Immigrant background and medicine use for aches: national representative study of adolescents.

OBJECTIVES: The aims of the study were to examine the association between immigrant background and medicine use for headache and stomach-ache among adolescents, and whether symptoms of headache and stomach-ache could explain the differences in medicine use. METHODS: We used data from the Danish contribution to the WHO-affiliated international cross-sectional survey Health Behaviour in School-aged Children (HBSC) in 2006. Among boys, a total of 4170 ethnic Danes, 244 descendants of immigrants, and 224 immigrants participated. Among girls, 4310 ethnic Danes, 264 descendants of immigrants, and 232 immigrants were included. The associations between migrant background and medicine use for headache and stomach-ache by means of multilevel multivariate logistic regression analyses adjusted for age group, symptoms and the clustering effect of school and stratified by sex due to interactions. RESULTS: Among boys, the risk of medicine use for stomach-ache was higher for immigrants (odds ratio (OR), 1.54; 95% confidence intervals (CI), 0.99-2.44)) and descendants (OR, 1.97 (1.33-2.94)) compared to ethnic Danes. Similar associations were found for use of medicine for stomach-ache for immigrant girls (OR, 1.55 (1.12-2.15) and use of medicine for headache among boys (immigrants (OR, 1.36 (1.02-1.97 and descendants (1.48 (1.12-1.97)). Symptoms of aches were all independently associated with medicine use. After adjusting for these factors the association between immigrant background and medicine use attenuated slightly. CONCLUSION: Among adolescents in Denmark, the risk of medicine use for headache and stomach-ache was higher for immigrants and descendants as compared to ethnic Danes, with the exception of medicine use for headache among girls.

Adverse drug reactions from psychotropic medicines in the paediatric population: analysis of reports to the Danish Medicines Agency over a decade.

BACKGROUND: The prescribing of psychotropic medicines for the paediatric population is rapidly increasing. In attempts to curb the use of psychotropic medicine in the paediatric population, regulatory authorities have issued various warnings about risks associated with use of these products in childhood. Little evidence has been reported about the adverse drug reactions (ADRs) of these medicines in practice. As spontaneous reports are the main source for information about previously unknown ADRs, we analysed data submitted to a national ADR database. The objective was to characterise ADRs reported for psychotropic medicines in the Danish paediatric population over a decade. FINDINGS: All spontaneous ADR reports from 1998 to 2007 for children from birth to 17 years of age were included. The unit of analysis was one ADR. We analysed the distribution of ADRs per year, seriousness, age and gender of the child, suspected medicine and type of reported ADR. A total of 429 ADRs were reported for psychotropic medicines and 56% of these were classified as serious. Almost 20% of psychotropic ADRs were reported for children from birth up to 2 years of age and one half of ADRs were reported in adolescents, especially for antidepressants and psychostimulants. Approximately 60% of ADRs were reported for boys. Forty percent of all ADRs were from the category 'nervous and psychiatric disorders'. All but one ADR reported for children below two years were serious and two of these were fatal. A number of serious ADRs reported in children from birth up to 2 years of age were presumably caused by mothers' use of psychotropic medicines during pregnancy. CONCLUSION: The high number of serious ADRs reported for psychotropic medicines in the paediatric population should be a concern for health care professionals and physicians. Considering the higher number of birth defects being reported greater care has to be given while prescribing these drugs for pregnant women.

Use of over-the-counter analgesics is associated with perceived stress among 25-44-year-olds: a national cross-sectional study.

AIMS: To examine the association between perceived stress and use of over-the-counter analgesics among 25-44-year-olds, and to examine the association across various sociodemographic strata. Furthermore, to examine whether the association attenuates when controlled by stress-related symptoms. METHODS: National cross-sectional study in Denmark. The study population consisted of men and women aged 25-44 years, n = 3461. The survey was conducted by face-to-face interviews followed by a self-administered questionnaire. The outcome measure was use of over-the-counter analgesics (OTCA). The determinant was perceived stress measured by the perceived stress scale (PSS). Demographic variables and complaints were included as co-variables. RESULTS: Analyses stratified by gender, education, cohabiting status, and whether or not the respondents had children all showed a significant association between stress and OTCA use. The odds for OTCA use mounted with increasing stress. The association attenuated somewhat in analyses adjusted for sociodemographic variables and pain, but remained significant. The crude odds ratio (OR) for OTCA use was 1.51 (1.24-1.83) among participants with medium levels of perceived stress, and 2.26 (1.83-2.80) among participants with high levels of perceived stress, compared to participants with low levels of perceived stress. CONCLUSIONS: There was a significant association between perceived stress and OTCA use that could not be explained by potential stress-related pain across all the examined sociodemographic strata. OTCA may be used outside their indication to treat feelings of stress. Those in charge of dispensing medicines and policy makers should be aware of this potentially harmful use of products that are available without prescription.

Use of natural medicines in the Danish population: a national cross-sectional survey.

