Over a period of 20 years (from 1968 to 1988) all inpatients (n = 839) who were admitted for the first time to the adolescent psychiatric unit in Copenhagen were registered, and 40 social and psychiatric variables were recorded, to investigate early predictors of later readmission. Overall, 44.8% of the patients were readmitted within a certain observation period (range, 1.5-21.5 years). Among a subsample of 488 patients (58%) who could be followed up for more than 10 years after their first admission 26% became heavy users of psychiatric services, defined as long-term inpatients or revolving-door patients. Severe early diagnoses (schizophrenia and affective psychoses) were strongly associated with rapid relapses and frequent readmissions. A statistical estimate of the risk of later heavy use based on 12 independent variables is presented.
The prevalence of contact allergy in the general population has traditionally been investigated through population-based epidemiological studies. A different approach is the combination of clinical epidemiological (CE) data and the World Health Organization-defined drug utilization research (DUR) method. The CE-DUR method was applied in Denmark to estimate the prevalence of contact allergy in the general population and compare it with the prevalence estimates from the Glostrup allergy studies. Contact allergy prevalence estimates ranging from very liberal ('worst case') to conservative ('best case') assumptions were based on patch test reading data in combination with an estimate of the number of persons eligible for patch testing each year based on sales data of the 'standard series'. The estimated 10-year prevalence of contact allergy ranged between 7.3% and 12.9% for adult Danes older than 18 years. The 10-year prevalence of contact allergy measured by CE-DUR was slightly lower than previous prevalence estimates from the Glostrup allergy studies. This could probably be explained by a decrease in nickel allergy. The CE-DUR approach holds the potential of being an efficient and easy monitoring method of contact allergy prevalence.
Since 1950, the Public Dental Service (PDS) has gradually been developed in Norway. In addition to rendering free and systematic treatment to children aged 6--17 years, which has priority, the PDS also offers treatment to other categories of patients at fixed fees, generally lower than those in private practice. The purpose of the present study was to elucidate the impact made by PDS on the dental treatment pattern within one particular area (the district of Harstad with a population of approximately 29,000). Furthermore, the study included a description of the clientele in the PDS, excluding the "free clientele" aged 6--17, in relation to that treated in private practice. During a limited period in February--March 1974, all the 9 dentists in the PDS treating "paying clientele" and all the 9 private practitioners in the district, filled in a questionnaire by each patient visit (course of treatment) (Fig. 1). In addition to the information on social and demographic characteristics, data were also collected on dental treatment pattern, the treatment presently rendered, and the presence of teeth and possible dentures (Fig. 1). Four--fifths of the visits made by "paying clientele" were made in private practice, only one--fifth in the PDS. In private practice, rural people, women and people of young age were underrepresented. Children under 6 years of age comprised 3% of the clientele in private practice and 9% in the PDS. No significant difference was found between the two types of practice regarding the social class composition of the clientele. Dental status as measured by the occurrence of teeth and dentures was generally poorer among the PDS patients, seemingly due to the overweight of rural people and of those with an irregular or occasional treatment pattern. Totally 40% of all visits were made by regular treatment attenders. 20% of the services delivered were prophylaxes and/or periodontics, 56% were conservative and/or endodontic treatments. The introduction of the FDS in the district some 10--15 years ago has conceivably contributed to an overall increase in the demand for dental services, and to an improvement of denial treatment patterns. During this period, the number of public dentists has increased from 2--3 to a total of 12. Correspondingly, the number of private practitioners has increased from 5 to 9, of whom 2 work part time. The treatment attendance of some population subgroups is, however, still lagging behind: rural people, small children and persons over 50 years of age, and particularly people belonging to lower socio-economic brackets.
The purpose of this study was to provide some preliminary description of the Latin-Canadian community by reporting the socioeconomic status, physical activity, and weight status (i.e., healthy weight, overweight, or obese status) of Colombians newly immigrated to London, Ontario Canada. Face-to-face interviews were conducted on a convenience sample of 77 adult Colombian immigrant food bank users (46.8% men; mean age 39.9 yr., SD=11.8). Physical activity was gauged using the International Physical Activity Questionnaire and self-report Body Mass Index, and sociodemographic data were collected. Of respondents, 47% had a university education, and 97% received social support. 61% met recommended levels of physical activity. Men were more active, being involved in about 130 min. more of exercise per week, and more men were overweight than women (63.9% versus 39.0%, respectively). Of respondents, 73% reported being less active than before coming to Canada. This pilot study indicates that Latin-Canadian immigrants are a vulnerable group in need of acculturational support. Further study is warranted.
This paper describes the administrative process by which the Ottawa General Hospital (OGH) closed 6 beds and used the staff and space resources thus released to set up an acute day hospital (ADH) for the treatment of 8 acutely ill psychiatric patients. Outcome data are presented on the first 160 patients admitted to the ADH.
