With the increasing number of elderly people in The Netherlands the prevalence of chronic diseases will rise in the next decades. It is recognized in general practice that many older patients suffer from more than one chronic disease (comorbidity). The aim of this study is to describe the extent of comorbidity for the following diseases: hypertension, chronic ischemic heart disease, diabetes mellitus, chronic nonspecific lung disease, osteoarthritis. In a general practice population of 23,534 persons, 1989 patients have been identified with one or more chronic diseases. Only diseases in agreement with diagnostic criteria were included. In persons of 65 and older 23% suffer from one or more of the chronic diseases under study. Within this group 15% suffer from more than one of the chronic diseases. Osteoarthritis and diabetes mellitus are the diseases with the highest rate of comorbidity. Comorbidity restricts the external validity of results from single-disease intervention studies and complicates the organization of care.

PURPOSE Because recognition and management of patients with somatoform disorders are diffi cult, we wanted to determine the specifi city, sensitivity, and the test-retest reliability of the 15-symptom Patient Health Questionnaire (PHQ-15) for detection of somatoform disorders in a high-risk primary care population. METHODSWe studied the performance of the PHQ-15 in comparison with the Structured Clinical Interview for the Diagnostic and Statistical Manual-IV Axis I disorders (SCID-I) as a reference standard. From January through September 2006, we approached patients for participation. This study was conducted in primary care settings in the Netherlands. Patients aged between 18 and 70 years were eligible if they belonged to 1 or more of the following groups: (1) patients with unexplained somatic complaints, (2) frequent attenders, and (3) patients with mental health problems. For the SCID-I interview we invited all patients with a PHQ-15 score of 6 or greater and a random sample of 30% of patients with a PHQ-15 score of less than 6. The primary study outcomes were the sensitivity and specifi city for the validity and the κ coeffi cient for the test-retest reliability.RESULTS Of 2,147 eligible patients, 906 (42%) participated (mean age 48 years, 62% female). At a cutoff level of 3 or more severe somatic symptoms during the past 4 weeks, sensitivity was 78% and specifi city 71%. The test-retest reliability was 0.60. CONCLUSIONSThe PHQ-15 is a valid and moderately reliable questionnaire for the detection of patients in a primary care setting at risk for somatoform disorders. INTRODUCTIONI n primary care 20% to 50% of all patients complaining of physical symptoms can be categorized as having medically unexplained symptoms.1,2 Earlier research shows that the criteria for somatoform disorders are met in 10% to 16% of all primary care patients. [3][4][5] Usually, the medically unexplained symptoms spontaneously resolve or improve by effective management. Sometimes the complaints persist, leading to functional impairment. 6 Somatoform disorders are a burden for both patients and family physicians. Patients with these disorders are at risk of overtesting and unnecessary treatment, 7,8 and the doctor-patient relationship is often diffi cult and strained.9 It is a challenge for physicians to improve their competence in recognizing and managing patients with somatoform disorders, and a screening questionnaire for somatoform disorders might be helpful.We wanted to test a screening questionnaire in a subgroup of patients for whom family physicians will most likely use the instrument. Because screening for early detection in a high-risk population is a key concept in family medicine, 10 we opted to screen the following population in the context of regular primary care: frequent attenders and patients who were identifi ed by their family physicians as having either mental health problems or unexplained somatic complaints. Hiske van 233 DE T EC T ING S O M ATOF OR M DIS OR DER SWe used the Dutch version of the Patient...

We conclude that 20 d of dietary supplementation with fructooligosaccharides had no major effect on blood glucose, serum lipids, or serum acetate in patients with type 2 diabetes. This lack of effect was not due to changes in dietary intake, insufficient statistical power, or noncompliance of the patients.

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