Validation of a brief version of the Difficulties in Emotion Regulation Scale (DERS-16) with an older Norwegian population.

Emotion regulation is proposed to have a salient role in optimal aging. However, currently used measures of emotion regulation have not been validated for older adults. Therefore, we evaluated the psychometric properties of the Difficulties in Emotion Regulation Scale-short form (DERS-16) in a large Norwegian sample consisting of individuals between 70 and 95 years (n = 2525). Tests of internal consistency, reliability, assessment of intra-domain correlations, and confirmatory factor analyses were performed. Construct validity was further investigated by assessing concurrent associations between DERS-16 and well-established measures of psychological disorders, psychological health, and well-being (five-item version of Geriatric Depression Scale, Geriatric Anxiety Inventory-short form, and OECD guidelines on measuring subjective well-being). All subscales derived from the instrument showed adequate internal consistency. Furthermore, we obtained a theoretically consistent factor structure, in which a bifactor model combining a general emotion regulation factor and five additional domain-specific facet-factors had superior model fit. As expected, difficulties in emotion regulation correlated positively with symptoms of depression and anxiety, and negatively with psychological health and well-being. Associations were generally of moderate strength. We can thus conclude that the DERS-16 demonstrates excellent psychometric properties when used in samples with older adults and may safely be employed in studies of emotion regulation difficulties in the older segment of our population.

[Utilisation of first-line antibiotics six years after a multifaceted intervention]. / Uso de antibióticos de primera línea 6 años después de una intervención multifacética.

OBJECTIVE: No study has evaluated the impact of a multifaceted intervention on the quality of the antibiotics prescribed more than 5 years later. METHODS: A total of 210 general practitioners (GP) from eight different regions of Spain were asked to participate in two registrations of respiratory tract infections (RTI) in 2008, before, and in 2009, just after a multifaceted intervention including prescriber feedback, clinical guidelines, training sessions focused on appropriate antibiotic prescribing, workshop on rapid tests and provision of these tests in the GP consultation. They were all again invited to participate in a similar registration in 2015. A new group of clinicians from the same areas who had never participated in antimicrobial stewardship courses were also invited to participate and acted as controls. RESULTS: The 121 GPs who continued the study (57.6%) and the 117 control GPs registered 22,407 RTIs. The antibiotic most commonly prescribed was amoxicillin and clavulanic acid, prescribed in 1,801 cases (8.1% of the total), followed by amoxicillin (1,372 prescriptions, 6.2%), being lower among GPs just after the intervention. The third leading antibiotic among GPs just after the intervention was penicillin V (127 cases, 3.3%) whereas macrolides ranked third in the other three groups of GPs. CONCLUSIONS: The use of first-line antibiotic for RTIs wanes over time after an intervention, but their utilisation is still significantly greater among intervened clinicians six years later compared to GPs who have never been exposed to any antimicrobial stewardship programmes.

Effects of Diagnostic Work-Up on Medical Decision-Making for Canine Urinary Tract Infection: An Observational Study in Danish Small Animal Practices.

BACKGROUND: Clinical signs of urinary tract disease in dogs often lead to prescription of antibiotics. Appropriate diagnostic work-up could optimize treatment and reduce the risk of inappropriate use of antibiotics. HYPOTHESIS/OBJECTIVES: To describe and evaluate the impact of diagnostic work-up on decision to treat (DTT) and choice of antibiotic treatment (COT) for dogs presenting with clinical signs of urinary tract disease. ANIMALS: One hundred and fifty-one dogs presenting to 52 Danish veterinary practices. METHODS: Prospective, observational study. Clinical signs, diagnostic work-up, and prescriptions were recorded. Urine samples were submitted to a reference laboratory for quantitative bacterial culture (QBC) and susceptibility testing. The laboratory results were used as reference for assessing the appropriateness of DTT and COT. RESULTS: In the majority of dogs, veterinarians performed dipstick (99%), microscopic examination of urine (80%) and bacterial culture (56%). Fifty-one percent of dogs had urinary tract infection (UTI) based on reference QBC. Appropriate DTT was made for 62% of the dogs, while 36% were over-prescribed and 2% under-prescribed. Inappropriate use of second-line agents was found in 57% of the UTI cases. Performing microscopy-but not culture-significantly impacted DTT (P = 0.039) while no difference was seen in COT (P = 0.67). The accuracy of in-house microscopy and culture were 64.5 and 77%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Over-prescription of antibiotics was common among dogs with suspected UTI, regardless of the diagnostic work-up performed. Test inaccuracy under practice conditions and incoherence between diagnostic test results and decision-making both explained inappropriate and unnecessary use of antibiotics.

