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PubMed1984

Measurement of drug utilization in Sweden: methodological and clinical implications.

The available sources of information on drug utilization in the Swedish population at large are reviewed. They comprise whole-sale statistics, drug deliveries to hospitals and prescription data. Drug consumption is preferably expressed in defined daily doses (DDD) per capita, where DDD is the average recommended dose on the major indication of the drug. Under ideal circumstances--drugs used continuously on one indication--the number of DDDs per population ought to agree with morbidity data. This turned out to be the case with antidiabetic drugs. The pitfalls with this unit of measurement include major discrepancies between recommended and prescribed doses, and the use of the drug on vastly different indications (such as neurosis and psychosis in the case of neuroleptics). Nevertheless, the DDD methodology may serve as a therapeutic audit in attempts to follow and influence therapeutic habits of health personnel in hospitals and primary health care. Wholesale data combined with individual-based prescription data are particularly useful in this regard.

Data Collection↗

PubMed1992

Drug related admissions to medical wards: a population based survey.

1. In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2. Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3. The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Noncompliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4. The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5. Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

A 1-year follow-up of prescribing patterns of analgesics in primary health care.

The prescription of analgesics and anti-inflammatory drugs (analgesics) was studied using computerized patient records from a Finnish health centre with a population base of some 27,000 inhabitants. A random sample of every fifth patient visiting the health centre in 1986 was chosen. This study sample consisted of 4,577 patients with 17,021 physician contacts and altogether 14,035 prescriptions during the 1-year follow-up: of these analgesics comprised 14.8%. The proportion of the study population who received at least one analgesic prescription was 23 +/- 1.2% (95% CI). The use of physician contacts as a base revealed 10.7 +/- 0.5% (95% CI) of the contacts with an analgesic prescription. The exposure to analgesics among males increased with age from 17% for those aged 15-34 years to 34% for those aged 75 years or more. Among women, exposure to analgesics increased from 17% (15-34 years) to 41% (75 years or more). Most of patients who received analgesic prescriptions were incidental users (one or two analgesic prescriptions per year). Only 4% of women and 3% of men were categorized as heavy users of analgesics (seven or more analgesic prescriptions per year). The proportion of heavy users increased with age and was highest in the oldest age-group (75 years or more). In order to make informed policy judgements about drug use in society, we need routine sales statistics and patient-specific drug-use data such as those presented in this paper.

Adolescent↗

PubMed1990

Epidemiology of adverse reactions to carbamazepine as seen in a spontaneous reporting system.

A survey was made of 505 reports on 713 adverse reactions to carbamazepine submitted to the Swedish Adverse Drug Reactions Advisory Committee from 1965-1987. For the period after 1972, the relation between the reports and sales statistics could be investigated. The total incidence of reported adverse reactions to carbamazepine was 4.5 per million defined daily doses (DDD), corresponding to 2.7 per million prescribed daily doses (PDD). Most often reported were skin reactions (48%), but reports on haematological (12%) and hepatic disorders (10%) were also frequent. Virtually all hepatic disorders and severe skin reactions, as well as the majority (60%) of the haematological reactions, occurred within the first 2 months of treatment. In view of the very low incidence of reported serious blood dyscrasias, such as pancytopenia (0.04/million PDD) and agranulocytosis (0.06/million PDD), continuous haematological monitoring seems to be of little value. The elderly appear to be at increased risk of developing blood dyscrasias and liver reactions, and alcohol abusers seem to represent a high-risk group for developing serious skin reactions.

Age Factors↗

PubMed1989

Glaucoma prevalence in the Nordic countries. Estimates based on glaucoma drug consumption.

Glaucoma prevalences in the 5 Nordic countries are estimated on basis of a) wholesale of glaucoma medicaments (Denmark, Iceland, Norway, and Sweden) and b) registered glaucoma patients receiving free medication (Finland). Prevalences are compared nationally and internationally. The estimated glaucoma prevalence is highest in Norway (2.19% related to the population greater than 40 years), lowest in Denmark (0.76% in the same age group). The prevalence in Iceland, Finland, and Sweden are 2.0, 1.94, and 1.55%, respectively. We suggest that the relatively large differences in glaucoma prevalence between the countries may be explained by geographical differences in occurrence of capsular glaucoma. The sources of error concerning prevalence estimates based on glaucoma drug consumption are discussed. Pre-supposing a balance numerically between undetected glaucoma cases and patients receiving glaucoma medication without really having glaucoma, the glaucoma drug sales statistics may be taken as fair indicators of glaucoma prevalence.

