A population-based study of antibiotic prescriptions for Danish children.

BACKGROUND: The aim of the study was to examine the use of systemic and topical antibiotics in relation to age and sex in Danish children. METHODS: We used the Pharmacoepidemiological Prescription Database to identify the individual prescriptions of antibiotics provided for all 0-to 15-year-old children in North Jutland County, Denmark, during 1997. The population was approximately 95000 children. RESULTS: We identified 44640 prescriptions for systemic antibiotics. The annual prescription rate was highest in the 1- to 2-year-olds, with 945 prescriptions/1000 children/year. One-half of these children received at least 1 prescription, and 12% received 3 or more prescriptions. Among the 11- to 15-year-old children 17% received one or more prescriptions. Overall 88% of the prescriptions were penicillins and 10% were macrolides. In children younger than 3 years 57% of prescriptions were for broad spectrum penicillins, but in children older than 6 years penicillin V was the most frequently used antibiotic. We identified 12 661 prescriptions for topical antibiotics used in eye infections. The prescription rate peaked in the 1- to 2-year-old children, one-third of whom received at least 1 prescription. CONCLUSIONS: Almost two-thirds of the 0- to 2-year-old children in the population were treated with either systemic or topical antibiotics during 1 year. Physicians prescribe mostly penicillins, but the proportion of broad spectrum penicillins for young children was so high, however, that enforcement of national guidelines should be reconsidered.

Is semen quality related to the year of birth among Danish infertility clients?

BACKGROUND: There is circumstantial evidence that human sperm count may have declined during past decades. The purpose of this study was to identify the association between semen quality and year of birth. METHODS: The study comprised 8608 men consulting four Danish medical centres from 1968 to 1992 because of infertility. Data on semen quality and urogenital disorders were obtained from medical records while lifestyle data were collected from a subset of the population by a postal questionnaire (response 80%). Semen characteristics were analysed as a linear function of year of birth, centre, season and calendar year at time of semen examination, sexual abstinence and lifestyle factors. Effects of age were accounted for by restriction and stratified analysis. RESULTS: The sperm count declined with increasing year of birth at two of the four centres, but this association disappeared when confounders were adjusted for. Within the subset of men born 1950-1970 we revealed a decrease in the average sperm count by 1.9 mill/ml (95% confidence interval [CI]: 1.45, 2.27) per one advancing year of birth. This finding was consistent across centres even after adjustment for effects of covariates. The proportion of morphologically normal sperm cells changed in parallel with the sperm count, while semen volume did not decline in any time periods. CONCLUSIONS: We found a birth cohort effect on sperm count and morphology among Danish infertile men born after 1950 but not in men born in the first part of the century. The findings are compatible with an environmental impact during prenatal life but the evidence is far from unequivocal.

IL-10 augments the IFN-gamma and TNF-alpha induced TARC production in HaCaT cells: a possible mechanism in the inflammatory reaction of atopic dermatitis.

The CC-chemokine TARC is known to be a ligand for the CCR4 receptor which in turn is known to be expressed selectively on the Th(2)-subset of lymphocytes. Atopic dermatitis is generally believed to be a Th(2)-type disease, and TARC has been shown to be expressed in the skin lesions of a murine model of AD. IL-10 is an interleukine generally known for its ability to inhibit cytokine production, however it has been found to be highly expressed in the skin from AD patients. We show in this report that IL-10 is able to augment the TARC inducing effects of TNFalpha and IFNgamma in HaCaT cells, a property that may be important in the determination of the composition of the cells of the inflammation in the skin of AD patients. In addition, we show that the IL10 agonist IT 9302, a nona-peptide from the carboxylic end of IL-10, has the same effect on TARC production from HaCaT cells.

Risk for reduced sperm quality among metal workers, with special reference to welders.

The purpose of this study was to investigate whether men employed in the metal industry have sperm of poorer quality than men in other types of work. A postal questionnaire was sent to men employed in the metal industry, certain other types of nonmetal industries, and other types of employment in which the factors suspected to influence sperm quality were not present. By means of this questionnaire survey, it was hoped to define the possible influences of the work environment on sperm quality. Out of the total of 3,119 men included in the investigation, 2,517 (81%) filled out the questionnaire satisfactorily. Semen analysis was performed for all 3,119 men. There was a greater risk for poor sperm quality among welders than among men not employed in welding. The risk for poor sperm quality was increased for those welders who worked with stainless steel. Welding in general, and specifically with stainless steel, is connected with a risk of reduced sperm quality.

Thiazides in the prophylactic treatment of recurrent idiopathic kidney stones.

