[A patient with Wegener's granulomatosis who worked in a foundry: a case for a causal association with silicon dioxide]. / Een arbeider in een ijzergieterij met de ziekte van Wegener: ondersteuning voor een causaal verband met siliciumdioxide.

The diagnosis Wegener's granulomatosis was made in a 42-year-old man. Occupational history revealed prolonged exposure to large amounts of silicon dioxide in dust during work in a foundry. The illness was stabilized with immunosuppressive treatment, but after one year the patient developed aseptic necrosis in both hips, which ultimately led to essential total hip arthroplasty on the left side. The patient was unable to work since the diagnosis. Similar case reports have been described, as well as a limited number of case-control studies. These indicate an association between Wegener's granulomatosis and exposure to silicon. There is growing evidence for a causal role of silicon dioxide in the pathogenesis of auto-immune disease.

Medication utilization and patient information in homes for the aged.

A random cross-sectional sample of 198 residents was taken from a convenience sample of 20 Flemish, community-based nursing homes for the aged. Twenty trained interviewers reviewed the medication list of these residents and interviewed the nurses responsible for their daily care to assess their activities of daily living (ADL) and cognitive status. Direct interview was possible of 128 residents (65%); communication with the other 70 residents was impossible because of dementia (55 patients) or communication problems, such as aphasia and deafness (15 patients). An average of 4.5 different medicines was mentioned on the medication lists of the 198 residents. Drug use increases with age but stabilises after the age of 80 y. Medicines are ordered from local community pharmacies and are delivered to the ward rooms in original drug dispensing packs. The nursing staff is responsible for distribution inside the institution. Nursing personnel read the inserts of the medicines given to 98% of the residents and keep the inserts of 77% in the nursing office. Only 11% of the residents maintained some autonomy in ordering, keeping and taking their medication, although 42% were evaluated by the nurses as functionally and cognitively fit. Only 4% of the 128 residents able to respond to an interview had a notion of the potential adverse effects of their medication; the two most important sources of information about medicines mentioned by those residents were the general practitioner and the nursing personnel; 4% mentioned relatives and friends, or the pharmacist, as information sources.

Attitude of the public toward technical package inserts for medication information in Belgium.

We designed an 84-item questionnaire to determine the attitude of the Belgian public toward package inserts (PI) for medication information, written in technical language and intended for health professionals, within an original drug-dispensing distribution system. There were 398 respondents to this general public survey, based on a 0.05 percent selection from election registers of the districts of Gent and Liège. Eighty-nine percent of the respondents read the PI, focusing their attention principally on adverse effects (88 percent), dosage and dosing guidelines (85 percent), contraindications (82 percent), indications (79 percent), and medication shelf-life (76 percent). Compliance (83 percent), reassurance (57 percent), increased knowledge about the medication (50 percent), and decision to take the medicine (31 percent) were among the respondents' motives for reading the PI. Most respondents considered the PI information useful and complete, but difficult to remember and understand. Readers further criticized its legibility and poor graphic illustration. The PI was seen as a supplementary source of information, instrumental to the physician-pharmacist-patient relationship, without the power to overrule the physician's or pharmacist's instructions. Some respondents reported that the PI made them afraid to use the medication. Expectations for the ideal PI were contradictory and can only be met with a never-optimal compromise between comprehensiveness and conciseness.

Package inserts for antihypertensive drugs: use by the patients and impact on adverse drug reactions.

In Belgium, all dispensed drugs are provided with package inserts. Traditional physician-orientated inserts are gradually being replaced by patient package inserts (PPIs). The present survey is focused on the use of inserts for antihypertensive drugs and their impact on the reported occurrence and attribution of adverse drug reactions (ADRs). A group of 28 general practitioners (GPs) from the Flemish part of Belgium collected data from 702 hypertensive patients. Each participating GP submitted a consecutive sample of his patients to an interview in the Spring 1989, when 25% of the antihypertensive specialties carried a PPI-version. 1049 prescriptions for antihypertensive drugs had been dispensed. Two thirds of the patients, mostly those with a higher educational level, had read the package inserts. PPIs accounted for 16% of the inserts, and they had not been read significantly more than the traditional inserts. Reporting by the patients of possible drug-related health problems (spontaneously + after having heard the items on a check-list) was not affected by reading the insert or by the type of insert. However, the PPI did bring about spontaneous reporting, especially by patients with a low educational level. Attribution of at least one health problem to the medication was not affected by reading in itself but by the type of insert. Attribution was higher when the patient had received a PPI, except in the case of highly educated patients. Spontaneous reporting and attribution of health problems to the medications prescribed was found more frequently among patients with higher education, who did not seem to need a PPI to recognize problems as being drug-related.

[Patient-oriented package inserts for drugs. Historical overview and current status]. / Patient-gerichte bijsluiters bij geneesmiddelen. Historich overzicht en stand van zaken.

After a short note on terminology, in this review article a survey is given of former and existing initiatives concerning the Patient Package Insert (PPI) in the USA and in Western Europe, with emphasis on the situation in Belgium. Arguments in favour of and against the PPIs are given, based upon the literature. The need for drug information for the general public is illustrated by a number of studies. Content and presentation of the PPI as a source of drug information are discussed. Studies on the impact of PPIs on satisfaction, knowledge, compliance, adverse drug reactions emotions, risk/benefit-decisions etc. are reviewed. Finally, attention is drawn to remaining problems and to the needs for further research.