Adult↗

PubMed2000

An experimental study of a change from over-the-counter to self-service sales of alcoholic beverages in monopoly outlets.

OBJECTIVE: To evaluate if a change from over-the-counter to self-service sales of alcoholic beverages in monopoly outlets has an impact on the sales volume. METHOD: Fourteen Swedish towns were selected, each having only one state-run monopoly shop selling alcoholic beverages. Seven pairs were formed by matching towns in terms of demographic and economic criteria, and according to sales of alcoholic beverages. Within each pair, one town continued with the traditional over-the-counter sales, while the other switched to self-service sales of beer, wine and spirits. This was decided by randomization. The effect of switching to self-service was evaluated by comparing monthly sales volume of experimental and control towns over an extended period of time. In order to evaluate changes due to transfer of customers from neighboring towns, the sales statistics in these towns were analyzed. In two towns, this transfer was also evaluated with the aid of customer surveys before and after the change. RESULTS: It was found that the change produced an increase in sales volume of 17%. The increase was permanent. Approximately one half of the increase could be explained by an inflow of new customers from neighboring towns. CONCLUSIONS: The self-service shops became quite popular among the customers, and sales volume increased substantially. About one half of the increase appears to be due to new customers from neighboring towns. The remaining increase may be due to increased consumption by the local residents. Thus, the results seem to confirm the hypothesis that the physical availability of alcoholic beverages may affect consumption levels.

Alcohol Drinking↗

PubMed1999

[Comparison of two types of behavior and attitude surveys on alcohol, tobacco and illegal drug use].

BACKGROUND: The aim of this study was to compare the results of two types of surveys frequently used in France to monitor alcohol, tobacco and illegal drug consumptions. METHODS: Data from a random sample phone survey (1993 18-75 year old French adults in November and December 1995), a quota sample face-to-face survey (1000 18-75 year old French adults in November 1995) and other sources (sales statistics and other surveys) were compared. RESULTS: Results from the two types of surveys were similar for alcohol and tobacco consumption prevalence. Concerning smoking prevalence, the random survey gave an estimate of 35.5% for the smokers ratio versus 35.2% with the quota sample survey. The daily alcohol consumer percentage was 20.9% and 22.1% respectively with the random and the quota sample surveys. Differences were observed for attitudes and illegal substances consumption: the random sample phone survey estimated at 15.5% people using drug during their life versus 13.9% for the quota sample face-to-face survey. CONCLUSIONS: Quota sampling and face-to-face surveys can be used to monitor alcohol, tobacco consumption and to a lesser extent, drug consumption trends, especially by repeated surveys, instead of random sample phone survey which are more time and money consuming.

Adolescent↗

PubMedDate not supplied

[Equipment for ultrasound densitometry: problems and prospects].

Summary, The paper analyzes the Russian market of ultrasound densitometric devices. Based on the sales statistics, the development of this market is forecast. A comparative review of various types of equipment is given and the optimal outline of an ultrasound densitometer is proposed.

Aged↗

PubMed2001

Prevention of cardiovascular disease in Sweden: the Norsjö community intervention programme--motives, methods and intervention components.

OBJECTIVES: When epidemiologic data on cardiovascular disease (CVD) mortality rates in different Swedish regions were published in the early 1980s, there was great concern about the high CVD incidence in the northernmost counties of Sweden, namely Västerbotten and Norrbotten. This paper describe the development of a Northern Sweden community intervention programme for the prevention of CVD. METHODS: As there were no Swedish prototypes, the programme was designed by drawing on experiences from other community interventions. One unique emphasis of the Norsjö intervention programme was to combine a population strategy with efforts to contact each person individually when they became 30, 40, 50, and 60 years of age (the primary care approach). Using the primary care system as part of the community intervention, systematic risk factor screening and counselling by family medicine providers were carried out at the same time as the community intervention programme invoked other efforts to raise public awareness. RESULTS: During the first 10 years of the programme >90% of those invited participated in the individual health screening and counselling. A new food labelling system was introduced in the grocery stores, which after a few years became the official Swedish food labelling system. Sales statistics regarding dairy products showed a significant turnover of low fat products. According to public opinion, the health screening and counselling were reported to be the most influential factors supporting lifestyle changes. CONCLUSIONS: It was possible in Norsjö to create a local health promotion collaboration between healthcare providers, grocery stores, schools, municipal authorities, and the public in order to develop a Swedish model for community intervention. The different programme components were well received by the public.

Adult↗

PubMed1992

[Gingival hyperplasia induced by calcium channel blockers. Rare or frequent in Norway?].