Demographic and clinical information including diagnostic (DSM-III-R; Global Assessment of Functioning [GAF]) and questionnaire data (Symptom Checklist-90 Revised [SCL-90R]; Beck Depression Inventory [BDI]; State-Trait Anxiety Inventory [STAI]; patient satisfaction) were obtained from 160 ADH patients at admission and discharge. Forty-two of these patients provided follow-up data 3 to 6 months postdischarge. The outcome of ADH patients was compared with that of a retrospectively obtained random sample (n = 100) of inpatients on selected diagnostic and demographic variables.
On clinician-rated and self-report clinical scales, ADH patients showed significant clinical improvement reflected in higher GAF scores and less psychological distress, depression, and anxiety at discharge relative to admission. There were no significant group differences in outcome indices except for shorter length of stay in the ADH group compared with inpatients. The ADH group rated the program highly in help received and quality of service. Short-term follow-up showed that gains made during treatment were maintained 3 to 6 months later.
These results show that a time-limited day hospital program is clinically effective for acutely ill psychiatric patients and leads to a more efficient use of inpatient resources. We believe that partial hospitalization for the treatment of acute psychiatric disorders may have wide application in psychiatric hospital practice.
We investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data.
Our sample included 715 adolescents aged 15-18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use.
Stronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity.
In a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.
Cyclooxygenase 2-selective non-steroidal anti-inflammatory drugs (NSAIDs, coxibs) are recommended primarily for patients at high risk of gastrointestinal bleeding, most of them being elderly. Our objective was to describe and analyse patient- and physician-related factors affecting the adoption of celecoxib and rofecoxib 2 years after their launch in Finland.
Retrospective analysis of the nationwide Prescription Register. Physicians who had issued at least 200 reimbursed prescriptions in 2002 (n = 12 033, 80% of working-age Finnish physicians) were involved in the analysis.
Excluding patients with rheumatoid arthritis (RA), almost one-fifth (18%) of NSAIDs prescriptions were for coxibs. In patients with RA the share was 25%. The share of coxib prescriptions of all NSAIDs increased with age of the patient. Over one half (58%) of coxib prescriptions were issued for patients under 65 years of age. Specialists in physical and rehabilitation medicine were the fastest adopters of coxibs: one-third of their NSAID prescriptions in 2002 were for coxibs. Primary care physicians were the most conservative both in adopting and favouring coxibs.
Coxibs have gained the status of standard prescription NSAIDs within a few years. Their use should be restricted to patients who could benefit most from the use. Routine prescribing of expensive new drugs increases the drug bill without additional health gain.
Older adults take almost one-third of the drugs prescribed today yet represent only about 12 percent of the population. Adverse drug events are common in this population, but often these events appear to be preventable. Interest in adverse events related to the use of prescription drugs has rarely been higher or broader. The research community continues to develop new tools to study adverse effects of drugs in individuals and populations. However, the published literature on drug-related adverse events is fraught with problems, starting with the original reports and extending to systematic reviews. Prospective data are missing, adverse drug events are poorly described, and analytical methods are questionable. This leads to problems with imprecise estimates and generalizability of results.
Spontaneous reporting of adverse drug reactions (ADRs) is a cornerstone in pharmacovigilance. However, information about the underlying consumption of drugs is rarely used when analysing spontaneous reports. The purpose of this study was to combine ADR reports with drug consumption data to demonstrate the additional information this gives in various scenarios, comparing different drugs, gender-stratified sub-populations and changes in reporting over time.
We combined all Norwegian ADR reports in 2004-2013 from the EudraVigilance database (n?=?14.028) with dispensing data from the Norwegian Prescription Database (more than 800 million dispensed prescriptions during 2004-2013). This was done in order to calculate drug-specific consumption-adjusted adverse drug reaction reporting rates (CADRRs) by dividing the number of reports for each drug with the number of users of the drug during the same time period.
Among the ten drugs with the highest number of ADR reports and the ten drugs with the highest CADRR, only four drugs were in both categories. This indicates that drugs with a high number of reports often also have a high number of users and that CADRR captures drugs with potentially relevant safety issues but a smaller number of users. Comparing reported ADRs in females and males using methylphenidate, we found that the two groups report different ADRs. Finally, we showed that changes in ADR reporting for simvastatin and atorvastatin during 2004-2013 were due to changes in consumption and that atorvastatin had a higher CADRR but fewer reports than simvastatin.
CADRR provides additional information compared with number of reports alone in studies using spontaneous reports. It is important for researchers to adjust for consumption whenever possible in pharmacovigilance studies.
Cites: JAMA. 2002 May 1;287(17):2215-20 PMID 11980521