Optimising gout treatment: insights from a nurse-led cohort study.

OBJECTIVES: Currently, gout management, particularly urate-lowering therapy (ULT), is often suboptimal. Nurses successfully manage various diseases including gout. As gout prevalence is rising, and rheumatologists and general practitioners face shortages, a new approach is imperative. This real-life prospective cohort study evaluated the effectiveness of nurse-led care employing a treat-to-target strategy for gout management over a 2-year period. METHODS: All consecutively confirmed gout patients were included. The nurse-led clinic provided a structured treatment plan with consultations, patient leaflets, telephone contacts and laboratory monitoring. After a year of nurse-led care, patients transitioned to continued care in general practice. Follow-up data were complete through registries. The primary outcome was achieving target p-urate levels (<0.36 mmol/L) at 2 years after diagnosis. Secondary outcomes included treatment continuation and achievement of target p-urate levels in specific subgroups. The results were compared with patients diagnosed in the same clinic but followed up in 'usual care'. RESULTS: In the nurse-led group (n=114), 83% achieved target p-urate levels and ULT was continued by 98%. This trend persisted across various patient subgroups. Only 44% of patients in usual care achieved target p-urate and with insufficient doses of allopurinol . Nurse-led care involved an average of two visits and three telephone contacts over 336 days. The 2-year mortality rate was 15%. CONCLUSIONS: Nurse-led gout care, employing a targeted approach, was associated with a very high uptake of and adherence to ULT. The encouraging results were not achieved in usual care although a direct comparison might be influenced by selection bias.

Diagnostic flow for all patients referred with non-specific symptoms of cancer to a diagnostic centre in Denmark: A descriptive study.

BACKGROUND: Since 2012, Cancer Patient Pathways for Non-specific Symptoms and Signs of Cancer (NSSC-CPP) have been implemented in Scandinavia and UK. OBJECTIVES: This study aimed to describe the diagnostic flow for all patients referred from 1 January to 30 June 2020 to the NSSC-CPP in the Diagnostic Centre in Farsø (DC-F), Denmark. METHODS: During the study period, we prospectively recorded information on the diagnostic flow, including: pathway trajectory, symptoms and findings leading to referral, diagnostic procedures and diagnoses at the end of DC Farsø work-up and within 6-months for all patients referred to the NSSC-CPP in DC Farsø using electronic patient files and the Danish National Patient Registry (DNPR). RESULTS: Of the 314 referrals to DC Farsø, 227 had diagnostic work-up in DC Farsø, the remaining were redirected to other CPPs (n = 11), outpatient clinics (n = 45) or redirected to general practice (n = 25). Of total referrals, 25 (8%) received a malignant diagnosis, 20 (6%) a non-malignant but clinically relevant diagnosis with initiation of treatment, 16 (5%) a non-malignant diagnosis but no treatment needed and in 253 (81%) referrals no severe new condition was diagnosed. Two (1%) additional malignancies were diagnosed within a 6-month follow-up period. CONCLUSION: By tracking all patients referred to the NSSC-CPP in DC Farsø, including those redirected, this is the first study to describe the diagnostic flow for all patients referred to a diagnostic centre in Denmark. This knowledge is important for further organisation and planning of the NSSC-CPP.

Eight percent of NSSC-CPP referrals yielded cancer diagnoses, with two additional cancers diagnosed in a 6-month follow-up.Over one-fourth of referrals to NSSC-CPP were redirected to other departments or general practitioners.This study outlines the diagnostic flow for all NSSC-CPP-referred patients, offering unique insights crucial for comparing European diagnostic practices.

Less prevalent use of biologics for inflammatory bowel disease in patients from Non-Academic hospitals - a Danish register-based study of a region with 580,000 citizens.

