A. Abouelfath

Use of health insurance claim patterns to identify patients using nonsteroidal anti-inflammatory drugs for rheumatoid arthritis.

To determine healthcare claim patterns associated using nonsteroidal anti‐inflammatory drugs (NSAIDs) for rheumatoid arthritis (RA).

Observation of the Long-term Effects of Lifestyle Intervention during Balneotherapy in Metabolic Syndrome

OBJECTIVE Estimate the effect of lifestyle adjustment activities in patients with metabolic syndrome treated by prescribed balneotherapy. METHODS Observational pilot cohort study with 12-month follow-up after multidimensional lifestyle training (physical, dietary, educational) during 3-week standard stay in the spa town of Eugénie-les-Bains. RESULTS Of 145 eligible patients, 97 were included; 63 were followed and analysable. At inclusion all had ≥3 National cholesterol education program-Adult treatment panel III (NCEP-ATPIII) criteria defining metabolic syndrome, 76.2% were female, mean age was 61.2 years. At the end of follow-up (median:10.4 months, Inter-Quartile Range: [6.7;11.4]), 48 of these 63 patients (76.2%) no longer had metabolic syndrome (95%CI [65.7;86.7]). These 48 patients without metabolic syndrome at the end of follow-up represented 49.5% of the 97 included (95%CI [39.5;59.4]). CONCLUSIONS Future studies of lifestyle interventions taking advantage of the spa environment can be expected to find least one third of patients free of metabolic syndrome at the end of 12-month follow-up in the intervention group.

Patterns of Laxative Use in Self-Medication

TO THE EDITOR: Laxatives have long been a typical example of selfprescribed medicines. However, in 2002, the Food and Drug Administration required removal of 2 stimulant laxative ingredients (aloe and cascara) from over-the-counter drugs, as these products were not generally recognized as safe and effective.1 The European Medicines Agency stated in 2007 that, without medical supervision, the stimulant laxatives cascara, aloe and senna should only be used on a short-term basis,2 which was already the case in France for stimulant laxatives, all recommended for a maximum of 8 to 10 days. The purpose of this study was to evaluate patterns of laxative use in self-medication in actual practice. Methods. A cross-sectional study was conducted in a random sample of community pharmacies in the Bordeaux area, in southwestern France, in accordance with the requirements of the Regional Ethics Committee. All sales of laxatives without prescription were identified during a 2week period. Characteristics of users and patterns of use were collected during a face-to-face interview by using a structured questionnaire filled out by the pharmacist for each purchase of laxative without prescription. Results. A total of 137 users of laxatives in 29 pharmacies (19% of sampled pharmacies) were identified during the study period. The mean number of self-medicating laxative users was 2.4 per pharmacy per week (range 0–10); 86.1% were female, 64.2% were known customers of the pharmacy, and the median age was 64 years (interquartile range, 46–75 y). Among individuals in the study population, 18.3% purchased more than one brand and 40.9% purchased more than one box of laxatives. Table 1 summarizes patterns of laxative use in self-medication. Laxatives were used for the purpose of weight loss by 8.0% of the study population and chronically (ie, daily and for ≥1 y) by 31.4%. Stimulant laxatives, which were the most commonly used, were used chronically (31.8%) to the same extent as other types of laxatives (30.8%). Discussion. The participating pharmacy rate was rather low but concordant with that found in other studies using no follow-up or fee.3 This study confirms data in the literature showing that laxatives are used primarily by women and the elderly.4 Although notable, the proportion of laxatives used for weight loss among the population studied could have been underestimated, since such nonapproved use is often denied. The finding that stimulant laxatives were used chronically, contrary to the current guidelines and recent regulatory decisions, highlights the poor impact of leaflet warnings. The daily use of these laxatives may be based on the erroneous concept that a daily bowel evacuation is necessary for good health. Motola et al.5 made the same observation in their study, conducted among 70 pharmacies in southern Italy. Almost half of the studied population used laxatives because they considered themselves to be constipated, despite evacuating 3 or more times per week. A large education campaign for patients regarding constipation and the proper use of stimulant laxatives would certainly be appropriate.