Prescripción antibiótica en infecciones respiratorias agudas en atención primaria / Antibiotic prescribing in acute respiratory tract infections in general practice

Introducción: La resistencia a antimicrobianos representa una amenaza para la salud pública mundial. Las infecciones respiratorias agudas son el principal motivo de prescripción antibiótica en la población pediátrica española. El objetivo del estudio fue describir la frecuencia de prescripción y el patrón de utilización de antibióticos en infecciones respiratorias agudas, diagnosticadas en atención primaria, en la población pediátrica de Aragón. Material y método: Se incluyeron los episodios de otitis aguda, faringoamigdalitis aguda, infección respiratoria superior inespecífica y bronquitis aguda, registrados durante un año, en niños de 0-14 años. Se calculó la proporción de episodios que recibieron antibiótico, por diagnóstico y grupo de edad, y describió el patrón prescriptor. Resultados: El 50% de los niños fueron diagnosticados de infección respiratoria aguda durante el periodo de estudio, siendo la infección respiratoria superior inespecífica la más frecuente. Se prescribió un antibiótico en el 75% de las faringoamigdalitis, 72% de otitis, 27% de bronquitis y 16% de infecciones respiratorias superiores inespecíficas. Los antibióticos más prescritos fueron los de amplio espectro, principalmente amoxicilina y amoxicilina-clavulánico. Conclusiones: El uso de antibióticos en infecciones respiratorias agudas pediátricas fue, en general, elevado, y la elección del tipo de antibiótico podría ser inadecuada en un porcentaje elevado de casos. Se considera necesaria una mejora en la práctica prescriptora de antibióticos en niños (AU)

Introduction: Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). Methodology: A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. Results: Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. Conclusions: Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed (AU)

[Antibiotic prescribing in acute respiratory tract infections in general practice]. / Prescripción antibiótica en infecciones respiratorias agudas en atención primaria.

INTRODUCTION: Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). METHODOLOGY: A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. RESULTS: Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. CONCLUSIONS: Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed.

Quantification of Faecalibacterium prausnitzii- and Subdoligranulum variabile-like bacteria in the cecum of chickens by real-time PCR.

The intestinal microbial community is playing an important role in health and production performance of chickens. To understand the effect on the intestinal microflora induced by various feeding strategies, feed additives, infections, and intestinal disorders, it is important to have methods for quantifying potentially important bacteria in the intestine. We describe a real-time quantitative assay for detection and quantification of a whole group of Faecalibacterium prausnitzii and Subdoligranulum variabile-like bacteria, which has recently been found to dominate in the cecum of broiler chickens. The F. prausnitzii-S. variabile-like bacteria were quantified using a multiprobe assay in which one primer set was used to amplify DNA from all bacteria, whereas 2 probes detected all bacteria and the group of F. prausnitzii-S. variabile-like bacteria, respectively. The multiprobe assay accurately quantified the percentage of this group in a sample if it constituted more than approximately 5% of the total bacterial community. If the fraction of F. prausnitzii-S. variabile-like bacteria was lower than 5%, a duplex assay was applied in which the total bacteria were amplified in one tube and the F. prausnitzii-S. variabile-like group of bacteria was amplified in another tube using a specific forward primer. The F. prausnitzii-S. variabile-like group of bacteria was quantified in the cecum and ileum of conventional and organic raised chickens, in chickens kept in an isolator from 1 d of age, and in hatcher material. Quantification of this group of F. prausnitzii-S. variabile-like bacteria has not been performed before by real-time PCR, but results confirm previous results obtained by cloning and sequencing showing that the F. prausnitzii-S. variabile-like group of bacteria constitutes a major fraction of the cecal bacterial community in chickens. Furthermore, results indicate that the poultry farm environment plays a role in recruitment and development of these bacteria in the intestinal microflora.