INTRODUCTION: Biologic therapy is widely used for inflammatory bowel disease (IBD) and may decrease surgery rates. However, it remains uncertain if there is unwarranted geographic variation in access to biologic therapy. The aim of the study was to explore if all patients had equal access to biologic therapy in the North Denmark Region. METHODS: A cross-sectional register-based study of use of biologics, hospital contacts and surgery among all IBD patients having a hospital contact in the geographically well-defined North Denmark Region during 2016-2018. ICD-10 diagnosis codes, hospital contacts and procedure codes were retrieved from the region's hospital registry. The population is served by an Academic Hospital and two Non-Academic Hospitals constituting three referral areas (according to postal codes). RESULTS: In total, 2371 patients with ulcerative colitis (UC) and 1383 patients with Crohn's disease (CD) had a hospital contact in the region during 2016-2018. Compared to patients from the Academic Hospital, patients from the Non-Academic Hospitals experienced a lower incidence of biologic therapy for UC IRR 0.786 (0.621: 0.994), as well as for CD IRR 0.912 (0.781: 1.065). The incidence of bowel related hospital contacts were higher in patients from Non-Academic hospitals for both UC IRR 1.318 (1.207: 1.438) and CD IRR 1.165 (0.915: 1.483). CONCLUSIONS: Patients with IBD living in a referral area to a Non-Academic Hospital in the North Denmark Region are less likely to receive biologics. This was associated with an increased prevalence of IBD related surgical procedures.

Long-term oral budesonide treatment and risk of osteoporotic fractures in patients with microscopic colitis.

BACKGROUND: Due to a substantial first-pass metabolism of oral budesonide, systemic bioavailability is low compared to other oral corticosteroids, thereby possibly avoiding adverse effects of systemic corticosteroid use. AIM: To determine whether use of oral budesonide is associated with osteoporotic fractures in patients with microscopic colitis (MC). METHODS: Applying data from the Danish nationwide health registries, we conducted a case-control study nested within a cohort of patients with MC from 2004 to 2012. We estimated odds ratios (ORs) for the association between budesonide use and osteoporotic fractures (hip, wrist and spinal fractures). RESULTS: We identified 417 cases with a first occurrence of an osteoporotic fracture. Eighty-six per cent were women and the median age was 78 years. The OR for the overall association between ever-use of budesonide and any osteoporotic fractures did not reach statistical significance (OR 1.13, CI: 0.88-1.47). The highest risk was observed for spinal fractures (OR 1.98, CI: 0.94-4.17), where a dose-response association seemed to exist, followed by hip and wrist fractures (OR 1.17 [CI: 0.79-1.73] and OR 0.99 [CI: 0.66-1.47] respectively). We generally found modestly increased ORs across subgroups at suspected high or low risk of fractures (1.00-2.49). No overall dose-response association was evident (OR for doubling of cumulative dose 0.93 (CI: 0.84-1.03). CONCLUSION: No overall association between use of oral budesonide and osteoporotic fractures was demonstrated among individuals with MC. There seemed to be an isolated adverse effect of budesonide on the risk of spinal fractures, which appears to be dose related.

Oral iron absorption test should not be performed with iron drops containing ferric iron.

INTRODUCTION: In an oral iron absorption test (OIAT), the rise in plasma iron concentration after oral ingestion of iron is a measure of intestinal iron absorption. We describe results of the OIAT using two different formulations of oral iron drops. METHODS: The study included all patients who had an OIAT performed at the Department of Internal Medicine, Farsø, Aalborg University Hospital, Denmark, from 1 January 2013 to 17 June 2014 (n = 24) using ferrous iron drops "Glycifer" and from 18 June to 3 November 2014 (n = 17) using ferric iron drops "Medic". A venous blood sample was drawn before and then 90, 180 and 240 min. after the intake of 9 ml iron drops of the "Glycifer" brand (270 mg ferrous iron) or the intake of 11 ml iron drops of the "Medic" brand (264 mg ferric iron). RESULTS: The patient characteristics (ferrous versus ferric iron drops) were similar in terms of gender, age, haemoglobin, ferritin and previous gastric bypass surgery. The fasting baseline plasma iron concentration was median 5 µmol/l in both groups (p = 0.4). The maximum plasma iron concen-tration increase from baseline after oral intake of the iron drops was median 2 µmol/l (range: 0-8 µmol/l) in the group given ferric iron drops and 48 µmol/l (range: 14-78 µmol/l) when ferrous iron drops were used (p < 0.001). CONCLUSION: OIAT performed with ferrous or ferric iron drops showed very different results with a lack of plasma iron concentration increase after ingestion of ferric iron drops. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Research at regional hospitals in Denmark can be reinforced]. / Forskning på regionshospitaler kan styrkes.

