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Biomedical subjects

F Bro

Publications and source records attributed to F Bro.

At least 19 recordsLinked to original sources
PubMed2001

HbAlc in an unselected population of 4438 people with type 2 diabetes in a Danish county.

OBJECTIVE: To describe the use and level of HbA1c in a large unselected Type 2 diabetic population in Denmark. In addition, to describe the characteristics of the patients and the general practitioners in relation to the monitoring of HbA1c. DESIGN: Data were collected from public data files for the period January 1993 to December 1997. SETTING: The County of Vejle with a background population of 342,597 citizens, 303,250 of whom were listed with participating general practitioners. PATIENTS: The Type 2 diabetic population alive and resident in the county on 1 January 1997. RESULTS: In a population of 4438 Type 2 diabetics, 73% had a minimum of one annual HbA1c measurement in 1997. No HbA1c measurement was associated with a long history of diabetes, diet treatment or old age. Poor glycaemic regulation was found in 65% of the Type 2 diabetics in 1997. Poor glycaemic regulation was associated with tablet or insulin treatment, age under 70 years and long history of diabetes. The interpractice variation was huge. CONCLUSION: The quality of HbA1c monitoring of Type 2 diabetics needs to be improved. Possibilities for improvement seem to be present.

Aged↗
PubMed2001

Use and validation of public data files for identification of the diabetic population in a Danish county.

INTRODUCTION: This study aims to describe the process of identifying people known to have diabetes through public data files, to validate this method, and to describe models for optimization of such identification processes. PATIENTS AND METHODS: In a study population of 303,250 citizens, the diabetics were identified by combining information from public data files with information from general practitioners. Data validity was checked by comparing the results of data searches in public data files against information from general practitioners and a random sample of diabetics. Two models were defined to optimize the use of public data files for identification of diabetics. In model A the minimum number of parameters needed to obtain a sensitivity as high as possible was identified. In model B the optimal combination of parameters needed to obtain a high positive predictive value combined with a high sensitivity was identified. RESULTS: A total of 5449 diabetics were identified. Of those 4438 (81%) were classified as Type 2 diabetics and 1011 (19%) were classified as Type 1 diabetics. The data validation revealed that one person was misclassified as a diabetic and 93 persons were misclassified as non-diabetics. In model A the identification parameters included: "prescription", "HbA1c", "chiropodist service" and "glucose service". In model B the optimal combination of parameters was identified as: minimum two HbA1c measurements, minimum one visit to a chiropodist, minimum one prescription or minimum one abnormal HbA1c during one year. CONCLUSION: Public data files are suitable for identification of both Type 1 and Type 2 diabetics. Models have been developed to identify diabetics and to promote the possibilities of long-term follow-up and quality assessment in an unselected diabetic population in a region.

Adult↗
PubMed1999

[Quality assessment of diabetes care in a large general practice. Identification and biomedical status].

The aims of this study were to describe the diabetic population and to evaluate the routine diabetic care in one general practice. All patients with recognized diabetes were included. Information was collected from each patient's record and from patients' and doctors' questionnaire. One hundred an fourty (1.8%) of the patients had recognized diabetes and 81% of these diabetes had non-insulin-dependent diabetes (NIDDM). According to the records, HbA1c had been monitored in 85% of the NIDDM patients in the preceding year and in 76% of the IDDM patients. The corresponding figures for albuminuria were 84% vs. 76%, for S-creatinine 74% vs. 81%, for S-cholesterol 37% vs. 24%, for weight 47% vs. 43%, for blood pressure 60% vs. 48%, for foot care 67% vs. 62% and for eye examination 76% vs. 75%. International targets for good control were obtained for HbA1c in 42% of cases, for weight in 23%, for blood pressure in 30% and for S-cholesterol in 40% at the last control. The results of the study indicate that there is a continuous demand for quality monitoring and improvement of diabetic care in general practice.

Adolescent↗
PubMed1993

The effect of reimbursement on the use of antibiotics.

OBJECTIVE: To examine the effect of a reduction on the reimbursement of drugs on the use of antibiotics by general practitioners in Denmark. DESIGN: A prospective study using a questionnaire comparing the results with a similar study 3 years before, a period with normal reimbursement. PARTICIPANTS: 553 general practitioners prescribed antibiotics for 5765 patients. MAIN OUTCOME MEASURE: Number of treated patients and choice of antibiotics. RESULTS: 7607 patients were treated in 1987 compared with 5765 in 1990, the relative number of patients treated for sinusitis, other upper respiratory tract infections, acute bronchitis, pneumonia and upper gynaecological infections was significantly less in 1990 than in 1987. Other infections, particularly those that are often diagnosed by culture or microscopy by the general practitioners themselves, increased significantly. They included tonsillitis and urinary tract infections. CONCLUSION: Reimbursement can be a very powerful tool controlling the use of antibiotics by general practitioners.

