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  • 1
    Electronic Resource
    Electronic Resource
    Antidepressants, depression and suicide: an analysis of the San Diego study
    Amsterdam : Elsevier
    Journal of Affective Disorders 32 (1994), S. 277-286 
    Details
    ISSN: 0165-0327
    Keywords: Antidepressant ; Depression ; Suicide ; Toxicology
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine , Psychology
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0165-0327(94)90092-2
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  • 2
    Electronic Resource
    Electronic Resource
    The measurement of drug consumption (1975)
    Springer
    European journal of clinical pharmacology 8 (1975), S. 83-89 
    Details
    ISSN: 1432-1041
    Keywords: Diabetes ; insulin ; sulphonylureas ; biguanides ; drug utilization ; geographical differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The consumption of insulin and oral antidiabetic drugs was measured at the gross sales level in Sweden and Norway and at the prescription level in Northern Ireland. “Agreed daily doses” were used as units of comparison, which defined as follows: insulin 40 I.U., tolbutamide 1 g, acetohexamide 500 mg etc. Consumption was expressed as the number of “agreed daily doses” per 1,000 inhabitants per day. This provided a rough estimate of the number of subjects for whom the drug had been prescribed per 1,000 population. The data were collected during the three months April – June 1971. Marked differences in the consumption of antidiabetic drugs were found between the three countries and also between areas within each country. The consumption of insulin was similar in Norway and Northern Ireland (3.5 and 3.9 agreed daily doses per 1,000 inhabitants per day), but almost twice as high in Sweden. In Norway much lower use was found in certain rural areas. The variation in the consumption of oral antidiabetic drugs was even more marked. Surprisingly, consumption was considerably higher in Sweden (15.8) than in the nearby Norway (7.3), and was even lower in Northern Ireland (4.3). The major use was of sulphonylureas, especially chlorpropamide. Within the countries there was marked regional variation in the choice of individual biguanides and sulphonylureas. The data are discussed in relation to such factors as the incidence of diabetes, the sole use of dietary treatment etc. It is concluded that studies in depth, which link the actual use of drugs by patients to diagnosis, diabetic symptoms and clinical outcome of treatment are necessary in order to explore the reasons behind the marked geographical differences and to define a rational drug policy. However, the methods described in the study may be used for early detection of gross national differences in drug utilization, the further investigation of which may reveal to be of great public health interest.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00561555
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  • 3
    Electronic Resource
    Electronic Resource
    Workplace drug testing (WDT) likely to increase in Europe (2000)
    Springer
    European journal of clinical pharmacology 56 (2000), S. 103-120 
    Details
    ISSN: 1432-1041
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Will it take a series of drug-related accidents that have already occurred in the USA before workplace drug testing (WDT) becomes accepted in Europe as a preventive measure? Currently, the development of WDT in most European countries lags some 10–15 years behind that in the USA. – Labour authorities in Europe now ought to take initiatives to demand a mandatory programme for accrediting drug analytical laboratories for WDT. – Companies should realise that illicit drug use is no longer only a problem at street corners, and that having a testing system in place is important, not just for public health, but also for their reputations as responsible societal actors. – Improved networking among police and regulatory authorities is required to keep pace with the rapid appearance and dissemination of new substances of abuse. – European research collaboration, including the newly formed European Workplace Drug Testing Group, is needed to assess the impact of drug-testing policies on accidents and other outcome variables, and thereby to convince the general public and politicians that drug testing is beneficial and necessary. – A 1993–1994 survey of quality analysis in some 200 European laboratories reported from Institut Municipal d'Investigació Mèdica (IMIM), Spain, showed good agreement between nominal and found concentrations but that only 10% of the laboratories could both screen, identify and quantify samples. – Experiences from Italy show that proficiency testing schemes lead to improved accuracy of results. These were some major conclusions of the First European Symposium on Drug Testing held at Huddinge University Hospital in Stockholm, Sweden, 30 March to 1 April 1998, organised by Karolinska Institute, with participants from 22 countries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050728