We examined the conditions for health research at regional hospitals in Denmark. The study was conducted as an interview-based case study containing interviews with key persons at the governing level as well as medical doctors at the operating level. The results showed that the settings and opportunities regarding health research vary between university hospitals and non-university regional hospitals. However our findings indicate, that focusing on a long-term strategy to implement health research in regional hospitals will enable these to be more active in health research.

[Research in regional hospitals in two Danish regions]. / Forskning på regionshospitaler i Region Midtjylland og Region Nordjylland.

The quantity of interest, experience, and barriers to research in non-university hospitals in Denmark is undocumented. Therefore, a questionnaire was distributed to all employees at non-university hospitals in two Danish regions. The results showed that a substantial number of medical doctors were engaged in ongoing research. 24% of the respondents were supervisors in research projects, and 19% conducted contract research. Thus, Danish non-university hospitals have employees with both interest and experience in medical research. The four most commonly stated barriers for research were lack of time, funding, supervision, and training courses.

Adiposity in 277 young adult male offspring of women with diabetes compared with controls: a Danish population-based cohort study.

OBJECTIVE: To examine the associations of maternal diabetes, overall and stratified according to treatment of diabetes, with weight-related outcomes at the time of military conscription, at age 18-20 years. DESIGN AND SETTING: Cohort study of 277 Danish male offspring of mothers with recognized pre-gestational or gestational diabetes. As population-based controls we selected 870 men matched from the Civil Registration Office. METHODS: Data on weight-related outcomes were retrieved from the Danish military conscription registry. MAIN OUTCOME MEASURES: Military rejection due to adiposity and body mass index (BMI) at conscription. RESULTS: Army rejection rate due to adiposity was 5.8% (n= 16) among 277 diabetes mellitus-exposed men compared with 3.1% (n= 27) in 870 controls (risk difference 2.7 (95% confidence interval (CI) -0.3-5.7)) and mean BMI at conscription was 1.4 kg/m(2) (95%CI 0.8-2.0) higher among those diabetes mellitus-exposed men. In analyses adjusted for birthweight and gestational age, compared with controls, the BMI was 0.6 kg/m(2) (95%CI -0.3-1.5) higher in sons of mothers with pre-gestational and 2.7 kg/m(2) (95% (CI): 0.9-4.5) higher with gestational diabetes. The greatest BMI difference was in offspring of mothers with gestational diabetes in whom insulin was initiated during pregnancy. We found no difference in conscript height. CONCLUSIONS: Compared with controls, male offspring of women with diabetes had a higher rejection rate due to adiposity and higher adult BMI. Subgroup analyses showed that the association was most pronounced in sons of mothers with gestational diabetes, whereas pre-gestational diabetes was only weakly associated with higher offspring BMI.

A substantial number of scientific publications originate from non-university hospitals.

INTRODUCTION: As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities. MATERIAL AND METHODS: We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus. RESULTS: In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Publications were cited more often if the first or last author was from a university hospital and even more so if they were affiliated to foreign institutions. Cardiology, gynaecology and obstetrics, and environmental medicine were the three specialities with the largest number of regional hospital publications. CONCLUSION: A substantial number of scientific publications originate from non-university hospitals. Almost two thirds of the publications were original research published in international journals. Variations between specialities may reflect local conditions. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Validity of asthma diagnoses in the Danish National Registry of Patients, including an assessment of impact of misclassification on risk estimates in an actual dataset.

OBJECTIVE: Asthma diagnoses recorded in the Danish National Registry of Patients (DNRP) are a misclassified measure of the actual asthma status. We quantified this misclassification and examined its impact on the results of an epidemiologic study on asthma. STUDY DESIGN AND SETTING: We validated the DNRP asthma diagnoses against records of asthma diagnosed at medical examinations conducted during mandatory conscription evaluation. We had data on 22,177 male conscripts who were born from January 1st, 1977 to December 31st, 1983, in a conscription district in northern Denmark. We obtained asthma diagnoses recorded among the conscripts in the DNRP from January 1st, 1977 through December 31st, 2003. We estimated sensitivity, specificity, and positive predictive value (PPV) of the DNRP asthma diagnoses. We then conducted sensitivity analysis to quantify the impact of nondifferential misclassification on the rate ratios measuring the association between asthma and risks of different skin cancers. RESULTS: The sensitivity of the DNRP for detecting an asthma diagnosis was 0.44 (95% confidence interval [CI]: 0.42-0.47), the specificity was 0.98 (95% CI: 0.98-0.99) and the PPV was 0.65 (95% CI: 0.62-0.68). Both direct and inverse associations between asthma and the different types of skin cancers became more pronounced after correcting for the misclassification. CONCLUSION: The DNRP registered asthma diagnosis may be used to measure asthma status in epidemiologic studies seeking to estimate relative effects of asthma. Even at low values of DNRP sensitivity of asthma diagnoses were not sufficient to nullify observed relative associations in an actual dataset. The specificity of DNRP asthma diagnosis is high.