Adolescent↗
PubMed1993

Vaginal discharge in general practice--women's perceptions, beliefs and behaviour.

OBJECTIVES: To describe women's perceptions and beliefs about their vaginal secretion and to relate these to their behaviour with respect to complaints of vaginal discharge. DESIGN: A multi-practice study including questionnaires for women and doctors and a semi-structured interview study. SETTING: North Jutland County and Aarhus County, Denmark. SUBJECTS: 283 women with and 417 women without complaints of vaginal discharge answered a questionnaire about their vaginal secretion. Ten women with vaginal discharge took part in the in-depth interviews. RESULTS: 179/274 (65%) women with and 111/417 (27%) women without complaints of vaginal discharge were bothered by their usual secretion. In 54/269 (20%) women with complaints, the pelvic examination was normal. In 59/416 (14%) women without complaints, the doctor found an abnormal vaginal secretion. Most women complaining of vaginal discharge had an external locus of control in relation to their symptoms, but an internal locus of control in relation to health in general. Fear of having a serious disease or a sexually transmitted disease was the reason for the visit to the general practitioner in 164/281 (58%). CONCLUSION: Women's perceptions and beliefs about their vaginal secretion varied and were related to their health seeking behaviour. In addition to information about possible biological causes of vaginal discharge, the general practitioner should also actively seek information about the women's perception of normality and beliefs in relation to the symptoms she experiences.

Adult↗
PubMed1991

Changes in prescription of antibiotics in general practice in relation to different strategies for drug information.

The worldwide use of antibiotics is increasing with increasing costs and resistant bacteria as a consequence. The Danish use of antibiotics is one of the lowest in DDD/1,000 inhabitants/year; however, the use of ampicillin and co-trimoxazole has been found to be too high. An information campaign in the beginning of 1987, using written material, stressed the importance of reducing the ampicillin and co-trimoxazole and increasing the penicillin usage in Denmark. This campaign was followed up by 10 lectures given by the same person in two (I and II) of the five counties of Zealand, Denmark. In county I, the lectures were given in meetings arranged by the local department of clinical microbiology. In county II, the lectures were given at meetings sponsored by a pharmaceutical company. The prescribing habits were generally changed significantly. In county I, the changes were significantly higher compared with counties only receiving written material. In county II, the prescribing habits did not change further compared with the counties only receiving written material. It is concluded that face-to-face information can improve the efficacy of written information, but sponsorship by pharmaceutical companies may weaken this efficacy.

Anti-Bacterial Agents↗
PubMed1990

Predictors of Chlamydia trachomatis infection in women in general practice.

The purpose of this study was to identify predictors of infection with Chlamydia trachomatis in order to suggest indications for culture among women in general practice. In a multi-practice study 29 general practitioners examined 352 women complaining of vaginal discharge and 225 women having a pelvic examination for other reasons. Information from patient history, pelvic examination, and laboratory tests was recorded, and a culture for C. trachomatis was performed. C. trachomatis was isolated from 30 women (8.5%) with complaints of vaginal discharge and from nine (4.0%) without complaints. The predictive value for chlamydial infection of the information obtained was examined by logistic regression. Complaints of vaginal discharge, age under 25 years, use of oral contraception, suspected exposure to sexually transmitted disease, increased amount of discharge on pelvic examination, pH of discharge above 5.0 and the presence of leucocytes on wet smear microscopy were predictive of infection with C. trachomatis. Using information from patient history alone it was possible to discriminate between patients with low and high risk for chlamydia infection, the range being from 2% to 37%. Indications for culture for C. trachomatis, based upon easily obtained information from the patient history, are suggested.

Adolescent↗
PubMed1990

Metronidazole pessaries compared with placebo in the treatment of bacterial vaginosis.