BACKGROUND: The use of natural medicines is widespread and increasing. In addition, natural medicine use is based primarily on individual's decisions without counseling from health professionals. Unlike with conventional medicines, it is not possible to evaluate sales statistics and prescription records to determine how much natural medicine is being used and by whom. Self-reporting is the only method available for investigating use of these products. OBJECTIVE: To investigate the use of natural medicines with respect to sociodemographic factors, health status, and conventional drug therapy in a general national population. METHODS: Data were derived from the Danish Health and Morbidity Survey 2000. A representative sample of the Danish population (N = 16 690) was interviewed face-to-face. The association between use of natural medicines within the past 14 days and age, education, health status, and conventional medicine use was analyzed by logistic regression. All analyses were performed separately for each gender. RESULTS: Fourteen percent of the sample population had taken natural medicines within the past 14 days. Use was most prevalent among women and increased with age, but decreased again in the oldest age group (> or = 80 y). Respondents with poor health were the greatest consumers of natural medicines. Use was not associated with educational level and conventional drug therapy. Among conventional medicine users, 14% and 22% of men and women, respectively, used natural medicines. CONCLUSIONS: This study demonstrated that natural medicine use is common and widespread health behavior in all strata of the population and should not be regarded as an alternative to conventional medicine. Clinicians should ask patients about natural medicine use to avoid interactions with conventional drugs.

International survey of self-reported medicine use among adolescents.

OBJECTIVE: To examine gender, age, and country variations in adolescents' self-reported medicine use. DESIGN: Cross-sectional school surveys of representative samples of 11- to 15-year-old girls and boys were used. The 1997/1998 Health Behaviour in School-aged Children study was referenced. A standardized questionnaire was completed during school hours. SETTING: Canada, US, Greenland, Israel, and 24 European countries. PARTICIPANTS: 123 227 participants equally distributed by gender and by 3 age groups (mean 11.7, 13.6, 15.6 y). MAIN OUTCOME MEASURES: Self-reported medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness during the past month. RESULTS: The magnitude of the adolescents' medicine use for headache, stomachache, difficulties in getting to sleep, and nervousness varied substantially across countries. In each of the 28 countries, more girls than boys used medicine for pain. Use of medicine for headache increased by age; use of medicine for stomachache increased by age among girls, but decreased among boys; and use of medicine for difficulties in getting to sleep and nervousness decreased from the age of 11 to 15 years. There was an increase in the crude girl versus boy ratios for medicine use by age for all 4 symptoms. Multivariate logistic regression analyses, adjusting for age group and country, revealed the following odds ratios (95% CI) for girls' versus boys' medicine use: headache 1.56 (1.53 to 1.60), stomachache 2.16 (2.10 to 2.22), difficulties in getting to sleep 0.96 (0.91 to 1.00), and nervousness 1.04 (0.99 to 1.08). CONCLUSIONS: Substantial proportions of adolescents used medicine for common health problems. The prevalence of use differed between type of symptom for which the medicine was used, between countries, and between gender and age groups. We suggest that young people's medicine use should be addressed in public health policy.

Cotrimoxazole prescribing by dispensing and non-dispensing doctors: do they differ in rationality?

BACKGROUND: Dispensing doctors (DDs) have been found to prescribe significantly more drugs, more injections and more antibiotics per patient than non-dispensing doctors (NDDs). However, the rationality of prescription in relation to diagnoses and symptoms has not been studied. OBJECTIVES: To identify and assess differences in the rationality of cotrimoxazole prescription by DDs and NDDs evaluated by drug choice and dosage in relation to diagnoses and symptoms. METHODS: Cohort study of 28 private sector DDs and 25 NDDs in Zimbabwe, using retrospective data from 688 patient records. Drug choice and dose in relation to the recorded diagnoses and symptom(s) were assessed. A new method was developed and tested to measure rationality in a specific and realistic way. A 'correctness-score list' was developed based on a panel of four evaluators assessing the rationality of cotrimoxazole prescription in relation to diagnoses and symptoms. This list was then used as a reference for the assessment. RESULTS: The two groups of prescribers did not differ significantly with respect to rationality of drug choice. Both DDs and NDDs prescribed cotrimoxazole to patients for diagnoses and symptoms for which cotrimoxazole could not be justified (41.4%vs. 43.5%). DDs compared with NDDs used subcurative doses more often (26.4% of the encounters compared with 11.7%; P = 0.035) and correct doses less frequent (58.0% compared with 72.6%; P = 0.047). CONCLUSION: The prescription of cotrimoxazole by both DDs and NDDs was widely irrational. They prescribed cotrimoxazole too frequently, and DDs used subcurative doses to a wider extent. By this prescribing practice, both groups, but especially the DDs, contribute to increasing health hazards, cost and risk of developing bacterial resistance. The method for assessing rationality of drug prescribing was found feasible, and it is recommended that it be further tested and developed.