Atopic Children in General Practice

The first part of this thesis focuses on obtaining valid prevalence rates of atopic disorders in children. Chapter 2 presents the results of a systematic review (including a meta regression analysis) determining worldwide prevalence rates regarding children with atopic eczema, asthma, allergic rhinitis, and of having all three disorders, using data obtained from ISAAC questionnaires (including nonofficial ISAAC studies) and examining interrelationships between these disorders. The aim of the study presented in Chapter 3 was to develop and validate objective search filters, applicable in frequently-used online medical literature databases, to identify studies that are conducted in, or apply to, or refer to family medicine and general practice settings. The efficiency of this filter is then examined by deploying it in the systematic review presented in Chapter 4; this review compares self-reported prevalence rates in the open population (ISAAC studies) with clinician-diagnosed prevalence rates of the three atopic disorders in general practice settings. The knowledge obtained from these reviews is then used to acquire more reliable prevalence rates from the extensive and representative NIVEL Primary Care Database. In Chapter 5 four strategies are examined that can analyze raw data obtained from a general practice database in order to calculate valid prevalence rates.

In the second part of this thesis, different characteristics of atopic children in general practice are explored, focusing on comorbidity, medication use, and healthcare utilisation. First, in Chapter 6 a total of 404 different symptoms and diseases, and their possible association with atopic disorders, are examined. In Chapter 7 a total of 93 different medication groups were investigated for their possible association with atopic disorders. Then, in Chapter 8 a study is presented that aimed to quantify the current primary healthcare burden posed by atopic eczema, asthma and allergic rhinitis on general practice resources. In Chapter 9 the main results are discussed and recommendations are made for further research together with implications for clinical practice.
Finally, Chapter 10 summarises the main results of this thesis in English.