Variability in the prescription of cholinesterase inhibitors and memantine.

BACKGROUND/AIM: To estimate the prevalence of Alzheimer's disease (AD) treatment in Aragon (Spain), analyzing differences according to age, gender and health area. METHODS: Retrospective study on AD treatment prevalence of cholinesterase inhibitors and memantine during 2005, using pharmaco-epidemiological data from prescription refunds transferred monthly from pharmacies to the Health Care Service. RESULTS: Differences between health areas were considerable, with adjusted prescription rates between 121.6 and 248.6/100,000 individuals. Treatment rates for women doubled those of men in each health area. Variability was greater among men than women. Drug prescription distribution was also different between health areas. CONCLUSION: Considerable variability in AD treatment has been detected. More consensus is needed to reduce variability in order to improve the quality of the pharmacotherapy for AD and assure equal treatment opportunities for every patient.

Photobacterium damselae subsp. damselae, an emerging pathogen in Danish rainbow trout, Oncorhynchus mykiss (Walbaum), mariculture.

A selection of 16 field isolates of Photobacterium damselae from marine rainbow trout farms in Denmark was subjected to phenotypic and genotypic characterization and pathogenicity to fish. All isolates belonged to the subspecies damselae, being positive for haemolysis, motility and urease. There were considerable differences in haemolytic properties, some isolates presenting a broad zone of haemolysis and others only a narrow zone. Pulsed-field gel electrophoresis revealed a high diversity indicating that P. damselae subsp. damselae is an opportunistic, not clonal pathogen in Danish marine rainbow trout. Virulence of the strains to rainbow trout was highly variable with LD(50) values ranging from 3.9 x 10(3) to 1.5 x 10(8) cfu at 20 degrees C. The virulence was significantly higher at 20 degrees C than at 13 degrees C. The strains with the strongest haemolytic properties were the most virulent suggesting a strong involvement of haemolysin in the pathogenesis. The pathological changes were consistent with a bacterial septicaemia and the haemorrhages were more pronounced than for most other bacterial infections.

Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care.

PURPOSE: To evaluate the effect of a combined or a single educational intervention on the prescribing behaviour of general practitioners (GPs). The primary endpoint was effect on inappropriate prescribing according to the Medication Appropriateness Index (MAI). METHODS: General practitioners were randomised to either (1) a combined intervention consisting of an interactive educational meeting plus feedback on participating patients' medication, (2) a single intervention with an interactive educational meeting or (3) a control group (no intervention). Elderly (>65 years) patients exposed to polypharmacy (>or=5 medications) were identified and approached for inclusion. Data on medications prescribed over a 3-month period were collected, and the GPs provided detailed information on their patients before and after the intervention. A pre- and post-MAI were scored for all medications. RESULTS: Of the 277 GPs invited to participate; 41 (14.8%) volunteered. Data were obtained from 166 patients before and after the intervention. Medication appropriateness improved in the combined intervention group but not in the single intervention group. The mean change in MAI and number of medications was -5 [95% confidence interval (CI) -7.3 to -2.6] and -1.03 (95% CI -1.7 to -0.30) in the combined intervention group compared with the group with the educational meeting only and the no intervention group. CONCLUSIONS: A combined intervention consisting of an interactive educational meeting plus recommendations given by clinical pharmacologists/pharmacists concerning specific patients can improve the appropriateness of prescribing among elderly patients exposed to polypharmacy. This study adds to the limited number of well-controlled, randomised studies on overall medication appropriateness among elderly patients in primary care. Important limitations to the study include variability in data provided by participating GPs and a low number of GPs volunteering for the study.

Microbial community composition of the ileum and cecum of broiler chickens as revealed by molecular and culture-based techniques.

