[Attention in the medical curriculum for the sequelae of DES administration]

There is still a lack of knowledge among physicians with respect to epidemiology, diagnosis, treatment and psychology of the former use of diethylstilboestrol (DES). A questionnaire was sent to 24 educational representatives of eight departments of general practice and 8 of gynaecology asking about the DES education programme in their departments. Response was 100%. Three of 8 general practice departments had a DES education programme, and all 8 gynaecology departments. With respect to epidemiology, diagnosis, treatment and psychology, the educational effort ranged from 50% to 75%, from 25% to 50%, and from 21% to 46% of the departments giving information regarding DES daughters, DES mothers, and DES sons respectively. The medical education with respect to DES depended much on the personal opinion and involvement of the individual teacher. Training of medical students with respect to the DES problem should be an integral part of preclinical medical education.

Sex differences among recipients of benzodiazepines in Dutch general practice

OBJECTIVE

To analyse sex differences among recipients of benzodiazepines in Dutch general practice.

DESIGN

Study of consultations and associated interventions as recorded in the Dutch national survey of general practice.

SETTING

Practices of 45 general practitioners monitored during 1 April to 30 June 1987.

SUBJECTS

61,249 patients (29,035 (47.4%) men in the age groups 19-44, 45-64, and 65 years and over.

MAIN OUTCOME MEASURES

Symptoms among recipients of repeat as well as new benzodiazepine prescriptions stratified by sex and age.

RESULTS

Prescriptions for benzodiazepines were found to be significantly more common among women than among men, (a) after correcting for the sex distribution of the total patient population, and (b) in the two oldest age groups after correcting for the number of consultations. Of all prescriptions for benzodiazepines, 89% (6055/6777) were repeats and 70% (4759/6777) requests. Only 9% (439/4759) of these were authorized by the general practitioner, the rest being issued by the general practitioner's assistant after he or she had referred to the diagnosis in the patient's record. In contrast, only three (1%) of the 492 first time recipients of benzodiazepines had requested a prescription and were not seen by the general practitioner. Women (43/96; 45%) aged 45-64 years received their first prescription for benzodiazepines almost twice as often as men (15/63; 24%) without symptoms or a diagnosis being an indication (female to male relative risk 1.88 (95% confidence interval 1.15 to 3.08)).

CONCLUSIONS

The sex difference among first time recipients of benzodiazepines seems to be due to general practitioners being less stringent when prescribing this drug for women. The difference continues in repeat prescriptions, physicians failing to check adequately the need for these.

[Pregnancy during residency]

The number of female residents in the Netherlands has steadily increased in recent years. Due to the increased time on waiting lists to enter residency programmes and to the increased duration of training, female residents will be older during their residencies. This will probably result in an increased number of pregnancies during residencies. A questionnaire regarding pregnancy during residency was sent to 191 residents in two university hospitals in the Netherlands. The response rate was 74.3%. Fifty percent of the male and only 19% of the female residents had children. No negative effects of a pregnancy on their training were experienced or anticipated by the residents. However, a negative effect on the functioning of the department was expected. No formal provisions, like replacements were available and many solutions to replace pregnant colleagues depended on the flexibility of the colleagues. The wish to have children was high and equally distributed among male and female residents, 92% and 96%, resp. Given the difficulty to seek a permanent position and to have children after residency, the choice of many female residents will be to have their children during residency. This increase in number of pregnancies requires anticipation of the residency programme directors. They should take the lead in proposing adequate regulations.

Differences in leading causes of death, hospitalization and general practice visits among Dutch women and men

Mortality differences between Dutch women and men were compared to differences in hospitalization and general practitioner visits. Ranks for the top fifteen diagnoses per sex as well as absolute and relative (to total of sex-specific diagnoses per group) sex ratio's were computed for the age groups 15-44 years, 45-64 years and over 65 years. To enhance comparability all procreative and contraceptive management data were excluded. Twice as many men compared to women die in all age groups, resulting in a surviving excess of women in the oldest age group (male/female ratio: 0.67). As expected from these mortality figures relatively more men than women are hospitalized, in particular in the oldest age group, 26.4 versus 19.5/100,000 (relative male/female ratio: 1.35). In a study population of twelve general practices, representative of the total Dutch population, more women sought medical care from the general practitioner than men and the individual women visited the general practitioner more frequently than men, resulting in a relative male/female ratio of 0.6 for general practice visits. Men visit the general practitioner for diseases for which they are also hospitalized and also often die from. Women visit the general practitioner for a wide range of ailments only in part representative of diseases for which they are hospitalized or die from. During aging, women tend to visit primary health care facilities more frequently for chronic, non-fatal disease, which can be explained partly by the absolute longer lifespan of women than men.