Sales statistics indicate that the number of Norwegians treated with calcium channel blockers increased from about 50,000 in 1986 to about 83,000 in 1991 (last year: nifedipine 39%, verapamil 27%, amlodipine 21%, diltiazem 10% and felodipine 3%). In spite of widespread use, only one report on gingival hyperplasia induced by calcium channel blockers has been received by the Norwegian Adverse drug reaction committee. The incidence of this adverse reaction is uncertain, but the few controlled studies that have been performed indicate that it may be as high as 15% in patients on long-term treatment, at least with nifedipine. This corresponds to nearly 5,000 cases among the about 32,000 users of nifedipine. Norwegian physicians and dentists are asked to report cases of gingival hyperplasia induced by calcium channel blockers. Although the voluntary report system is fraught with uncertainty, it is hoped that, in a relatively small and surveyable drug market as the Norwegian, the reporting may provide some relevant information, e.g. to allow comparison of the potential of the various calcium channel blockers to induce this adverse effect. A Norwegian controlled study on gingival conditions among long-term users of calcium channel blockers is in its initial stage. It may be of interest to compare the results of this study with the indications obtained from the spontaneous reporting on the incidence of this adverse effect, which is relatively easy to diagnose.

Adult↗

PubMed1992

Trends in tobacco use in Europe.

Tobacco consumption in Europe can be estimated from several sources, including sales statistics and population surveys. The first source provides a reasonable estimate of total tobacco consumption, whereas the second gives estimates of the prevalence of smokers by sex and age. In 1950, daily cigarette consumption by adults in European countries varied between 1.7 in Portugal and 6.9 in Ireland, the corresponding US consumption being 8.9. In 1989, the variation was much smaller, ie, between 3.5 in the Netherlands and 10.1 in Greece. In the countries where consumption was high in 1950, maximum consumption was achieved around 1975, followed by stabilization or reduction. In other countries, where consumption was low in 1950, it is still increasing. In a 1987 European survey, the proportion of current smokers varied between 33% in Portugal and 46% in Denmark. Much of this difference comes from the low prevalence of smoking habits in the adult female population of southern Europe.

Europe↗

PubMed1990

[Change of insulin strength in Norway--a study of an information campaign].

This article describes and discusses the effects of an information campaign carried out in 1987 when the strength of the insulin solution was changed from u-40 to u-100. The data comprised drug sales statistics, records of errors, questionnaires to pharmacies and hospitals and press cuttings. The campaign was organized by a group of experts appointed by the Directorate of Health. Local activities were carried out by pharmacies and hospitals, which proved to be effective information channels. Almost all diabetics changed to u-100 over a three-month period. We recorded incidents of serious erroneous prescribing and administration of insulin, but no deaths or irreversible injuries. It was more difficult to reach target groups of health personnel in the primary health care. The change led to a distinct and probably permanent rise in the sale of insulin in Norway.

Drug Information Services↗

PubMedDate not supplied

The use of chewing tobacco and snuff in Canada, 1986.

This paper reviews current data relating to the use of smokeless tobacco products in Canada. Sources of data include production, disposition, and sales statistics; special population surveys, and estimates obtained from the 1986 Labour Force Survey smoking supplement. In Canada, the use of smokeless tobacco products is confined to the male population. About 0.7% of males over age 15 use chewing tobacco and 0.4% use snuff. The pattern of use is similar to that of the United States in the early 70s. Prevalence rates for both substances tend to be higher in older age groups. Men employed in outdoor occupations are more likely to use chewing tobacco or snuff. Chewing tobacco use tends to be more prevalent in eastern Canada and snuff use in western Canada. The low national prevalence estimates conceal the relatively high usage rates among sub-populations. Among Inuit youth in the Northwest Territories in 1982, 25% of the 10-14 age group used smokeless tobacco.

Adolescent↗

PubMed1988

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. III. Consumption of alcohol.

Individual present and life time intake of aethanol has been studied in population samples of six areas of Italy (Torino, Varese), Spain (Navarra, Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%); 49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g. (36% in Navarra). Women drank much less and were more often abstinent: 50 to 94% of them did not drink or drank less than 20 g. a day. Wine was the most commonly consumed beverage (over 60% of total alcohol intake), except in Calvados where cider was still largely consumed (over 30%). Such differences in drinking habits by sex and region are of major public health importance. They do not appear in national sales statistics which must be complemented by surveys on individuals.

Adult↗

PubMed1982

Clostridium difficile and antibiotic associated diarrhoea in Sweden.