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  • 4
    Electronic Resource
    Electronic Resource
    Use of lipid-lowering drugs from 1990 to 1994: an international comparison among Australia, Finland, Italy (Emilia Romagna Region), Norway and Sweden (1997)
    Springer
    European journal of clinical pharmacology 53 (1997), S. 185-189 
    Details
    ISSN: 1432-1041
    Keywords: Key words Lipid-lowering drugs; International comparison
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: To compare the overall utilisation patterns of lipid-lowering drugs between 1990 and 1994 in Australia, Finland, Italy, Norway and Sweden as well as the pattern of use with respect to age and gender in Italy and Sweden. Methods: Data were retrieved from regulatory authorities in each country for the 5-year period and analysed according to the ATC/DDD methodology (Anatomical Therapeutic Chemical classification/Defined Daily Doses). Utilisation was calculated as the DDDs for 1000 inhabitants per day for all drugs of the ATC category B04 (serum lipid-reducing agents). Data from Sweden and Italy were also compared with respect to gender and age. Results: In 1994, Australia demonstrated the highest degree of utilisation (11.9 DDD) and the Nordic Countries the lowest (Sweden 5.6; Norway 4.9; Finland 4.0). In all countries except Italy, a steady increase was observed; in Italy, utilisation of these drugs reached a maximum in 1992 (11.5 DDD), but then underwent a reduction which was caused by restrictions in the reimbursement status in 1993 (10.4) and 1994 (6.7). Administration of statins increased in all countries, becoming the most used group of the B04 class. In 1988, the number of different drugs listed by each national health service ranged from 4 (Norway) to 16 (Italy); in 1994 it ranged from 6 (Norway) to 9 (Sweden). Analysis with respect to gender showed the opposite pattern in Sweden (males 4.6 and females 3.3 in 1992; 6.2 and 4.5, respectively, in 1994) than in Italy (males 10.8 and females 17.8 in 1992; 6.4 and 9.2, respectively, in 1994). Exposure was highest in people aged 60–69 years in both countries, followed by age group 50–59 in Sweden and 70–79 in Italy. Conclusions: Large variations in the utilisation of lipid-lowering drugs exist between countries, with Australia and Italy much higher than others. Of the drugs in the ATC category B04, the use of statins predominates in all countries, but to varying degrees. The large difference in the degree of drug utilisation with respect to age and gender between Italy and Sweden suggests major deviations from evidence-based medicine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050360
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  • 5
    Electronic Resource
    Electronic Resource
    Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions (2000)
    Springer
    European journal of clinical pharmacology 56 (2000), S. 269-272 
    Details
    ISSN: 1432-1041
    Keywords: Key words Anti-inflammatory agents ; Non-steroidal ; Drug utilisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: We examined to what extent the evidence of the relative gastrointestinal toxicity with non-steroidal anti-inflammatory drugs (NSAIDs) was implemented in clinical practice in Bologna, Italy, Funen, Denmark, and Stockholm, Sweden, areas with accurate computerised information on prescriptions purchased by defined populations. Methods: We ranked each NSAID by purchased volume in defined daily doses during September 1996 and compared it with the ranking of gastrointestinal complications from a meta-analysis of controlled epidemiological studies published between 1986 and 1994. We restricted our comparison to those NSAIDs that accounted for 90% of the use and within this DU90% segment we determined the proportion of “high risk” (azapropazone, ketoprofen, piroxicam) and “low risk” (ibuprofen, diclofenac) drugs with respect to gastrointestinal toxicity. Results: In Funen, Denmark, we found the best NSAID profile (63% low risk/11% high risk) while Bologna, Italy, had the other extreme (26% low risk/38% high risk), with Stockholm, Sweden, in between (43% low risk/20% high risk). Conclusion: Our study suggests that factors other than evidence-based medicine had a dominating impact on the use of prescription NSAIDs in 1996.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280000144
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  • 6
    Electronic Resource
    Electronic Resource
    Wide variation in serum chlorpropamide concentration in outpatients (1980)
    Springer
