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.
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.
The purpose of this paper is to present a Mediaeval skeleton of an approximately 16 year old boy, which was excavated at a Danish cemetery containing ca. 150 graves. The skeleton reveals several pathologic changes, probably due to congenital malformation. The most intriguing find is seen at both scapulae, and the changes are bilateral symmetric. Both the glenoid cavities are placed posterior but at the normal height of the bone. The joints are almost perpendicular to their normal direction. The size of the glenoid cavities is normal and the shape is rather flat in accordance to the development stage of the skeleton, where the epiphysis of the rim has not yet appeared to form the gently concave fossa as normally seen in adults. Both the surface and the borderlines of the glenoid cavities are, however, more irregular than normally at that age. The position of the joints may be caused by dislocation and/or congenital malformation which is discussed. Due to the shape of the cavities, to the symmetric bilaterality, and to the minor congenital malformations, it is primarily believed to be caused by congenital malformation. Probably the young man was not much affected by the malformation of the shoulder joints, which is indicated by the normal form and size of the humeri and the well-developed muscle attachments of the bones. The claviculae seem shorter and more twisted than normal, which may be caused by a twisting of the scapulae. So the glenoid cavities may have pointed almost in the normal direction in spite of the malformation. Other minor malformations are spina bifida of the atlas and the 5. lumbar vertebra, multiple minor changes of the joints of both feet and malformations of one metatarsal bone in both feet. Agenesi of the praemolars is also seen. Although our study of the literature, we have not succeeded in correlation our finds with any known congenital syndrome, and as far as we know no similar case has been described in clinical observation or in skeletal finds.
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.
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.
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%.
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.
Prescribed daily dose (PDD) of phenoxymethylpenicillin was estimated in a multipractice study in 1979 and in 1983. PDD increased from 2.08 mio IU in 1979 to 2.32 mio IU in 1983. PDD was independent of number of daily doses, and factors related to practice. Only slight variations with diagnosis and doctor's age was found.