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Social factors and professional attitudes as determinants of the frequency of small surgical procedures among children in Greece

Les facteurs sociaux et les attitudes médicales comme déterminants de la fréquence de la petite chirurgie infantile en Grèce

Der Einfluss sozialer Faktoren und ärztlicher Einstellung auf die Häufigkeit kleiner operativer Eingriffe bei Kindern in Griechenland

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Sozial- und Präventivmedizin

Summary

Data concerning histories of Adenoidectomy (Ad), Tonsillectomy (T) and Appendectomy (Ap) were collected from the escorts (mainly mothers) of 2296 children 3–12 years-old. The children were admitted as outpatients at the First Department of Paediatrics of the University of Athens or the Polyclinic of the Children's Welfare Center of PIKPA in Pireaus, during the last six months of 1983. Among children with median age of about six years, 12 percent had already had at least one operation (Ad, T or Ap); this proportion increased to about 25 percent among children with median age of about 10 years. The cumulative incidence of Ad and/or T was higher among boys, whereas the cumulative incidence of Ap was higher among girls. The age adjusted cumulative incidence of Ap was significantly higher in the lower social class, whereas there was no social gradient with respect to Ad or T. There were strong intraindividual correlations among the three studied operations; in particular the age adjusted cumulative incidence of Ap was 2.9 times higher among children with Ad and/or T than among children without any of these operations. Since there are no apparent biomedical reasons to account for the observed intra-individual associations, it appears likely, that these associations reflect parental or physician's attitudes leading to unjustifiable operations in some of the children.

Résumé

Les données concernant une anamnèse d'adénoïdectomie (Ad), tonsillectomie (T) et appendicectomie (Ap) ont été obtenues auprès des proches (principalement les mères) de 2296 enfants âgés de 3 à 12 ans. Ces enfants étaient des patients ambulatoires du Département de pédiatrie de l'Université d'Athènes ou de la Policlinique du Centre d'aide à l'enfance de PIKPA du Pirée ayant consulté durant les six derniers mois de 1983. Dans le groupe d'enfants dont l'âge médiant était d'environ 6 ans, 12% avaient subi au moins l'une des opérations (Ad, T ou Ap); cette proportion augmentait jusqu'à 25% dans le groupe d'enfants dont l'âge médian était d'environ 10 ans. L'incidence cumulée des Ad et/ou des T était plus élevée chez les garçons, alors que l'incidence cumulée des Ap était plus haute chez les filles. Après élimination de l'effet de l'âge, l'incidence cumulée des Ap était significativement plus haute dans les classes sociales inférieures, alors qu'il n'y avait aucun effet de la classe sociale concernant Ad ou T. Pour un même individu, il existe une forte corrélation entre ces trois opérations; en particulier, l'incidence cumulée (après contrôle de l'âge) de l'Ap était de 2,9 fois plus haute chez les enfants avec Ad et/ou T que chez les enfants n'ayant subi aucune de ces opérations. Puisqu'il n'existe aucune raison biomédicale connue permettant d'expliquer ces associations intra-individuelles, il paraît probable que ces corrélations reflètent l'attitude des parents ou des médecins conduisant à des opérations non justifiées chez certains de ces enfants.

Zusammenfassung

Anamnesedaten zur Adenoidektomie (Ad), Tonsillektomie (T) und Appendektomie (Ap) wurden bei den Angehörigen (meist den Müttern) von 2296 3-bis 12jährigen Kindern erhoben, welche während der letzten sechs Monate des Jahres 1983 entweder die pädiatrische Abteilung der Universität Athen oder die Poliklinik des Kinderzentrums von PIKPA in Pyräus für ambulante Behandlung aufsuchten. Von den kleineren Kindern (Medianwert des Alters etwa 6 Jahre) hatten bereits 12% mindestens eine Operation hinter sich (Ad oder Ap). Dieser Prozentsatz stieg auf 25% bei der Gruppe grösserer Kinder (Medianwert des Alters etwa 10 Jahre). Die kumulative Inzidenz von Ad und/oder T war höher bei den Knaben, während die kumulative Inzidenz von Ap bei den Mädchen bedeutender war. Altersbereinigte kumulative Inzidenz von Ap war signifikant erhöht in den niedrigen sozialen Klassen, Ad oder T zeigten keinen sozialen Gradienten. Eine starke intraindividuelle Korrelation zwischen den drei untersuchten Operationstypen konnte gefunden werden; besonders die altersbereinigte und die kumulative Inzidenz von Ap war 2,9mal höher bei Kindern mit Ad und/oder T als bei Kindern, welche bisher noch nie operiert worden waren. Da keine offensichtliche biomedizinische Erklärung für die beobachtete intraindividuelle Beziehung gefunden wurde, scheint es wahrscheinlich, dass diese Beziehungen die Einstellung der Eltern oder der Ärzte widerspiegelt, die zu ungerechtfertigten Operationen bei manchen Kindern führt.

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Authors and Affiliations

  1. Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA

    Eleni Petridou, Isabelle Valadian & Klea Katsouyanni

  2. PIKPA Welfare Organization, Athens

    Eleni Petridou

  3. Department of Hygiene and Epidemiology, University of Athens, Medical School, 11527, Athens, Greece

    Dimitrios Trichopoulos, Yannis Skalkidis & Klea Katsouyanni

  4. First Department of Paediatrics, University of Athens, School of Medicine, Greece

    Nickolaos Matsaniotis

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  1. Eleni Petridou
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  2. Isabelle Valadian
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  4. Yannis Skalkidis
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  5. Klea Katsouyanni
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  6. Nickolaos Matsaniotis
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Petridou, E., Valadian, I., Trichopoulos, D. et al. Social factors and professional attitudes as determinants of the frequency of small surgical procedures among children in Greece. Soz Präventivmed 31, 308–312 (1986). https://doi.org/10.1007/BF02077506

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