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Fever: Enemy or Friend? [Elektronische Ressource] : a comparison of the perception and management of childhood fever between parents in Germany, Luxembourg and the Netherlands / Danièle Christiane Anna Holper

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227 pages
Fever: Enemy or Friend? A comparison of the perception and management of childhood fever between parents in Germany, Luxembourg and the Netherlands Inaugural-Dissertation zur Erlangung des Doktorgrades der Hohen Medizinischen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn Danièle Christiane Anna Holper aus Den Haag/Niederlanden 2011 Angefertigt mit Genehmigung der Medizinischen Fakultät der Universität Bonn 1. Gutachter: Privatdozent Dr. Lutz Bindl 2. Gutachter: Professor Dr. Matthias Schrappe Tag der Mündlichen Prüfung: 12. Mai 2011 Aus der Kinderklinik des Centre Hospitalier de Luxembourg (CHL), Luxemburg Direktor: Dr. A. Kerschen Fir de Jupp an d‘ Jamie 5 Inhaltsverzeichnis 1. Background and objectives .......................................... 9 1.1 Introduction ........................................................... 9 1.2 Fever and hyperthermia: definition, pathophysiology, effects and treatment ...................... 17 1.3 Fever phobia: concerns, determinants and the physician’s contribution............................................. 26 1.4 Research question formulation ............................. 32 2. Digression: “Kurorten”, “uitzieken” and “a pill for every ill”: building a socio-cultural framework .............. 35 2.1 An introduction to the medical culture in Germany, Luxembourg and the Netherlands ...............
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Fever: Enemy or Friend?

A comparison of the perception and
management of childhood fever between
parents in Germany, Luxembourg and the
Netherlands





Inaugural-Dissertation
zur Erlangung des Doktorgrades
der Hohen Medizinischen Fakultät
der Rheinischen Friedrich-Wilhelms-Universität
Bonn

Danièle Christiane Anna Holper
aus Den Haag/Niederlanden

2011
Angefertigt mit Genehmigung der
Medizinischen Fakultät der Universität Bonn








1. Gutachter: Privatdozent Dr. Lutz Bindl
2. Gutachter: Professor Dr. Matthias Schrappe






Tag der Mündlichen Prüfung: 12. Mai 2011






Aus der Kinderklinik des Centre Hospitalier de
Luxembourg (CHL), Luxemburg
Direktor: Dr. A. Kerschen

Fir de Jupp an d‘ Jamie





5

Inhaltsverzeichnis
1. Background and objectives .......................................... 9
1.1 Introduction ........................................................... 9
1.2 Fever and hyperthermia: definition,
pathophysiology, effects and treatment ...................... 17
1.3 Fever phobia: concerns, determinants and the
physician’s contribution............................................. 26
1.4 Research question formulation ............................. 32
2. Digression: “Kurorten”, “uitzieken” and “a pill for
every ill”: building a socio-cultural framework .............. 35
2.1 An introduction to the medical culture in Germany,
Luxembourg and the Netherlands .............................. 35
2.2 Germany: “High-tech medicine and Heilpraktiker”
.................................................................................. 42
2.3 The Netherlands: “Letting the disease run its
course” ...................................................................... 46
2.4 Luxembourg: “A pill for every ill”. ...................... 51
2.5 Structural factors: Differences in health care
organisation ............................................................... 55
6

3. Methodology ............................................................. 64
3.1 Search strategy and questionnaire development ... 64
3.2 Sample size .......................................................... 65
3.3 Sample population ............................................... 66
3.4 Selection criteria and study protocol .................... 70
3.5 Statistical analysis................................................ 74
4. Results....................................................................... 76
4.1 The questionnaires ............................................... 76
4.2 Socio-descriptive data .......................................... 80
4.3 Defining fever...................................................... 86
4.3.1 Defining fever: the lower limit .......................... 86
4.3.2 Defining fever: the upper limit .......................... 89
4.4 Beliefs about fever ............................................... 92
4.4.1 “Combating bacteria” and “sweating out the
germs”: perceived beneficial effects of fever ............. 92
4.4.2.1 (Mis)conceptions about fever: the
Luxembourgish have more fearful assumptions about
fever than the German and Dutch caregivers .............. 98
4.4.2.2 Misconceptions about fever: an exploration . 104
4.5 Fever management ............................................. 111
7

4.5.1 Measuring fever: rectal temperature recording
prevails .................................................................... 111
4.5.2 Starting fever treatment: German and Dutch
parents start antipyretics at higher temperatures than
parents from Luxembourg ....................................... 115
4.5.3 Fever treatment: Junifen® syrup for kids in
Luxembourg, paracetamol suppositories for Dutch and
German kids ............................................................ 118
4.5.4 Non-pharmacological measures: parents in
Luxembourg and Germany use more physical methods
to treat a fever.......................................................... 126
5. Conclusions, discussion and limitations of the study 130
5.1 On fever definition ............................................. 131
5.2 On the beneficial effects of fever ....................... 133
5.3 On fever myths .................................................. 135
5.4 On fever measurements...................................... 140
5.5 On starting fever treatment................................. 142
5.6 On fever treatment ............................................. 145
5.7 Paracetamol, ibuprofen or both?......................... 151
8

5.8 On the consumption of medicine: Catholicism
versus Protestantism? .............................................. 154
5.9 On non-pharmacological interventions ............... 157
5.10 Strengths and limitations of the study ............... 158
6. Summary ................................................................. 167
6.1 Summary ........................................................... 167
6.2 Zusammenfassung ............................................. 172
7. Appendix ................................................................. 179
7.1 The questionnaire ............................................... 179
7.2 Statistical evaluations ........................................ 183
8. References ............................................................... 200
Acknowledgements ..................................................... 226
Lebenslauf ................................................................... 228

9

1. Background and objectives

1.1 Introduction

`Gebt mir ein Mittel um Fieber hervorzurufen, und ich will alle
Krankheiten heilen`.
Prof. Dr Johann Christian Harleß (1773-1853). Professor of
Pharmacotherapy in Erlangen and of Anatomy in Bonn, Germany, cited
in Bilz (1880).

´Humanity has but three great enemies: fever, famine and war. Of these,
by far the greatest, by far the most terrible, is fever`.
Osler (1849-1919), cited in Blatteis (2003).

“The reason that I give them Nurofen, Panadol or whatever when they
have their temperature is because the temperature gets to the level that I
don’t feel comfortable with. I start thinking of potential fitting or the fact
that you know, their head is going to explode”.
Parent 13 in Walsh et al (2007 a).



10

Fever is one of the most common reasons parents of infants
and young children seek medical care. Fever may be a sign
of serious illness but in the majority of cases, the fever is
caused by an infectious disease without any serious
consequence (Baraff, 1993; Slater and Krug, 1999).
Although important, fever is not the most important clinical
sign of disease gravity; other signs of overall functioning are
more important for clinical evaluation (Berger et al., 2008;
Richardson et al., 2007). Opinions about the symptomatic
treatment of fever have substantially changed in history.
thUntil the mid-19 century, fever was considered to be a
healthy reaction to infection and was to be deliberately
encouraged. This view has changed considerably and fever
became progressively seen by physicians and their patients
as deleterious to health and needing treatment. Nowadays
there is increasing evidence of the beneficial effects of fever
as a mediator of the immune response to infectious disease.
More and more guidelines, for example from France, the
USA, the Netherlands and the UK, advise fever lowering
therapy only in case of discomfort (Armengaud et al., 2006;