In a randomized, double-blind clinical trial from general practice, 500 mg metronidazole pessaries applied once daily for seven days were compared with placebo in the treatment of bacterial vaginosis. Seventy-five women completed the study. At the follow-up visit immediately after completion of treatment, none of the patients on metronidazole fulfilled the criteria for bacterial vaginosis, compared with 12 (35%) in the placebo group (p less than 0.001). Nine (22%) of the patients treated with metronidazole harboured Gardnerella vaginalis after treatments, compared with 31 (91%) in the placebo group (p less than 0.001). Symptoms had improved or disappeared in 33 (80%) on metronidazole, and in 18 (53%) on placebo therapy (p less than 0.05). Four weeks after the follow-up visit, symptoms were reported by 28% in the metronidazole group and by 44% in the placebo group (p greater than 0.05). Metronidazole pessaries are effective in the treatment of bacterial vaginosis.

Adult↗
PubMed1990

Single-dose 500-mg clotrimazole vaginal tablets compared with placebo in the treatment of Candida vaginitis.

In a double-blind controlled clinical trial, 29 practitioners randomized 55 women with culture-proven Candida vaginitis to treatment with single-dose 500-mg clotrimazole vaginal tablets, and 40 to placebo. At a follow-up visit 7 to 10 days after treatment, Candida was present in 21 (38%) of those treated with clotrimazole and in 30 (75%) in the placebo group (P less than .05). Symptoms had improved or disappeared in 38 (69%) treated with clotrimazole, compared with 22 (55%) in the placebo group (P greater than .05). In 10 (23%) of the mycologically cured women, symptoms were unchanged or worse, whereas symptoms had improved or disappeared in 26 (51%) in whom Candida was isolated at the follow-up visit (P = .015). Questionnaires sent to the 95 women 4 weeks after the follow-up visit were returned by 62. Vaginal symptoms were reported by 50% in both groups. Further clinical trials including placebo are needed in general practice in the evaluation of the treatment of Candida vaginitis.

Administration, Intravaginal↗
PubMed1989

An information campaign--an important measure in controlling the use of antibiotics.

Denmark is one of the countries using the smallest quantity of antibiotics in proportion to its population. Nevertheless, the use of ampicillin and co-trimoxazole has been found to be undesirably high. An information campaign was carried out to reduce the ampicillin and co-trimoxazole usage and to increase the penicillin usage as a consequence. To evaluate the efficacy of the campaign 602 general practitioners participated in the study, and the antibiotic treatment of 7607 patients, treated in week 13 in 1987, was recorded. These prescriptions were compared with the prescriptions recorded in two previous but identical investigations in 1979 and in 1983. The prescribing habits had changed significantly after the information campaign, resulting in national savings of two million Danish kroner/million inhabitants/year. Information could be an important measure in controlling the worldwide use of antibiotics.

Ampicillin↗
PubMed1989

Patients with vaginal discharge in general practice.

In a multi-practice study, 80 general practitioners registered 327 patients with spontaneous complaints of vaginal discharge. Forty-eight percent of the patients were between 20 and 29 years of age, compared with 20% in the general female population (p less than 0.001). An increase in discharge was reported by 89% of the women, itching by 53%, and malodour by 38%. More than one symptom was reported by 61%. The symptoms present were mutually independent and no correlation was found with age. Seventy-six percent of women 25 years or older had had earlier instances of vaginal discharge. In patients aged 15-19, 60% had experienced earlier episodes. Male consort symptoms were reported by 14% of patients less than 25 years old and by 7% of the patients 25 years or older (p less than 0.05). Symptoms had persisted for one week or less in 36% of the women, for between 1 and 2 weeks in 27%, and for more than one year in 5%.

Adolescent↗
PubMed1989

Use of antibiotics in general practice in Denmark in 1987.

The worldwide usage of antibiotics is increasing making detailed information on prescribing patterns and intervention methods necessary. This investigation focused on the general practitioner's (GP's) usage of antibiotics in Denmark. Information on 7,607 patients treated by 602 GP's during 1 week in March 1987 were collected. The most commonly treated infectious diseases were upper respiratory tract infections (40%) and lower respiratory tract infections (17%). Penicillin was by far the most frequently prescribed antibiotic (44%), followed by antibiotics used locally (17%) and ampicillins (14%). Compared with previous investigations, this result indicated a relative increase in prescription of penicillin during recent years. The mean number of daily dosages was 2-3 and the duration of treatment 6-7 days, with ampicillin generally given 1 day longer than penicillin. The differences between prescribed daily dosages (PDD) found and defined daily dosages (DDD) ranged from + 40% to - 50%, making estimations of numbers of treated patients from total usage of antibiotics in DDD/1,000 inhabitants/day impossible.

Adolescent↗
PubMed1989

The diagnosis of candida vaginitis in general practice.