Distribution of age and sex among patients with Clostridium difficile enterocolitis shows an increased ratio female: male (3:1) in age group 20 to 40 years and a corresponding 2:1 ratio in patients over 70 years of age, the latter group constituting 45% of 505 patients investigated. Being the only laboratory in Sweden performing cytotoxin-assay from cases of C. difficile enterocolitis during 1979-1981, we have observed that the frequencies with which clindamycin/lincomycin are associated with C. difficile enterocolitis have decreased from 30% (1979) to 9% (1981) while the role of cephalosporins has increased from 18% to 29%. Corresponding figures for the penicillins are 31% and 47% for the respective years. Against a background of sales statistics of these antibiotics in Sweden the risk of contracting C. difficile enterocolitis is appreciated for clindamycin/lincomycin and the cephalosporins in comparison to that of the penicillins. These calculations yielded a 63 times greater risk for clindamycin/lincomycin and a 36 times greater risk for the cephalosporins compared to that of penicillins. The susceptibility patterns of 96 clinical isolates of C. difficile are given showing an increased resistance to ceftriaxon, cephalotin, cefoperazone, cefoxitin and moxalactam, as compared to the susceptibility to other antibiotics. The cytotoxin and the enterotoxin produced by C. difficile are described. In our hands the enterotoxin causes hemorrhagic fluid accumulation and gross mucosal damage to rabbit ileal mucosa while the cytotoxin causes only mild inflammatory changes. It is pointed out that the assay demonstrating toxin in cases of C. difficile enterocolitis currently used in practise only measures the presence of cytotoxin and that a routine method for demonstration of enterotoxin is lacking to date.

Adolescent↗

PubMed1993

[Use of oral contraceptives in Denmark 1980-1990 and smoking habits among fertile women in 1990].

The purpose of this study has been to chart the changes in usage of different types of oral contraceptives (the pill) throughout the 1980's, as well to estimate the extent to which these changes can be expected to influence the incidence of cerebral thromboembolic attacks amongst fertile women. The use of different types of the pill and smoking habits in different age groups are also investigated. The work is based om cross-sectional studies during the period 1980-1990; the use of the pill is documented by national sales statistics from 1980-1990 as well as from questionnaires answered by 1370 healthy women from 1990. The total sale of the pill has been fairly stable throughout the decade, corresponding to a theoretical user percentage of 23-26. The proportion of pills sold containing 50 micrograms oestrogen has fallen steadily from 51% in 1980 to 11% in 1990, while the proportion of pills containing 30-40 micrograms oestrogen (this group includes the mulit-phase pills) has doubled from almost 40% to almost 80% over the same period. Finally, the proportion of minipills has fallen from 10% to 5%. It is estimated that the changed distribution in use of the different types of the pill through the eighties can be expected to reduce the incidence of cerebral thromboembolic attacks among fertile women by 4.5%. Since the 95% confidence limits on the incidence of such attacks among fertile women in Denmark is +/- 14%, one cannot expect to show significant changes in the total incidence of cerebral thrombo-embolic attacks among these women as a consequence of the change in contraceptive pill profile.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

[Changes in sales of estrogens 1989-1992. Effects of a national consensus conference?].

In November 1990 a consensus conference was held in Norway on the use of oestrogens for perimenopausal and postmenopausal complaints, and for preventive purposes. The sales statistics reveal an increase in sales of drugs for hormone replacement therapy after the conference, but the trend had already started before the conference was held. We found the conference had had a statistically significant impact on sales of some of the drugs. We also collected information on marketing campaigns before and after the conference. Only a modest change was found in marketing efforts by the pharmaceutical industry. Presentations in the media were considered to have a strong impact on oestrogen promotion.

Adult↗

PubMed1993

[The life style of Morgan Kane].

A series of 83 paperbacks describing the dramatic life of Morgan Kane was published in Norway in the period 1966-1982. Morgan Kane was born in 1855 on the Santa Fé trail in the United States. He became one of the fastest gunmen of his time, and as Texas ranger, US Marshal and Pinkerton agent was frequently involved in gunfights and violence. In terms of sales statistics, this series is one of the greatest successes in popular literature ever experienced in Norway. The present manuscript describes and discusses the health-related habits of Morgan Kane; his smoking habits, use of alcohol, gambling, food habits, sexual promiscuity and injury-related patterns of behaviour. In population surveys most of the health-related behaviours that are characteristic of Morgan Kane are found to be moderately, but consistently correlated. It is hypothesized that the direct impacts on the health behaviour of the readers are negligible. Furthermore, it is proposed that the cluster of health compromising behaviours which are typical of Morgan Kane contributes to an image which has considerable appeal.

Famous Persons↗