The microbial communities of the ileum and cecum of broiler chickens from a conventional and an organic farm were investigated using conventional culture techniques as well as cloning and sequencing of 16S rRNA genes. Eighty-five percent of the 557 cloned sequences were <97% related to known cultured species. The chicken ileum was dominated by lactobacilli, whereas the cecum harbored a more diverse microbial community. The cecum was dominated by a large group of bacteria with hitherto no close cultured relatives but most closely related to Faecalibacterium prausnitzii. Approximately 49 and 20% of the cecal clones belonged to this cluster in conventional and organic broiler chickens, respectively. We were, however, able to recover a number of these phylotypes by cultivation, and the isolates were shown to be butyric acid producers. The investigation was a descriptive rather than a comparative study of 2 different rearing systems; however, several differences were observed. For instance, Clostridium perfringens was found in significantly higher numbers in the birds from the organic farm compared with the conventional broilers, probably due to the addition of salinomycin to the conventional feed. In the ileum, the abundance of the different Lactobacillus species differed between the 2 broiler types. The culture-based and culture-independent techniques complemented each other well. Strengths and limitations of the different methods are discussed.

Trends in utilization of antiepileptic drugs in Denmark.

OBJECTIVES: To describe utilization of antiepileptic drugs (AEDs) in Denmark during 1993-2002, with special emphasis on oxcarbazepine, and to assess probable indications for AED use. MATERIALS AND METHODS: We retrieved prescription data from Odense University Pharmacoepidemiological Database, in Funen County, Denmark (population in 2002: 472,869). Within each calendar year we estimated period prevalence, incidence rate and monotherapy rate. Based on co-medication we defined 'epilepsy' when only AEDs were prescribed, 'pain' with co-prescription of opioids, and 'mood disorder' with co-prescription of antipsychotics or antidepressants. RESULTS: We identified 15,604 AED users. The prevalence of using AED increased from 9.3 (95% CI, 9-9.5) to 12.1 (11.8-12.4)/1000 persons. The incidence rate increased from 1.4 (1.3-1.6) to 1.7 (1.6-1.9)/1000 personyears. The monotherapy rate was 79-82%. AED use for 'epilepsy' declined by 19.7%, whereas the proportion of 'pain' and 'mood disorder' treatment increased by 11.2% and 8.4% respectively. CONCLUSIONS: Antiepileptic drug utilization increased during the study period, the increase probably caused by expanding use in areas other than epilepsy.

Effects of a Campylobacter jejuni infection on the development of the intestinal microflora of broiler chickens.

The effect of a Campylobacter jejuni colonization on the development of the microflora of the cecum and the ileum of broiler chickens was studied using molecular methods. The infection did affect the development and complexity of the microbial communities of the ceca, but we found no permanent effect of a C. jejuni infection on the ileal microflora of the broilers. In addition, denaturant gradient gel electrophoresis (DGGE) profiles generated from cecal and ileal contents revealed several DGGE bands that were present in the control chickens, but not in the chickens colonized with C. jejuni. Some of these DGGE bands could be affiliated with Lactobacillus reuteri, Clostridium perfringens, and the genus Klebsiella.

The influence of whole wheat feeding on Salmonella infection and gut flora composition in broilers.

In an experiment with broilers infected with a rifampicin-resistant Salmonella Typhimurium strain at 15 days of age, it was demonstrated that whole wheat feeding influenced the course of infection. The pH in the contents of the gizzard decreased as the amount of whole wheat in the diet increased over time. Following infection, lower numbers of Salmonella Typhimurium were found in the gizzard and ileum of birds receiving whole wheat compared to pellet-fed birds. However, there was no difference with respect to the numbers of Salmonella Typhimurium in the ceca and rectum between the two experimental groups. Quantitative cultivation of different groups of bacteria belonging to the natural intestinal microflora showed that whole wheat feeding significantly reduced the numbers of Clostridium perfringens in the intestinal tract of the birds. The present results indicate that the gizzard has an important function as a barrier organ, one that prevents pathogenic bacteria from entering the distal digestive tract.

