In June 1988, a questionnaire was sent to 221 Danish general practitioners chosen at random and to 195 registrars who had applied for postgraduate courses in general medicine. The percentage replies were 83 and 73, respectively. Employing the questionnaire, information was obtained about the doctor's employment of CS on the basis of definite case reports and the doctor's assessment of the certainty of the examination. The investigation revealed that there was a general tendency to freer indications than those officially recommended, that younger women were examined more frequently than recommended, that elderly patients were examined less frequently than recommended and that considerable excessive employment of CS took place in women with condylomata and herpes genitalis. As a rule, the doctors overestimated the reduction in the risk of disease obtained by CS. It is concluded that information from the official authorities concerning employment of CS sent to general practitioners is not satisfactory and that this should be considered in extension of future guidelines about the employment of methods of examination. Precise and effectively distributed information about rationel employment of an examination must be considered to be an important way in which to obtain optimal utilization of resources.
We used a prescription database to identify all reimbursed prescriptions for children aged 0-15 years living in North Jutland County (population 95,134), Denmark, during 1997. We identified 154,189 prescriptions for 48,091 child users. The mean prescription rate was 1621/1000 children/year. Overall, half of the child population purchased > or = 1 prescription. In children younger than three years, 75.3% purchased prescriptions, and 17.5% received > or = 5 prescriptions. Systemic antibiotics, anti-asthmatics, ophthalmologicals, and dermatological corticosteroids accounted for 82% of the prescriptions. One-third of the 0-2 year old children purchased prescriptions for anti-asthmatics, mainly systemic beta 2-agonists, and almost half purchased antibiotics, mainly broad-spectrum penicillins. In the 7-15 year olds, 39.1% redeemed at least one prescription. The study stresses the need for epidemiological studies on the reasons for drug use and evaluation of pharmacological effects in children.
Previous investigations have demonstrated that considerable problems may exist in the diagnosis of purulent meningitis (PM) in general practice. Referrals from general practitioners/duty roster doctors concerning 97 children discharged the diagnosis of PM were reviewed retrospectively. The patients were subdivided into two groups according to whether the diagnosis was established by the referring doctor or not. Only 35% of the children under one year were admitted for suspected PM, whereas 65% of the children between one year and 15 year were hospitalized with the correct diagnosis. The commonest positive findings in both age groups were alterations in consciousness which were found in more than 80% of the children. Children in whom the diagnosis was not established by the referring doctor had fewer classical signs of meningitis (neck-stiffness, Kernig's sign, bulging fontanelle and petecchia) than children in whom the diagnosis was established. Children with negative cultures from the cerebro-spinal fluid were significantly more frequently treated with antibiotics prior to hospitalization. Approximately half of the children admitted with suspected meningitis were not treated according the guidelines issued by the Danish Board of Health, without this having any effect on the survival rate.
We examined the pattern of prescribed drug use in Danish children and used a pharmacoepidemiological prescription database to identify all reimbursed prescriptions for children aged 0-15 y living in North Jutland County (population 95 189), Denmark, during 1997. We identified 154 189 prescriptions for 48 091 drug users. The 20 most frequently prescribed chemical substance subgroups comprised 71.3% of all prescriptions. The mean annual prescription rate was 1621/1000 children/y. Overall, 50.6% of the population received one or more prescription. In children younger than 3 y, 75.3% received prescriptions and 17.5% obtained five or more prescriptions. Systemic antibiotics, anti-asthmatics, ophthalmologicals and dermatological corticosteroids accounted for 82% of prescriptions. One-third of the young children received anti-asthmatics, mainly oral beta-2 agonists, and almost half received antibiotics, mainly broad-spectrum penicillins. In the 7-15-y-olds, 39.1% received prescriptions. Hormones, antihistamines, anti-epileptics, anti-acne preparations and anti-diabetics comprised an increasing proportion of prescriptions. About 20% received antibiotics and 6% anti-asthmatics. In conclusion, the level of exposure to prescribed drugs was considerable at all ages and was highest in early childhood. Our study supports the need for epidemiological studies on the reasons for drug use and evaluation of their pharmacological effects in children.
The incomplete understanding of drug effects at the time of marketing has led to ongoing epidemiological monitoring. The Danish National Health Service covers part of the expenses for most kinds of prescription drugs. The accounting system within the pharmacies is increasingly computerized. In 1992 we found that 96% of the pharmacies were computerized. The computerized accounting systems give no information about adverse drug effects, but this can be obtained from the Danish Hospital Register by cross-checking registries, and in some cases from the register of birth and the register of congenital malformations. There is a great need for new data sources in pharmacoepidemiology. In spite of some evident methodological problems, the Danish data sources probably have high validity compared with international sources, since they are population based.