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儿童非特异性身体症状的全科医生会诊与父母之间的关联:一项病例对照研究。

The association between GP consultations for non-specific physical symptoms in children and parents: a case-control study.

作者信息

Shraim Mujahed, Blagojevic-Bucknall Milisa, Mallen Christian D, Dunn Kate M

机构信息

Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom; Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America; Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America.

Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom.

出版信息

PLoS One. 2014 Sep 24;9(9):e108039. doi: 10.1371/journal.pone.0108039. eCollection 2014.

Abstract

BACKGROUND

Non-specific physical symptoms (NSPS) such as abdominal pain, headache and musculoskeletal pain are widespread in the community, and are common reasons for visiting a general practitioner (GP). Causes of NSPS are multifactorial, but may include parental influences.

OBJECTIVE

To investigate associations between GP consultations for NSPS in parents and their children.

METHODS

Matched case-control study using GP consultation data from 12 GP practices in the United Kingdom. Participants were 1328 children who consulted a GP for NSPS in 2009 (cases), 3980 controls who consulted a GP in 2009 but not for NSPS, plus parents of cases and controls (n = 8354).

PRIMARY OUTCOME MEASURE

child consultation status for NSPS.

RESULTS

Maternal consultation for NSPS was associated with significantly increased odds of their child consulting for NSPS (odds ratio (OR) 1.51, 95% confidence intervals (CI) 1.33, 1.73); there was no significant association with paternal consultations (OR 0.87, 95% CI 0.71, 1.08). Each additional maternal consultation for NSPS was associated with an increase in the rate ratio for number of consultations for NSPS in the child by 1.03 (95% CI 1.01, 1.05). This overall association was clearest in maternal-child consultations for painful NSPS and for specific bodily systems including gastrointestinal, musculoskeletal and neurologic symptoms.

CONCLUSIONS

Maternal GP consultation for NSPS is associated with increased odds of GP consultations for NSPS in children. This study included a large sample of children and parents and used medical records data which is not subject to recall bias. However, analysis was based on medical records, thus the presence of NSPS not leading to consultations is unknown. Medical practitioners managing children with NSPS need to be aware of this association.

摘要

背景

非特异性身体症状(如腹痛、头痛和肌肉骨骼疼痛)在社区中广泛存在,是患者拜访全科医生(GP)的常见原因。非特异性身体症状的病因是多因素的,但可能包括父母的影响。

目的

调查父母因非特异性身体症状拜访全科医生与他们孩子之间的关联。

方法

采用匹配病例对照研究,使用来自英国12家全科诊所的就诊数据。参与者包括2009年因非特异性身体症状拜访全科医生的1328名儿童(病例组)、2009年拜访过全科医生但不是因非特异性身体症状的3980名对照者,以及病例组和对照组的父母(n = 8354)。

主要观察指标

儿童因非特异性身体症状的就诊状态。

结果

母亲因非特异性身体症状就诊与孩子因非特异性身体症状就诊的几率显著增加相关(优势比(OR)为1.51,95%置信区间(CI)为1.33, 1.73);与父亲就诊无显著关联(OR为0.87,95% CI为0.71, 1.08)。母亲每增加一次因非特异性身体症状的就诊,孩子因非特异性身体症状就诊次数的率比增加1.03(95% CI为1.01, 1.05)。这种总体关联在母亲 - 孩子因疼痛性非特异性身体症状以及包括胃肠道、肌肉骨骼和神经症状在内的特定身体系统的就诊中最为明显。

结论

母亲因非特异性身体症状拜访全科医生与孩子因非特异性身体症状拜访全科医生的几率增加相关。本研究纳入了大量儿童和父母样本,并使用了不受回忆偏倚影响的医疗记录数据。然而,分析基于医疗记录,因此未导致就诊的非特异性身体症状的存在情况未知。管理患有非特异性身体症状儿童的医生需要了解这种关联。

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