Neonatal non-hemolytic hyperbilirubinemia: a prevalence study of adult neuropsychiatric disability and cognitive function in 463 male Danish conscripts.

OBJECTIVE: To examine whether neonatal non-hemolytic hyperbilirubinemia is associated with adult neuropsychiatric disability and cognitive function. METHODS: The study included all men born as singletons > or =35 gestational weeks in two Danish counties from 1 January 1977 to 31 December 1983 that registered at conscription in a Danish region. Their infant levels of hyperbilirubinemia was ascertained from hospital records. At conscription, the prevalence of neurologic conditions and performance on a standard group intelligence test (Boerge Prien test) was compared between men with and without neonatal non-hemolytic hyperbilirubinemia. RESULTS: The study group consisted of 463 conscripts exposed to neonatal non-hemolytic hyperbilirubinemia and 12 718 unexposed conscripts. The median value of maximum serum bilirubin concentration was 256 micromol/l (range 105-482). Among the exposed, 5.6% were deemed unfit for military service due to a neurologic or a psychiatric condition, compared with 4.8% among the unexposed (prevalence ratio 1.18, 95% CI 0.81 to 1.73). Among men with Boerge Prien measurement, mean Boerge Prien test score among 391 exposed men was 42.4 points compared with 43.4 points among 11 248 unexposed men (mean difference 1.0 points, 95% CI 0.0 to 1.9). There was no association between level of hyperbilirubinemia and cognitive score. Adjusted prevalence ratio of obtaining a Boerge Prien test score in the lowest quartile was 1.04 (95% CI 0.87 to 1.23). CONCLUSION: The study found no evidence of an association between neonatal non-hemolytic hyperbilirubinemia and adult neurodevelopment and cognitive performance in male conscripts. Since cognitive performance was not associated with the severity of hyperbilirubinemia we ascribe the slightly lower cognitive scores among exposed to uncontrolled confounding.

[A survey of research funding at Danish regional hospitals]. / Forskning ved regionale hospitalsenheder i Vestdanmark.

INTRODUCTION: According to recently passed Danish legislation, all Danish hospitals are obliged to take part in scientific research. As data on financial support for research activities are lacking, we assessed the resources allocated to research from the budget of the central hospital management as a percentage of the total budget at Danish regional hospitals in 2007. MATERIAL AND METHODS: A postal survey was conducted at 13 hospitals in the Western part of Denmark. The questionnaire comprised items in the following major categories: 1) budget allocated specifically for research and travel grants; 2) employment of scientific and technical support staff; 3) facilities and equipment for research; and 4) research dissemination. RESULTS: Questionnaires were returned from 11 hospitals. Six hospitals reported to have dedicated fixed amounts on the budget for research, exact figures were reported in four cases only equivalent to 0.1%, 0.3%, 0.3% and 0.6% of the total budget. Most hospitals had associate professors, but only five had full professors. Seven hospitals supplied laboratories and technical facilities, eight hospitals held staff-meetings on a regular basis and four published an annual report on research activities. CONCLUSION: In the majority of regional hospitals in Western Denmark, less than 0.3% of the total budget administered by the central hospital management was allocated specifically for research. These figures, however, may not be accurate as individual departments may allocate additional resources from local budgets. We recommend that regional hospitals define research strategies and allocate the necessary funding in their budgets.

Association of Apgar score at five minutes with long-term neurologic disability and cognitive function in a prevalence study of Danish conscripts.