    European journal of clinical pharmacology 18 (1980), S. 165-169 
    Details
    ISSN: 1432-1041
    Keywords: chlorpropamide ; diabetes ; drug utilisation ; patient compliance ; diet ; plasma concentration ; maturity onset diabetes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Serum chlorpropamide concentrations (s-CPA) were determined and related to clinical findings in 83 outpatients with maturity onset diabetes. The daily doses of CPA (mg/kg) varied six-fold, but s-CPA ranged 18-fold between the patients. There was a significant correlation between dose and s-CPA (r=0.61), which rose to 0.75 in the 30 patients who had prescribed no other drugs. Patients given other drugs concomitantly were over-represented amongst subjects with extreme values of apparent plasma clearance of CPA. There was no correlation either between serum creatinine or age and s-CPA. Of the 83 patients 40 (48%) had acceptable blood and urinary glucose values according to our criteria; but as 17 were overweight, only 23 patients (28%) had acceptable clinical control. Of the remaining 60 patients, too low a dose was being given to only 12, and dietary failure was the most probable explanation in the others. Thirteen patients (16%) probably did not need CPA. It is likely that this is a partial explanation for the high utilisation of oral antidiabetic drugs in Sweden. There was no general correlation between dose or s-CPA and blood glucose values, but analysis of s-CPA may still be of value in explaining unexpected changes in clinical control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00561585
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  • 7
    Electronic Resource
    Electronic Resource
    Patient medication on admission to a medical clinic (1981)
    Springer
    European journal of clinical pharmacology 20 (1981), S. 185-191 
    Details
    ISSN: 1432-1041
    Keywords: compliance ; prescribing habits ; drug utilisation ; age effect ; multiple therapies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The drug history of 285 consecutive patients admitted to two medical wards of a Swedish university hospital was investigated. In 30 cases (11%) no information about current drug therapy could be obtained from the patients themselves, and in further 21 (7%) additional drugs from other sources were discovered. Current drug therapy of 234 patients (82%) was identified, of whom 217 had medicines supplied by prescription and 52 used drugs bought over the counter. The medication was “chronic” for 85% of the prescribed drugs, and 18% were prescribed to be taken as required. Significantly more women than men were taking medicines, but, amongst the users, there was no significant difference in the number of drugs taken by men or women. The average number of drugs prescribed for the 217 patients was 3.7, more being prescribed for the older patients. Cardiovascular and psychotropic medicines were the agents most commonly prescribed. Digoxin was prescribed for 65 patients. The mean daily dose was 0.20 mg, and it was reduced for older patients and for those with elevated serum creatinine. Twelve patients (19%) had no measurable digoxin in their plasma; the median concentration was 1.15 nmol/l. Ten of 32 patients (31%) had a significant change in their plasma digoxin concentration after supervised drug intake in hospital, indicating previous irregular intake of digoxin. Compliance with the prescribed drug regimen was evaluated from interviews of 151 patients. Of them, 59 (39%) were classified as having been non-compliant for half their drugs during the last two days prior to admission. Non-compliance was reported significantly more often by patients who were aged 65 years or more, and who had more than three drugs prescribed for regular intake. The number of drugs prescribed did not seem to influence compliance in patients under 65 years of age. Significantly more doses were reported to be missed for drugs meant to be taken thrice daily (31%), than for those with once (18%) or twice (20%) daily dosage schedule. The difference between once and twice daily schedules was not significant.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00544596
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  • 8
    Electronic Resource
    Electronic Resource
    Therapeutic traditions in Northern Ireland, Norway and Sweden: II. Hypertension (1986)
    Springer
    European journal of clinical pharmacology 30 (1986), S. 521-525 
    Details
    ISSN: 1432-1041
