Relational coordination and organisational social capital association with characteristics of general practice.

Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation's performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study.

Information on risk of constipation for Danish users of opioids, and their laxative use.

BACKGROUND: While it is well known that use of opioids often cause constipation, little is known about the information given to patients regarding this potential side-effect and their use of laxatives to prevent it. OBJECTIVE: To assess the degree of information provided by the prescriber to users of opioids by the time of the first prescription regarding the risk of constipation. METHOD: Interviews with patients filling an opioid at a community pharmacy were performed by the dispensing pharmacist or pharmaconomist at the pharmacy. Information collected concerned the patient, the opioid, information received regarding constipation, current constipation and current laxative treatment. RESULTS: A total of 286 interviews were completed. Overall, 28.3 % remembered having received information about the risk of constipation by the time of the first prescription. Excluding 49 first-time opioid users, we found 91 laxative users and 146 non-laxative users, of whom 73.6 and 4.8 %, respectively, currently experienced constipation. CONCLUSION: Only a small proportion of patients with a prescription for opioids remembered having had information on potential constipation caused by opioids and having received any recommendation on how to use laxatives to prevent constipation. Interventions should focus on whether constipation is present and on rational use of laxatives.

Association between prescribing patterns of anti-asthmatic drugs and clinically uncontrolled asthma: a cross-sectional study.

OBJECTIVE: Studies based on prescription data have shown that many asthmatics tend to use large quantities of inhaled beta-2-agonists, suggesting poorly controlled disease. The aim of the present study was to investigate the association between clinically uncontrolled asthma and prescribing patterns of anti-asthmatic drugs with a primary focus on short-acting beta-2-agonists (SABA). METHODS: In a cross-sectional study 357 subjects, selected by their prescriptions of inhaled beta-2-agonists in Odense Pharmaco-Epidemiological Database, underwent individual clinical assessment including the Asthma Control Questionnaire (ACQ) and spirometry. The associations between uncontrolled asthma (ACQ score ≥ 1.50) and individual anti-asthmatic prescribing were analysed by means of logistic regression. RESULTS: Clinically uncontrolled asthma was positively associated with SABA use, the association becoming stronger with higher annual quantity of SABA use, odds ratio (OR) 11.1 (95% CI 4.4-28.0) for ≥400 DDD/year. This trend persisted after stratifying for gender, age, and controller treatment. Although subjects using ≥450 DDD/year were all uncontrolled, there was substantial overlap in SABA use between controlled and uncontrolled subjects below this limit. We found no effect modification by age and gender. Use of inhaled corticosteroids protected against uncontrolled asthma, OR 0.51 (95% CI 0.27-0.95). CONCLUSION: Asthmatics with a high use of SABA frequently have problems with uncontrolled asthma, and users of ICS are protected against uncontrolled asthma. The associations we found were, however, to weak too allow firm conclusions about asthma control for most individual asthma patients.

Impact of socioeconomic status on the use of inhaled corticosteroids in young adult asthmatics.

OBJECTIVE: The aim of this population-based longitudinal study was to examine the associations between socioeconomic status (SES) and anti-asthmatic treatment with inhaled corticosteroids (ICS) among young Danish adult asthmatics, and to investigate whether these associations were consistent over time. METHODS: We extracted data on prescription drug use, education, and income in 97 665 users of anti-asthmatic drugs, aged 18-44 years, identified in Statistics Denmark during 1997-2005. Individual information on education and income was used as measures of SES. Education was categorised into basic school/high school, vocational training, and higher education, and income was categorised into low, middle, and high income. Associations between ICS use and SES were estimated by logistic regression models. RESULTS: High levels of education and income were independently associated with ICS use, education demonstrating the strongest association. Using basic school/high school and low income as baselines, the adjusted odds ratios (ORs) of ICS use for higher education were 1.46 (95% CI 1.40-1.51) and 1.10 (95% CI 1.06-1.14) for high income. Higher education was a nearly constant factor associated with ICS use throughout the observation period, but high income did not demonstrate any association before 2001 with increasing ORs observed each year hereafter. All associations became more pronounced when restricting to 35-44 year-olds. CONCLUSION: High levels of SES were positively associated with ICS use in young adult asthmatics. To encourage ICS use, special attention should be paid to asthmatics with low educational level and low income. Further studies are needed to elucidate underlying mechanisms for this socioeconomic inequality.

A population-based clinical study of allergic and non-allergic asthma.

BACKGROUND: The aim of this study was to describe differences between allergic and non-allergic asthma in a large community-based sample of Danish adolescents and adults. METHODS: A total of 1,186 subjects, 14 to 44 years of age, who in a screening questionnaire had reported a history of airway symptoms suggestive of asthma and/or allergy, or who were taking any medication for these conditions were clinically examined. All participants were interviewed about respiratory symptoms, and furthermore skin test reactivity, lung function, and airway responsiveness were measured. RESULTS: A total of 489 individuals had clinical asthma of whom 61% had allergic asthma, whereas 39% had non-allergic asthma. Subjects with non-allergic asthma were more likely to be females, OR = 2.24 (1.32-3.72), p = 0.003, and to have cough as the predominant symptom, OR = 1.96, (1.19-3.23), p = 0.008, but were less likely to have AHR, OR = 0.40, (0.24-0.66), p < 0.001, food allergy, OR = 0.28, (0.11-0.73), p = 0.009, and symptoms of rhinitis, OR = 0.08 (0.05-0.14) compared with subjects with allergic asthma. Subjects with non-allergic asthma had had persistent symptoms within the last 4 weeks more often than subjects with allergic asthma (68% vs. 53%), p = 0.001. CONCLUSIONS: Non-allergic asthma accounts for two in every five cases of asthma in adults and constitutes symptomatically, and in terms of lung function, a more severe form of disease than allergic asthma.

Season of birth and risk of atopic disease among children and adolescents.

BACKGROUND: Season of birth (SOB) has been regarded as a risk factor for atopy. The aim of this study was to explore the relationship between season of birth (SOB) and later development of atopic disease in children and adolescents. METHODS: A total of 1,007 randomly selected subjects, 7 to 17 years of age, who were living in urban Copenhagen, Denmark were studied. All participants were interviewed about respiratory symptoms and possible risk factors for atopic disease. Skin test reactivity, serum total immunoglobulin E (IgE), and airway responsiveness were measured using standard techniques. RESULTS: The overall risk of atopy, as judged by skin test reactivity and serum total IgE, was the same regardless of SOB. On the contrary, asthma was more common in subjects born in the autumn compared with subjects born during the remaining part of the year (12.4% vs. 5.6%), OR = 2.40, 95% CI (1.56-3.94), p < 0.001. This was observed both for atopic asthma OR = 2.41, 95% CI (1.25-4.64), p = 0.007, non-atopic asthma, OR = 2.35, 95% CI (1.14-4.83), p = 0.02, and house dust mite (HDM) sensitive airway hyperresponsiveness, OR = 3.00, 95% CI (1.44-6.24), p = 0.002. Rhinitis and pollen allergy were not significantly related to SOB. CONCLUSIONS: Atopy itself is independent of season of birth, whereas asthma is more prevalent among subjects born during the autumn. Regarding asthma, these results suggest that the first months of life enclose a period of particular vulnerability towards environmental risk factors, especially exposure to aeroallergens like HDM.