BACKGROUND: Apgar score is used for rapid assessment of newborns. Low five-minute Apgar score has been associated with increased risk of severe neurologic outcome, but data on milder outcomes, particularly in the long term, are limited. We aimed to examine the association of five-minute Apgar score with prevalence of neurologic disability and with cognitive function in early adulthood. METHODS: We conducted a prevalence study among draft-liable men born in Denmark in 1978-1983 and presenting for the mandatory army evaluation in a northern Danish conscription district. We linked records of this evaluation, which includes medical exam and intelligence testing, with the conscripts' records in the Medical Birth Registry, containing perinatal data. We examined prevalence of neurologic disability and of low cognitive function according to five-minute Apgar score. RESULTS: Less than 1% (136/19,559) of the conscripts had 5-minute Apgar scores <7. Prevalence of neurologic disability was 2.2% (435/19,559) overall; among conscripts with Apgar scores <7, 7-9, and 10 (reference), it was 8.8%, 2.5%, and 2.2% respectively. The corresponding prevalences of low cognitive function (intelligence test score in the bottom quartile) were 34.9%, 27.2%, and 25.0%. The outcomes were more prevalent if Apgar score <7 was accompanied by certain fetal or obstetric adversities. After accounting for perinatal characteristics, 5-minute Apgar score <7 was associated with prevalence ratios of 4.02 (95% confidence interval: 2.24; 7.24) for neurologic disability and 1.33 (0.94; 1.88) for low cognitive function. CONCLUSION: A five-minute Apgar score <7 has a consistent association with prevalence of neurologic disability and with low cognitive function in early adulthood.

Cognitive function and army rejection rate in young adult male offspring of women with diabetes: a Danish population-based cohort study.

OBJECTIVE: While maternal diabetes is a known risk factor for perinatal complications, there is little data on long-term intellectual outcome in offspring. We compare the rejection rate and cognitive functioning of military conscripts according to maternal diabetes status during pregnancy. RESEARCH DESIGN AND METHODS: We identified a cohort of Danish male offspring of diabetic mothers born between 1976 and 1984 and followed this cohort together with population-based control subjects to military conscription. The main outcome was army rejection rate and cognitive function measured with a validated intelligence test. RESULTS: The army rejection rate was 52.5% among 282 men whose mothers had diabetes during pregnancy and 45.4% among 870 control subjects (risk difference 7.3 [95% CI 0.6-14.0]). Mean cognitive scores were 41.4 units (95% CI 40.2-42.6) in diabetes-exposed conscripts and 42.7 units (42.0-43.4) in control subjects. Stratification by gestational age, Apgar score, and White's class (A-F) did not change the associations. In a subgroup analysis using available data on A1C levels during pregnancy, this variable was inversely associated with cognitive functioning. In men with maternal A1C <7%, cognitive scores were identical to those in control subjects. CONCLUSIONS: The slightly higher army rejection rate in men with maternal diabetes indicates higher morbidity. The identical cognitive functioning in cases of well-controlled maternal diabetes compared with that in control subjects is reassuring, but the negative association between A1C and cognitive score highlights the importance of striving for optimal metabolic control in diabetic women who are or plan to become pregnant.

Rates of lumbar disc surgery before and after implementation of multidisciplinary nonsurgical spine clinics.

STUDY DESIGN: Correlation study. OBJECTIVES: To assess the rates of lumbar disc surgery in North Jutland County, Denmark, before and after implementation of two nonsurgical spine clinics, and to compare the observed rates with those for the rest of Denmark in the same time periods. SUMMARY OF BACKGROUND DATA: Few studies have addressed initiatives to reduce high rates of lumbar disc surgery by improving nonsurgical care offered to patients with sciatica and low back pain. METHODS: The study was conducted in North Jutland County, Denmark with 500,000 inhabitants (10% of the Danish population). In 1997, two nonsurgical spine clinics were established, along with an educational program for general practitioners. The clinics targeted patients with sciatica of 1 to 3 months' duration, with or without low back pain. Data on rates of lumbar disc surgery were obtained from the National Registry of Patients. RESULTS: The annual rate of lumbar disc operations for patients in North Jutland County decreased from approximately 60 to 80 per 100,000 before 1997 to 40 per 100,000 in 2001 (P = 0.00), and the rate of elective, first-time disc surgeries decreased by approximately two thirds (P = 0.00). In contrast, the annual rate of lumbar disc operations for patients in the rest of Denmark remained unchanged during the same period. CONCLUSIONS: The implementation of multidisciplinary, nonsurgical spine clinics coincided closely with a significant reduction in the rate of lumbar disc surgery. The observed reduction seems most likely to be causally associated with educational activities and improved patient care provided by the clinics.

