring features of metacognition, henceforth referred to as the Awareness of Independent Learning Inventory (AILI), and further to establish the similarities and differences between this model and existing instruments for measuring metacognition. Sample The AILI questionnaire was distributed to 1058 students in various types of Teacher Training Institutes in the Netherlands and Belgium. The abridged English version of the questionnaire was administered to another sample of 729 students reading Economics and Business Administration at the University of Maastricht in the south of the Netherlands. Design and methods The AILI instrument was constructed on the basis of a facet design along two dimensions: components of metacognition and topics of concern to students in higher education. The data gathered with the instrument was analyzed by means of a generalisability study and a decision study, respectively. The validity of the instrument was investigated by using confirmatory factor analysis. Results The generalisability study showed that the reliability of the instrument was satisfactory. The decision study revealed that the number of items included in the questionnaire could be reduced substantially by leaving out two components of one of the dimensions in the facet design, without losing too much generalisability. The validity study showed that there was a considerable level of congruity between parts of the AILI questionnaire and the relevant parts of the Motivated Strategies for Learning Questionnaire (MSLQ). Conclusions The AILI questionnaire is a reliable and valid instrument for measuring metacognitive knowledge, regulation and responsiveness. It is suitable for use in the evaluation of the effects of interventions that purport to increase metacognitive knowledge, regulation and responsiveness of students in higher education

Outcomes of Early Endoscopic Realignment Versus Suprapubic Cystostomy and Delayed Urethroplasty for Pelvic Fracture-related Posterior Urethral Injuries : A Systematic Review

Peer reviewedPostprin

An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: Study protocol for a cluster randomised trial

Background: Fever is the most common reason for a child to be taken to a general practitioner (GP), especially during out-of-hours care. It is mostly caused by self-limiting infections. However, antibiotic prescription rates remain high, especially during out-of-hours care. Anxiety and lack of knowledge among parents, and perceived pressure to prescribe antibiotics amongst GPs, are important determinants of excessive antibiotic prescriptions. An illness-focused interactive booklet has the potential to improve this by providing parents with information about fever self-management strategies. The aim of this study is to develop and determine the effectiveness of an interactive booklet on management of children presenting with fever at Dutch GP out-of-hours cooperatives. Methods/design: We are conducting a cluster randomised controlled trial (RCT) with 20 GP out-of-hours cooperatives randomised to 1 of 2 arms: GP access to the illness-focused interactive booklet or care as usual. GPs working at intervention sites will have access to the booklet, which was developed in a multistage process. It consists of a traffic light system for parents on how to respond to fever-related symptoms, as well as information on natural course of infections, benefits and harms of (antibiotic) medications, self-management strategies and 'safety net' instructions. Children < 12 years of age with parent-reported or physician-measured fever are eligible for inclusion. The primary outcome is antibiotic prescribing during the initial consultation. Secondary outcomes are (intention to) (re)consult, antibiotic prescriptions during re-consultations, referrals, parental satisfaction and reassurance. In 6 months, 20,000 children will be recruited to find a difference in antibiotic prescribing rates of 25% in the control group and 19% in the intervention group. Statistical analysis will be performed using descriptive statistics and by fitting two-level (GP out-of-hours cooperative and patient) random intercept logistic regression models. Discussion: This will be the first and largest cluster RCT evaluating the effectiveness of an illness-focused interactive booklet during GP out-of-hours consultations with febrile children receiving antibiotic prescriptions. It is hypothesised that use of the booklet will result in a reduced number of antibiotic prescriptions, improved parental satisfaction and reduced intention to re-consult. Trial registration: ClinicalTrials.gov identifier: NCT02594553. Registered on 26 Oct 2015, last updated 15 Sept 2016

High resolution exposure modelling of heat and air pollution and the impact on mortality

