Patient characteristics associated with prescribing of a newly introduced drug: the case of rofecoxib.

OBJECTIVE: To identify socio-demographic characteristics of the first patients receiving a new drug--rofecoxib. OUTCOME MEASUREMENT: Patients starting on rofecoxib or another non-steroidal anti-inflammatory drug (NSAID) and who had not received any NSAIDs the 90 days prior to starting. RESULTS: Starting on rofecoxib was associated with an increasing age (OR in age 80 years and older 8.7; 95% CI 6.7-11.2), a poor self-perceived health (OR=2.4; 95% CI 1.8-3.3), female gender (OR=1.4; 95% CI 1.2-1.6), private insurance (OR=1.3; 1.1-1.5) and previous acetaminophen use (OR=1.3; 1.1-1.7). CONCLUSION: This study noted that specific patient characteristics were associated with getting rofecoxib prescribed shortly after marketing. General practitioners should be aware of selectively prescribing new drugs to specific patients because it may place patients at unintentional and avoidable risk.

Patterns of psychotropic medicine use and related diseases across educational groups: national cross-sectional survey.

OBJECTIVE: To analyse whether the use of different groups of psychotropic medicines among educational groups in a general population was congruent with the occurrence of related diseases. METHODS: Data from The Danish Health and Morbidity Survey 2000 were analysed. The survey was conducted by face-to-face interviews with a representative sample of the Danish population aged 16 years and above ( n=16,690). The prevalence of four different types of psychotropic medicine use and related diseases in educational groups was analysed by indirect standardisation. Age and gender standardised prevalence ratios (SPRs) and 95% confidence intervals were calculated based on the total study population. RESULTS: In general, respondents in the two least-educated groups used psychotropic medicines more often and had a higher proportion reporting the related disease than could be expected according to indirect standardisation. The opposite picture appeared for respondents in the two highest educated groups (SPR<100). The overall patterns were similar for all four groups of psychotropic medicine users, although some of the SPRs were not significant. CONCLUSIONS: The results documented an uneven distribution of health problems in the general population. Psychotropic medicine use was congruent with the distribution of related health problems, which means that the least-educated groups in most need of treatment also had the most-frequent medicine use. Expenses incurred by the individual user did not seem to be a barrier to access to medicines, not even for specific groups of medicine ineligible for reimbursement in Denmark.

Prescription and non-prescription medicine use in Denmark: association with socio-economic position.

OBJECTIVE: To analyse the association among different types of medicine use and different measures of socio-economic position (SEP) in one and the same general population. METHODS: Data from The Danish Health and Morbidity Survey 2000 were analysed. The survey was conducted by face-to-face interviews with a representative sample of the adult Danish population (n=16,690). The associations between prescription and over-the-counter (OTC) medicine use and education, occupation and income were assessed by logistic regression analyses. All analyses were adjusted for age, gender and two measures of health status. RESULTS: This cross-sectional analysis of medicine use in a large representative sample of the Danish population found greater use of prescription medicines among disability pensioners and "others" than in salaried employees. Disability pensioners and self-employed individuals used less OTC medicine than salaried employees. Individuals with low income used more prescription medicines but not more OTC medicines, than those with high income. No major differences were found in prescription medicine use with respect to education, but men within the two middle educational groups tended to use prescription medicine less frequently than both lower and higher educated men. A similar trend was not found for women. OTC medicine use was not associated with education for either gender. CONCLUSIONS: The prevalence of prescription medicine use increases with declining SEP, after adjusting for health status. Such an association does not exist for OTC medicine use. The results show that the least affluent have access to prescription medicine. The difference between prescription and OTC medicine use may be explained by a compensation mechanism.

Methylenedioxy- and methoxyflavones from Melicope coodeana syn. Euodia simplex.

Three new natural products, 3,8-dimethoxy-5,7-dihydroxy-3',4'-methylenedioxyflavone, 3,6,8-trimethoxy-5,7-dihydroxy-3',4'-methylenedioxyflavone and 3,6,8,3',4'-pentamethoxy-5,7-dihydroxyflavone were isolated from Melicope coodeana syn. Euodia simplex (Rutaceae) along with 3,6,3'-trimethoxy-5,7,4'-trihydroxyflavone and 3,3'-dimethoxy-5,7,4'-trihydroxyflavone. The structural assignments are based on (1)H and (13)C NMR data, including discussion of the chemical shifts of C-2 in 3,5-dihydroxy- and 3-methoxy-5-hydroxyflavones. The presence of highly methoxylated and methylenedioxyflavones is characteristic of the genus Melicope, and the present findings support the recent transfer of Euodia simplex to Melicope.