In a double-blind prospective clinical study patients with at least two verified episodes of urolithiasis, but stone-free at the time of inclusion in the study, were subjected to prophylactic treatment with either bendroflumethiazide (2.5 mg) + 573 mg potassium chloride 3 times a day, or placebo. The material included a total of 22 patients, all males, aged 20-49 years. We found a clear tendency to reduced stone formation in the group treated with the active drug (P less than 0.01). Calcium excretion was reduced by 25-50% in 7 of 12 patients treated with thiazide.

[Pregnancy-related and work-related sick leave of pregnant women]. / Graviditetsrelaterede og arbejdsmaessige begrundelser for fravaersmelding af gravide.

Pregnant women are allowed sick leave (SL) due to obstetrical or occupational risk factors. The aim was to describe reasons for SL during pregnancy. Pregnant women in a Danish county applying for SL were consecutively included in the study during 12 months in 1991-92. Data were obtained by questionnaires mailed to the women and their medical doctors. Of 1483 pregnant women on SL, 994 participated. Approximately 96% were on SL due to obstetrical risk factors. Occupational factors contributed to SL in at least 50% of the cases, mainly when working in a standing or walking position or when lifting. The women were rarely replaced in other jobs before leaving work. On average the women were absent for 83 days before official pregnancy leave started. Although SL during pregnancy is overwhelmingly due to obstetrical risk factors, occupational factors often contribute. Occupational Health and Safety Organizations are rarely involved at the workplace before issuing a sick leave certificate.

[Cheese-packers' disease--respiratory complaints at a cheese-packing dairy]. / Ostepakkersyge--luftvejsklager på et skimmelostepakkeri.

Twenty-one present and three former employees working in the paching room of a cheese-making dairy underwent clinical examinations including symptom history, smoking habits, chest examination, and pulmonary function tests. Blood samples were drawn to determine level of peripheral eosinophil count and antibodies to microorganisms detected by air samples. Air sample concentrations of Penicillium camemberti var. candidum, used in the cheese-production, were very high (> 6000 colony forming units per cubic metre of air). In 15 of the 24 exposed workers, precipitating antibodies towards this fungus were detected, but no antibodies were detected in a reference consisting of pooled blood from 1000 donors. Of the sixteen workers with airway symptoms five had asthma requiring treatment. Two-thirds of the symptomatic cheeseworkers but only half of those without symptoms had precipitating antibodies. The high frequency of precipitating antibodies together with the clinical causes of the airway symptoms indicates an aetiological relationship between airway symptoms and heavy exposure to Penicillium camemberti.

[What did the consumers get out of the examination at a clinic of occupational medicine?]. / Hvad fik brugerne ud af undersøgelse på arbejdsmedicinsk klinik?

In order to evaluate the function of a department of occupational medicine regarding consumer satisfaction, a mailed questionnaire was sent to 605 patients examined at the Department of Occupational Medicine, Aalborg Sygehus, during the period 01.10.1988-31.12.1989. A similar questionnaire was sent to the persons referring the patients to the department. Seventy-three percent of the patients and 76% of the persons referring patients participated in the investigation. Of the patients 44% had their expectations fulfilled, of the persons referring 78%. Half of the patients and 69% of the persons referring found the advice given relevant in relation to the health problem. Satisfaction among patients was related to whether the patients expected to start a compensation case or suffered from a chronic disease for which treatment was difficult. There was a difference between the expectations of the patients and persons referring the patients examination.

[The clientele at a clinic of occupational medicine--a medical statistical review]. / Klientellet på en arbejdsmedicinsk klinik--en medicinalstatistisk opgørelse.

To elucidate changes over time in the patient clientele examined at the department of occupational medicine, Aalborg Sygehus Nord, in the period 1982-1991, 4956 registrations related to referral and examination were studied in a retrospective investigation. The number of patients working at the time of examination has been steadily declining during the period. The number of patients with toxic encephalopathy is declining, while the number of patients with diseases in the musculoskeletal system is growing. Pregnant women with possible risk in the occupational environment and patients with cancers and mental illness form only a small part of the patient clientele in this department of occupational medicine. It is concluded that there have been changes in the patient clientele in the period 1982-1991. The small number of occupied patients diminishes the possibilities of replacement in work. Shorter periods of sickness and better possibilities for rehabilitation are expected to improve the situation in such a way, that the department of occupational medicine will be involved in health problems in the occupational environment in the future.

[Hearing ability of Danish school children when starting and leaving school]. / Høreevnen hos danske skolebørn ved ind- og udskolingsundersøgelsen.