Background Elevated temperature and air pollution have been associated with increased mortality. Exposure to heat and air pollution, as well as the density of vulnerable groups varies within cities. The objective was to investigate the extent of neighbourhood differences in mortality risk due to heat and air pollution in a city with a temperate maritime climate. Methods A case-crossover design was used to study associations between heat, air pollution and mortality. Different thermal indicators and air pollutants (PM10, NO2, O3) were reconstructed at high spatial resolution to improve exposure classification. Daily exposures were linked to individual mortality cases over a 15 year period. Results Significant interaction between maximum air temperature (Tamax) and PM10 was observed. During “summer smog” days (Tamax > 25 °C and PM10 > 50 μg/m3), the mortality risk at lag 2 was 7% higher compared to the reference (Tamax 15 °C and PM10 15 μg/m3). Persons above age 85 living alone were at highest risk. Conclusion We found significant synergistic effects of high temperatures and air pollution on mortality. Single living elderly were the most vulnerable group. Due to spatial differences in temperature and air pollution, mortality risks varied substantially between neighbourhoods, with a difference up to 7%

An illness-focused interactive booklet to optimise management and medication for childhood fever and infections in out-of-hours primary care: study protocol for a cluster randomised trial

Background Fever is the most common reason for a child to be taken to a general practitioner (GP), especially during out-of-hours care. It is mostly caused by self-limiting infections. However, antibiotic prescription rates remain high, especially during out-of-hours care. Anxiety and lack of knowledge among parents, and perceived pressure to prescribe antibiotics amongst GPs, are important determinants of excessive antibiotic prescriptions. An illness-focused interactive booklet has the potential to improve this by providing parents with information about fever self-management strategies. The aim of this study is to develop and determine the effectiveness of an interactive booklet on management of children presenting with fever at Dutch GP out-of-hours cooperatives. Methods/design We are conducting a cluster randomised controlled trial (RCT) with 20 GP out-of-hours cooperatives randomised to 1 of 2 arms: GP access to the illness-focused interactive booklet or care as usual. GPs working at intervention sites will have access to the booklet, which was developed in a multistage process. It consists of a traffic light system for parents on how to respond to fever-related symptoms, as well as information on natural course of infections, benefits and harms of (antibiotic) medications, self-management strategies and ‘safety net’ instructions. Children < 12 years of age with parent-reported or physician-measured fever are eligible for inclusion. The primary outcome is antibiotic prescribing during the initial consultation. Secondary outcomes are (intention to) (re)consult, antibiotic prescriptions during re-consultations, referrals, parental satisfaction and reassurance. In 6 months, 20,000 children will be recruited to find a difference in antibiotic prescribing rates of 25% in the control group and 19% in the intervention group. Statistical analysis will be performed using descriptive statistics and by fitting two-level (GP out-of-hours cooperative and patient) random intercept logistic regression models. Discussion This will be the first and largest cluster RCT evaluating the effectiveness of an illness-focused interactive booklet during GP out-of-hours consultations with febrile children receiving antibiotic prescriptions. It is hypothesised that use of the booklet will result in a reduced number of antibiotic prescriptions, improved parental satisfaction and reduced intention to re-consult

Alarming signs and symptoms in febrile children in primary care: An observational cohort study in The Netherlands

__Abstract__ Context: Febrile children in primary care have a low risk for serious infection. Although several alarming signs and symptoms are proposed to have predictive value for serious infections, most are based on research in secondary care. The frequency of alarming signs/symptoms has not been established in primary care; however, in this setting differences in occurrence may influence their predictive value for serious infections. Objective: To determine the frequency of alarming signs/symptoms in febrile children in primary care. Design: Observational cohort study. Clinical information was registered in a semi-structured way and manually recoded. Setting: General practitioners' out-of-hours service. Subjects: Face-to-face patient contacts concerning children (aged ≤16 years) with fever were eligible for inclusion. Main outcome measures: Frequency of 18 alarming signs and symptoms as reported in the literature. Results: A total of 10,476 patient contacts were included. The frequency of alarming signs/symptoms ranged from n = 1 (ABC instability; 40°C as reported by the parents; 12.9%) to 8,647 contacts (parental concern; 82.5%). Conclusion: Although the prevalence of specific alarming signs/symptoms is low in primary care, ≥50% of children have one or more alarming signs/symptoms. There is a need to determine the predictive value of alarming signs/symptoms not only for serious infections in primary care, but as well for increased risk of a complicated course of the illness