Infection models for Salmonella typhimurium DT110 in day-old and 14-day-old broiler chickens kept in isolators.

A series of experiments was undertaken to investigate the infection dynamics of various doses of S. typhimurium in day-old and 14-day-old broiler chickens kept in isolators. The infections were followed quantitatively in ceca and ileum by enumerating the colony forming units (cfu) of the challenge strain. It was found that the inoculation of 10(7) cfu of S. typhimurium to day-old chickens established stable cecal infection in all the animals for 35 days. For 14-day-old chickens, stable and lasting infections were seen with inoculation of 10(9) cfu. Lower doses yielded more variable results, and the bacteria were rapidly eliminated from most birds, especially in 14-day-old inoculated chickens. Salmonella was found in spleen and liver 2-3 days postinoculation. Salmonella was cleared from both organs or reduced to very low numbers within 3 weeks.

Guidelines accompanied by changes in reimbursement rules. Effects on lipid-lowering drug prescribing.

OBJECTIVE: To analyse the effect of guidelines accompanied by changes in reimbursement rules for the prescription of lipid-lowering drugs (LLDs). DESIGN: Observational study focusing on LLD use before (1994-98) and after an intervention (1999). SETTING: Guidelines were developed by the Danish College of General Practitioners and focused on prevention of cardiovascular heart disease (CHD). Guidelines were sent out and changes in reimbursement took place in December 1998. Prescriptions for LLDs were extracted from a population-based prescription database (Odense University Pharmacoepidemiological Database, OPED) covering 10% of the Danish population (470,000 inhabitants). MAIN OUTCOME MEASURES: Incidence rate and 1 year prevalence rate (annual prevalence) of LLD use. RESULTS: The incidence of LLD use increased significantly in the year following the intervention. Incidence rate ratio (after/before) was 1.43 (CI 1.35-1.52). The annual prevalence of LLD use in the population increased by 0.4% after the intervention (0.2% before). The corresponding figure for patients with diabetes mellitus (treated with insulin or oral anti-diabetics) was 2.3% after the intervention (1.2% before), and for patients with CHD (treated with vasodilators) 8.1% after the intervention (5.0% before). CONCLUSION: Guidelines accompanied by a change in reimbursement rules had a significant influence on the prescribing of lipid-lowering drugs.

[How many prescription drugs does a general practitioner handle? A prescription database study]. / Hvor mange forskellige laegemidler håndterer en praktiserende laege? En receptdatabase-undersøgelse.

INTRODUCTION: General practitioners must know of treatments for a broad range of diseases, but it may be difficult to keep abreast of the effects and adverse reactions of a large spectrum of drugs, and a good quality of prescribing implies the use of a limited number of analogue products. The aims were to investigate the number of different drugs prescribed per practice and to analyse the influence of practice characteristics on this number. MATERIAL AND METHODS: The study comprised 173 general practices (99 single and 74 group practices in the County of Funen, Denmark. All prescription registered on the Odense Pharmaco-epidemiological Database (OPED) were analysed. The main outcome measure was the number of different drugs prescribed per dispensing unit. RESULTS: The number of different drugs prescribed per dispensing unit varied almost fourfold (range: 102 to 381) and four practice characteristics were able to predict 74% of this variation. Practices with several doctors, a high number of patients listed per doctor, a high percentage of elderly patients, and a heavy workload showed the highest number of different drugs prescribed. CONCLUSION: There is almost a fourfold variation in the number of different drugs used in general practice, and three-quarters of this variation is associated with factors related to the practice.

Nitrification in sequencing biofilm batch reactors: lessons from molecular approaches.