    Keywords: hypertension ; hypertensive therapy ; drug utilization ; therapeutic traditions ; international differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary A questionnaire survey based on hypertension case histories was performed among a representative sample of 400 GP's and hospital doctors in Northern Ireland, Norway and Sweden, countries having markedly different utilization of antihypertensive drugs. We found a greater propensity to start antihypertensive drug treatment in Northern Ireland than in Norway and Sweden. This was true both in mild diastolic and isolated systolic hypertension. Yet the utilization of antihypertensive drugs in Sweden is about 60% higher than in Northern Ireland and 30% higher than in Norway. Swedish physicians preferred beta-blockers as their first choice to a greater extent than physicians in Northern Ireland and Norway who selected thiazides more often. In general, the choice of drugs agreed with the sales and prescribing patterns in the three countries. Besides providing more insight in therapeutic traditions the study indicates that the lower prescribing of antihypertensive drugs in Northern Ireland, and to some extent in Norway, compared to Sweden, might be due to differences in true or apparent morbidity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00542409
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  • 9
    Electronic Resource
    Electronic Resource
    Use of digoxin in a low density population area in Sweden (1976)
    Springer
    European journal of clinical pharmacology 10 (1976), S. 19-24 
    Details
    ISSN: 1432-1041
    Keywords: Digoxin ; diuretics ; drug compliance ; drug utilization ; intoxication ; plasma levels
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Plasma digoxin was measured in all patients receiving digoxin (Lanacrist, Draco) in a well-defined low density population area in Sweden. The number of treated patients (n=75) corresponded to 3 % of the population. The average prescribed daily dose of digoxin was 0.25 mg, and the mean plasma concentration (n=74) was 0.85 (S.D. 0.52) ng/ml. Of the concentrations found 3 % were above and 62 % were below the apparent therapeutic range, 1 – 2 ng/ml. The findings were compared with analyses performed in a hospital laboratory (n=300), the majority being inpatients receiving a similar daily dose. In the latter, 22 % had a plasma level above and about 33 % below the apparent therapeutic range. In the former group no difference in plasma digoxin concentration could be demonstrated between patients treated with digoxin (n=34) and those treated with both digoxin and diuretics (n=40). In a group of eight patients plasma digoxin rose significantly after they were informed of the importance of taking their medicine regularly. Poor compliance with prescribed therapy was even documented in patients in cardiac failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00561544
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  • 10
    Electronic Resource
    Electronic Resource
    Utilization of antidiabetic drugs in the island of gotland, sweden: Agreement between wholesale figures and prescription data (1978)
    Springer
    European journal of clinical pharmacology 14 (1978), S. 213-220 
    Details
    ISSN: 1432-1041
    Keywords: Diabetes ; antidiabetic drugs ; drug utilization ; prescribing habits ; geographical differences ; methodology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In a comparison of three European countries Sweden utilized more antidiabetic drugs than Northern Ireland and Norway. Swedish wholesale figures for a quarter of a year used for the comparison were based on “daily doses”/1000 inhabitants/day. In order to validate the Swedish figures, a defined geographical area was investigated in 1972–1973, the island of Gotland with 54000 inhabitants. Antidiabetic drugs distributed on a wholesale basis were compared with those distributed on a prescription basis. Additional information was gathered (interviews, questionnaires, hospital records etc.) from a sample of patients (n=54) and their prescribing doctors (n=37). There was good agreement between the wholesale and prescription figures for oral antidiabetic drugs over a three month period (30.0 vs 29.8 “daily doses”/1000 inhabitants/day), but this did not apply to insulin (5.9 vs 7.2) unless a longer time period was studied. The average daily doses prescribed were higher than the theoretically derived “daily doses”. Combination antidiabetic drug therapy was preseribed for 28% of the patients. Thirteen different oral antidiabetics were issued during the study period, four of which constituted 90% of the total. Phenformin, the second most commonly prescribed oral antidiabetic drug was prescribed by 33 doctors, and metformin was prescribed by only 14 doctors. Few patients were treated with diet alone and few doctors could obtain assistance from a dietician. There was little or no evidence that patients failed to comply with the prescriptions, but by contrast they adhered poorly to written dietary instructions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02089962
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