Risk of acute pancreatitis in users of finasteride: a population-based case-control study.

GOALS: To examine the risk of acute pancreatitis in > or = 60-year-old male users of finasteride in a case-control study from a population of 490,000 persons in North Jutland County, Denmark, from 1993 to 2000. STUDY: We identified all men age 60 and over with incident acute pancreatitis from the County Hospital Discharge Registry in North Jutland, 1993 to 2000, and selected 10 age-matched controls per case from the Danish Civil Registration System based on incidence density sampling. All prescriptions for finasteride within 90 days prior to admission with acute pancreatitis were identified from the population-based North Jutland Prescription Database. Data on potential confounding factors were also extracted from registries. We used conditional logistic regression to estimate the relative risk of acute pancreatitis, adjusted for these potential confounders. RESULTS: There were 302 men age 60 and older with incident acute pancreatitis, of whom 3 were exposed to finasteride, and 2994 controls, of whom 37 were exposed to finasteride. The crude odds ratio for having reimbursed prescriptions for finasteride was 0.8 (95% confidence interval, 0.2-2.6). After adjustment for alcohol-related diseases, gallstone disease, hyperlipidemia, hypercalcemia, and hyperparathyroidism, the odds ratio was slightly decreased to 0.5 (95% confidence interval, 0.1-2.5). CONCLUSION: We did not find any increased risk of acute pancreatitis in users of finasteride.

Skin cancers and non-hodgkin lymphoma among users of systemic glucocorticoids: a population-based cohort study.

Patients treated with glucocorticoids may have an increased risk of skin cancer. Using data from the population-based North Jutland Prescription Database and the Danish Cancer Registry, we compared observed and expected numbers of cases of skin cancer and non-Hodgkin lymphoma among 59 043 individuals who received prescriptions for glucocorticoids, a common immunosuppressive therapy, during an 8-year period from January 1, 1989, through December 31, 1996. The overall risks for squamous cell carcinomas and basal cell carcinomas of the skin were increased, particularly among persons who had 15 or more prescriptions (standardized incidence ratio [SIR] for squamous cell carcinomas = 2.45, 95% confidence interval [CI] = 1.37 to 4.04; SIR for basal cell carcinomas = 1.52, 95% CI = 1.09 to 2.07). An elevated risk was also found for non-Hodgkin lymphoma among those with 10-14 prescriptions (SIR = 2.68, 95% CI = 1.16 to 5.29). Our data suggest that use of glucocorticoids may be a shared risk factor for certain skin cancers and lymphomas.

Hospital discharges and 30-day case fatality for drug poisoning: a Danish population-based study from 1979 to 2002 with special emphasis on paracetamol.

OBJECTIVE: To examine the number of hospital discharges and 30-day case fatalities due to drug poisoning based on data from a Danish County Hospital Discharge Registry from 1979 to 2002. METHODS: All patients with a hospital discharge diagnosis of drug poisoning were identified and separated into groups taking: (1) opioid analgesics; (2) non-opioid analgesics; (3) anxiolytics; (4) antidepressants; (5) antipsychotics; or (6) non-specified. Paracetamol and salicylate were analysed separately. From 1994 to 2001, the total amount of drugs sold in the county was identified from a national drug database. RESULTS: A total of 13,432 patients with a median age 41.5 years at discharge of whom 59% were females accounted for 20,249 discharges for drug poisoning. The overall number of discharges remained essentially stable around 170 discharges per 100,000 inhabitants per year. From the mid-1990's, paracetamol became the most frequently used drug in poisoning with the largest increase in female teenagers. Thirty-day case fatality in poisoning with opioids was 3.6% compared with around 1% in other drug categories. For most drug categories, a sale of around 80,000 defined daily doses was associated with one hospital discharge due to drug poisoning. CONCLUSION: The overall number of hospital discharges remained stable and seems primarily related to amount of drugs available. With almost 10 years delay, the easier access to paracetamol was followed by an increase in hospitalisation due to poisoning with paracetamol. However, although the majority of hospitalisations were found in the younger age group, the highest mortality was seen among the elderly.