The nitrifying microbial diversity and population structure of a sequencing biofilm batch reactor receiving sewage with high ammonia and salt concentrations (SBBR 1) was analyzed by the full-cycle rRNA approach. The diversity of ammonia-oxidizers in this reactor was additionally investigated using comparative sequence analysis of a gene fragment of the ammonia monooxygenase (amoA), which represents a key enzyme of all ammonia-oxidizers. Despite the "extreme" conditions in the reactor, a surprisingly high diversity of ammonia- and nitrite-oxidizers was observed to occur within the biofilm. In addition, molecular evidence for the existence of novel ammonia-oxidizers is presented. Quantification of ammonia- and nitrite-oxidizers in the biofilm by Fluorescent In situ Hybridization (FISH) and digital image analysis revealed that ammonia-oxidizers occurred in higher cell numbers and occupied a considerably larger share of the total biovolume than nitrite-oxidizing bacteria. In addition, ammonia oxidation rates per cell were calculated for different WWTPs following the quantification of ammonia-oxidizers by competitive PCR of an amoA gene fragment. The morphology of nitrite-oxidizing, unculturable Nitrospira-like bacteria was studied using FISH, confocal laser scanning microscopy (CLSM) and three-dimensional visualization. Thereby, a complex network of microchannels and cavities was detected within microcolonies of Nitrospira-like bacteria. Microautoradiography combined with FISH was applied to investigate the ability of these organisms to use CO2 as carbon source and to take up other organic substrates under varying conditions. Implications of the obtained results for fundamental understanding of the microbial ecology of nitrifiers as well as for future improvement of nutrient removal in wastewater treatment plants (WWTPs) are discussed.

[Resistance testing in general practice--is it valid?]. / Resistensbestemmelse i almen praksis--duer det til noget?

Resistance of uropathogenic bacteria to antibiotics is an increasing problem in primary health care. The aim of this study was to evaluate antibacterial susceptibility testing of uropathogenic when performed in general practice. Urine specimens with a known quantity of typically uropathogenic bacteria were sent to 25 general practices. The predictive values of testing a bacterial strain as susceptible ranged from 0.89 (nitrofurantoin) to 1.00 (sulphamethizole), and the predictive value of testing a bacterial strain as resistant ranged from 0.55 (trimethoprim) to 0.90 (nitrofurantoin). If susceptibility testing is to be widely implemented in general practice it would be necessary to improve the validity.

Wide variation in the number of different drugs prescribed by general practitioners. A prescription database study.

OBJECTIVES: To investigate the number of different drugs prescribed per dispensing unit and to analyse the influence of practice characteristics on this number. DESIGN: Register analysis based on the Odense Pharmacoepidemiological Database (OPED). SETTING: General practices in the County of Funen, Demnark. SUBJECTS: 173 general practices (99 single-handed and 74 group practices). MAIN OUTCOME MEASURES: Number of different drugs prescribed per dispensing unit. RESULTS: The number of different drugs prescribed per dispensing unit varied nearly fourfold (range 102-381) and four practice characteristics were able to predict 74% of this variation. Practices with several doctors, a high number of patients listed per doctor, a high percentage of elderly individuals, and a heavy workload showed the highest number of different drugs prescribed. CONCLUSION: As the quality of drug prescribing is associated with the use of a limited number of drugs, it is suggested that GPs should agree on a formulary containing the most essential drugs in primary health care.

Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions.

OBJECTIVE: We examined to what extent the evidence of the relative gastrointestinal toxicity with non-steroidal anti-inflammatory drugs (NSAIDs) was implemented in clinical practice in Bologna, Italy, Funen, Denmark, and Stockholm, Sweden, areas with accurate computerised information on prescriptions purchased by defined populations. METHODS: We ranked each NSAID by purchased volume in defined daily doses during September 1996 and compared it with the ranking of gastrointestinal complications from a meta-analysis of controlled epidemiological studies published between 1986 and 1994. We restricted our comparison to those NSAIDs that accounted for 90% of the use and within this DU90% segment we determined the proportion of "high risk" (azapropazone, ketoprofen, piroxicam) and "low risk" (ibuprofen, diclofenac) drugs with respect to gastrointestinal toxicity. RESULTS: In Funen, Denmark, we found the best NSAID profile (63% low risk/11% high risk) while Bologna, Italy, had the other extreme (26% low risk/38% high risk), with Stockholm, Sweden, in between (43% low risk/20% high risk). CONCLUSION: Our study suggests that factors other than evidence-based medicine had a dominating impact on the use of prescription NSAIDs in 1996.