In a multi-practice study, 29 general practitioners registered 361 women with increased vaginal discharge, malodour, or pruritus, and 229 women without vaginal complants. A wet-smear was examined for Candida by the general practitioner. Culture for Candida was performed in the general practitioner's laboratory, and at a microbiological laboratory. Candida was found by microscopy or culture in 140 (39%) women with vaginal symptoms, compared with 51 (22%) without vaginal complaints (p less than 0.001). In 34 women with symptoms (24%) Candida was found by wet-smear microscopy, in 98 (76%) by microscopy or culture in the general practitioner's laboratory, and in 126 (90%) by microscopy or culture at the microbiological laboratory. No relation was found between the number of Candida isolated and the presence of vaginal symptoms (p greater than 0.05). The sensitivity of microscopy was low compared with previous studies and underlines the need for multi-practice studies in the evaluation of diagnostic procedures. Vagicult is recommended for general practice, but problems exist in the interpretation of a positive culture result.

Adult↗
PubMed1989

Vaginal microbial flora in women with and without vaginal discharge registered in general practice.

To compare the microbiological findings for patients with and without vaginal discharge, 29 general practitioners registered 361 women with and 229 women without complaints of vaginal discharge in a multi-practice study in the county of Aarhus, Denmark. In five of the patients (1.4%) with vaginal discharge, Neisseria gonorrhoeae was isolated compared with one (0.4%) in women without vaginal discharge. Chlamydia trachomatis was isolated in 30 (8.3%) and nine (3.9) respectively, Candida in 113 (31.3%) and 44 (19.2%), Gardnerella vaginalis in 187 (51.8%) and 93 (40.6%), and Trichomonas vaginalis in 10 (2.8%) and one (0.4%). The criteria of bacterial vaginosis were fulfilled by 129 (35.7%) women with vaginal discharge, and by 19 (8.3%) without symptoms. Except for T. vaginalis and N. gonorrhoeae, the microorganisms were significantly (p less than 0.05) more frequent among patients with than without vaginal discharge. C. trachomatis was found in 25 (11%) women under the age of 25, compared to 14 (4%) aged 25 years or older (p less than 0.01). The isolation rates of the other microorganisms were not related to age. G. vaginalis was found in high concentrations in 73% of those harbouring this bacterium. No difference in concentration was found between women with and without vaginal discharge (p less than 0.05).

Adult↗
PubMed1988

Variation in use of penicillin for treatment of sinusitis in general practice.

The present study describes the use of phenoxymethylpenicillin and broad-spectrum penicillin for the treatment of sinusitis in general practice, in relation to some variables related to the prescribing doctors: region (county), practice form (single-handed or partnership), and the doctors' seniority (year of graduation). Log-linear analysis was used to make it possible to evaluate the influence of single factors. There was considerable variation between the counties included in the study. Practitioners in partnership practices used phenoxymethylpenicillin more frequently and broad-spectrum penicillin less frequently in the treatment of patients with sinusitis, compared with their colleagues in single-handed practices. Younger practitioners chose broad-spectrum penicillin more frequently and phenoxymethylpenicillin less frequently than their older colleagues. The individual practitioner was rather stable in his choice of drug for the treatment of consecutive patients with the same diagnosis.

Age Factors↗
PubMed1988

Changes in penicillin prescribing in general practice.

In the present study, we have analysed changes from 1979 to 1983 in the use of phenoxymethyl penicillin and broad spectrum penicillin in the treatment of sinusitis in general practice. The changes are related to the doctors' seniority and to their practice conditions. All GPs in five counties were invited to register all prescriptions of antimicrobials during two periods, from 19 to 23 March 1979 and from 21 to 25 March 1983. In 1979 and 1983, 574 and 625 GPs participated, constituting 67% and 66%, respectively, of all the GPs in the five counties. A total of 15,863 prescriptions of antimicrobials was registered. In all, 1,567 patients with sinusitis were included in the study. Log-linear analyses were performed in order to take into consideration covariation in the explanatory variables and changes in the composition of the material between 1979 and 1983. The probability that a patient with sinusitis was treated with phenoxymethyl penicillin was reduced between 1979 and 1983 (odds ratio = 0.84), while the probability for treatment with broad spectrum penicillin was increased (odds ratio = 1.18). The log-linear analyses revealed no relationship between the doctors' seniority, the practice form or localisation, and changes in use of phenoxymethyl penicillin or broad spectrum penicillin.

Drug Utilization↗