School health records for a group of Danish school children, who started school in 1977, 1987 and 1997, were studied in order to evaluate hearing ability at the time of starting school and leaving school. One thousand, six hundred and five children who were evaluated by audiometry were included in the study. We found a higher prevalence of hearing loss in children who started school in 1987 and 1997 compared to those who started in 1977. The typical hearing loss was in the high frequencies. At the end of school the hearing ability of children who had started school in 1977 was just as poor as of that of those who had started in 1987. Whether this hearing loss may lead to poorer learning capacities in the afflicted children should be evaluated by further studies that include information on exposure to noise.

[Are health and disease equally distributed among children?]. / Er børns sundhed og sygdom ligeligt fordelt?

Living conditions for children and young people are of great interest. In previous investigations, differences in sickness among social groups have been found. WHO plans to reduce differences in health conditions among groups within the countries by at least 25%. In this article, attention is drawn to inequalities in health among children in Denmark. Parameters such as the risk of stillbirth, congenital malformations and death during the first year of life do not differ between social groups. Where the less harsh data are concerned, inequalities still exist between social groups, also among Danish children. In relation to the goals set by WHO, it is important to be aware that the existing ways of measurement may not be sufficient.

[Social and health inequality in an area of community housing in Odense]. / Sociale og sundhedsmaessige uligheder i et område med almennyttigt boligbyggeri i Odense.

This investigation is a cross-sectional investigation based on the registers available which describe the conditions of health in children born in 1978 and resident in 1987 in two different social districts, one of which was socially, stressed while the other was slightly less stressed. The vaccination coverage was found to be lower in the socially stressed district and lower among immigrant children. More unvaccinated children were observed among children of mothers who received public assistance and of single parents. Hospital admissions on account of diagnoses due to infection were thrice as frequent from the socially stressed district. As regards height, weight and psychomotor status, no differences were observed between the districts. The investigation indicates that social inequalities cause health inequalities and that, in particular, there appears to be a need for health-promoting efforts where the socially stressed environments are concerned e.g. immigrant families.

Pharmacokinetics and metabolism of a vitamin D analogue (Seocalcitol) in rat and minipig.

1. Seocalcitol (EB 1089), a vitamin D analogue with strong antiproliferative effects in vitro and in vivo, is presently under clinical evaluation for the systemic treatment of various solid tumours. 2. The aim was to investigate the pharmacokinetics of Seocalcitol after single and multiple oral administration to rat and minipig. Furthermore, the hepatic metabolism of Seocalcitol was studied both in vitro and in vivo. In vitro metabolism was also investigated in human. 3. In rat, the pharmacokinetic profile of Seocalcitol (Cmax, AUC, Tmax, T(1/2)) was the same after single and oral administration. Pharmacokinetics were also demonstrated as dose-independent. The same was more difficult to evaluate in the minipig due to a great variation among individual animals. 4. In the male rat, the serum T(1/2) was 3 h, but in the female rat and minipig (both genders) T(1/2) = 8 h. 5. At Tmax the concentration of Seocalcitol in the liver (both species) was 10-fold higher than the concentration in serum. The major metabolites in the liver were various isomers of 26-hydroxy Seocalcitol, although the concentration of the individual isomers in rat and minipig were not the same. 6. The same metabolites were formed in vitro following incubations with rat, minipig and human S9 fractions.

Toxicity of vitamin D analogues in rats fed diets with standard or low calcium contents.

Sprague-Dawley rats were fed either a standard diet with 0.9/0.7% Ca/P or a semisynthetic low-calcium diet with 0.5/0.4% Ca/P and treated orally for 28 days with 1 alpha-hydroxycholecalciferol [1 alpha (OH)D3], a synthetic analogue of the physiologically active form of vitamin D3, 1 alpha,25-dihydroxycholecalciferol [1 alpha,25(OH)2D3], at dose levels of 0.2 and 2.0 micrograms kg/day. The high dose caused severe hypercalcaemia with retarded growth, nephrosis, and structural bone changes in rats fed the standard diet. The same dose caused only slight hypercalcaemia without growth retardation or bone changes, and only minimally affected the kidneys in rats fed the low-calcium diet. Hypercalcaemia with less pronounced pathological changes was found in the standard diet low-dose rats, whereas no hypercalcemia or pathological changes were found in the low-calcium diet low-dose group. The rats fed the low-calcium diet tolerated 1 alpha(OH)D3 at dose levels up to 10 times higher than rats on the standard diet. The use of diets low in calcium and low in phosphorus will thus allow the administration of higher dosages of vitamin D compounds without causing hypercalcaemia. This may permit a better evaluation of the pharmacologic and toxic effects not directly associated with the calcium-regulating properties of vitamin D metabolites and analogues.