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Objective - To study differences in diabetes-related parameters in type 2 diabetic patients treated with the support of a Diabetes Service compared to conventional general practice care. Design - Parallel clinical trial with randomisation at practice level. Setting - Fifteen general practices. Patients - Type 2 diabetic patients, aged < 76 years, treated by a GP. Main outcome measures - Level of glycated haemoglobin (HbA1c). Results - 246 patients entered the study. Final mean HbA1c of all evaluable patients allocated to the intervention (n =84) was 7.1 ± 1.2%, vs 7.5 ± 1.8% in the controls (n = 140) (p = 0.06). Patients who were initially poorly controlled (Fasting Blood Glucose > 10 mmol/l) had a significantly lower final HbA1c if they were in an intervention practice (p =0.001). Fewer patients in intervention practices were referred to hospital specialists (1 vs 14). Conclusions – Support by the Dutch Diabetes Service did not significantly influence glycated haemoglobin. The subgroup of initially poorly controlled patients developed a significantly lower HbA1c in intervention practices (supported by a Diabetes Service) than in control practices. [ABSTRACT FROM AUTHOR]

Memory deficits are considered the most prominent characteristics of mental deterioration in the early stages of Huntington's disease (HD) but empirical studies report contradictory results. The aim of this study was to assess memory and learning in 9 individuals with an increased risk (≥ 96%) of HD but without clinical symptoms and signs. Seventeen individuals with a decreased risk (≤ 5 %) formed a group of controls. Verbal and visual memory, various aspects of learning, word fluency and procedural learning were assessed. Conventional group comparisons showed no significant differences in the performances of the high risk and the low risk groups. [ABSTRACT FROM AUTHOR]

Objective - To assess the course of depression or borderline depression and its determinants in elderly primary care patients. Design - An observational cohort study with three measurements, at inclusion and after 6 and 12 months. Setting - 14 general practitioners (GPs) in the western region of the Netherlands. Patients - From a baseline random sample of 582 consecutive elderly patients 65+years of age, a total of 39 patients with depression and 60 with borderline depression were available for this cohort study. Main outcome measures - Diagnostic assessment was carried out in the patients' homes by trained interviewers according to the Diagnostic Interview Schedule (plus additional questions to assess minor depression). Results - Of the 39 patients with depression at baseline, 20 had depression after 6 months, and 18 after 12 months. Of the 60 patients with borderline depression at baseline, 53 had no evidence of depression after 6 months, and 54 had no evidence after 12 months. However, 7 patients had depression at 6 months and 6 patients at 12 months. Two determinants were related to a depressed state at 6 or 12 months among the patients with borderline depression: recognition by the GP and living with a partner. Conclusion - The results suggest that once elderly patients suffer from depression, this condition remains present for a long time. The prognosis for borderline depression was better, although 20% became depressed at 6 and/or 12 months. Future studies should aim to identify this group of patients. [ABSTRACT FROM AUTHOR]

Objective - To identify the most useful combinations of symptoms and the results of radioallergosorbent tests (RASTs) and skin prick tests (SPTs) for the diagnosis of allergic rhinitis. Design - A prospective comparison was made of symptoms and the results of RASTs and SPTs with 7 different nasal allergies; the references used were the “consensus diagnoses” provided by 3 experts. Setting - Nineteen general practices in The Netherlands. Patients - 365 consecutive patients aged 12 or over who visited their general practitioner because of chronic or recurrent nasal symptoms between 1 March 1990 and 1 March 1991. Main outcome measures - The most useful combinations of items from the history, RASTs, and SPTs, for the diagnosis of 7 different nasal allergies; the predictive probabilities of these combinations. Results - Diagnostic criteria could be drawn up resulting in a near-perfect discrimination between patients diagnosed as having allergic rhinitis and patients diagnosed as not having allergic rhinitis. Most of these criteria combined only a single item from the history with either RAST or SPT. For nearly all nasal allergies, both the negative predictive probabilities and the positive predictive probabilities were 97% or more. Conclusions - The common nasal allergies can be diagnosed with a very high certainty with the aid of simple diagnostic criteria. Data from a strictly limited case history combined with either RAST or SPT are sufficient. [ABSTRACT FROM AUTHOR]