International trends in clozapine use: a study in 17 countries.

OBJECTIVE: There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis. METHOD: A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide. RESULTS: In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000). CONCLUSION: While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation.

[Infectious complications in cesarean section: previous classification and use of antibiotics]. / Complicaciones infecciosas en la operación cesárea: clasificación previa y uso de antibióticos.

A retrospective study of all the patients that underwent cesarean section at "Ramón Gonzalez Coro" Gynecoobstetric Hospital in 1997 and 1998 was made. The information about some variables, such as the diagnosis of cesarean sections, the frequency of infectious complications, the presence of complications according to the classification, the correct and incorrect use of antibiotics according to the classification of the surgical procedure and the occurrence of infectious complications due to the correct or incorrect use of antibiotics that were collected in the database of the Automated System to register cesarean sections was processed. The main indication was anterior cesarean section (34.1%), followed by cephalopelvic disproportion (13.5%). 17.1% had some infectious complications. Endometritis was the most frequent complicatrion (7.9%). Most of the infectious complications occurred in the clean cesarean sections (16.7%) and in the dirty cesarean sections (22.3%). The best use of antibiotics was observed in both groups (96.5 and 96.6%, respectively). Patients with an incorrect use of antibiotics had more infectious complications (37.8%). A statistical association was found between these 2 variables (p = 7.569 x 20).