The course of mental health problems in children presenting with abdominal pain in general practice

Objective

To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months’ follow-up.

Design

A prospective cohort study with one-year follow-up.

Setting

53 general practices in the Netherlands, between May 2004 and March 2006.

Subjects

281 children aged 4–17 years.

Main outcome measures

The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up.

Results

A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3–44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2–46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7–51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months’ follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple non-specific somatic symptoms at follow-up.

Conclusions

In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain.Key Words: Abdominal pain, adolescent, child, cohort study, family practice, mental disorders, prognosisChildren with abdominal pain often have mental health problems; however, the prognosis of these problems is unknown. This follow-up study showed that:

• in one-third of the children depressive and anxiety problems persist over one year;
• characteristics of the abdominal pain during follow-up do not predict the presence of depressive and anxiety problems at 12 months’ follow-up;
• in children with persisting moderate to severe abdominal pain other non-specific somatic symptoms also persist.

     

The Cost of Persistent Asthma in Europe: An International Population-Based Study in Adults

Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30-54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30-54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.     

Prevalence of cervical insufficiency in polycystic ovarian syndrome

BACKGROUND Pregnant women with polycystic ovarian syndrome (PCOS) experience a greater rate of adverse obstetrical outcomes compared with non-PCOS women. We examined the prevalence and incidence of cervical insufficiency (CI) in a community cohort of pregnant women with and without PCOS. METHODS A retrospective cohort study was conducted within a large integrated health care delivery system among non-diabetic PCOS women with second or third trimester delivery during 2002-2005 (singleton or twin gestation). PCOS was defined by Rotterdam criteria. A non-PCOS comparison group matched for delivery year and hospital facility was used to estimate the background rate of CI. Women were designated as having new CI diagnosed in the index pregnancy (based on cervical dilation and/or cervical shortening) and prior CI based on prior diagnosis of CI with prophylactic cerclage placed in the subsequent pregnancy. RESULTS We identified 999 PCOS women, of whom 29 (2.9%) had CI. There were 18 patients with new CI and 11 with prior CI having prophylactic cerclage placement; four CI patients had twin gestation. In contrast, only five (0.5%) non-PCOS women had CI: two with new CI and three with prior CI. The proportion of newly diagnosed incident CI (1.8 versus 0.2%) or prevalent CI (2.9 versus 0.5%) was significantly greater for PCOS compared with non-PCOS pregnant women (both P < 0.01). Among PCOS women, CI prevalence was particularly high among South Asians (7.8%) and Blacks (17.5%) compared with Whites (1%) and significantly associated with gonadotropin use (including in vitro fertilization). Overall, the PCOS status was associated with an increased odds of prevalent CI pregnancy (adjusted odds ratio 4.8, 95% confidence interval 1.5-15.4), even after adjusting for maternal age, nulliparity, race/ethnicity, body mass index and fertility treatment. CONCLUSION In this large and ethnically diverse PCOS cohort, we found that CI occurred with a higher than expected frequency in PCOS women, particularly among South Asian and Black women. PCOS women with CI were also more likely to have received gonadotropin therapy. Future studies should examine whether natural and hormone-altered PCOS is a risk factor for CI, the role of race/ethnicity, fertility drugs and consideration for heightened mid-trimester surveillance in higher risk subgroups of pregnant women with PCOS.     

Electrocardiographic parameters in women ten years post-early preeclampsia

Objective

Women with a history of preeclampsia are at increased risk to develop cardiovascular disease (CVD) later in life, especially hypertension is common. In this study we aimed to evaluate electrocardiographic parameters as a proxy for detrimental hypertensive effects and later CVD.

Methods

The Preeclampsia Risk EValuation study in FEMales (PREVFEM) study is a prospective cohort study consisting of 339 women with a history of early onset preeclampsia (EOP) and 332 age-matched women without a history if EOP as reference. At ten years post index pregnancy a 12-lead electrocardiogram recording was made.

Results

There were no significant differences in ECG parameters between both groups at 39 years of age. In our cohort of young women SBP (OR_mmHg: 1.04; 95% CI: 1.2–1.06) as well as DBP (OR_mmHg: 1.04; 95% CI: 1.01–1.07) and stage 2 hypertension (OR: 3.35; 95% CI: 1.16–9.63) were significantly associated with ECG criteria for LVH, but not for other ECG abnormalities. EOP gives no significant adjusted risk on ECG abnormalities compared to women without EOP.

Conclusion

EOP is no significant predictor of non-specific ECG abnormalities. Routine ECG screening in young women after preeclampsia is not recommended in non-hypertensive women, but may be useful when hypertension is present.