de Lolkje Jong-van den Berg

Antiepileptic drug utilization in children from 1997-2005--a study from the Netherlands.

ObjectiveTo investigate the utilization of antiepileptic drugs (AEDs) in Dutch children and compare this with guidelines on the treatment of epilepsy in children.MethodFrom the Dutch Interaction Database (IADB.nl) we selected children aged 0–19 years who received at least one prescription for an AED (ATC-code beginning with N03A) between 1997 and 2005. We calculated cumulative incidences and prevalences per 1000 children per year, stratified by age-category, sex and type of AED, and the total number of months each patient received at least one prescription of AEDs, and we counted the number of person-months and AEDs prescribed. For each AED, proportions of person-months were calculated for mono- and combination therapy. Kaplan-Meier survival analysis was used to analyse the duration of AED use, stratified by sex.ResultsThe overall prevalence of the prescription of AEDs to children was constant at approximately 4.0 per 1000 children during the years of the study. The overall cumulative incidence from 1997–2005 was 0.67 per 1000 children. When stratified by age category or sex, there were no relevant differences in incidence or prevalence. Valproic acid was the most frequently prescribed drug, followed by carbamazepine and lamotrigine. In 20.3% of all person-months, patients received combination therapy; of these, 34.2% received combination therapy for 3 person-months or less. The older AEDs were prescribed more often as monotherapy than combination therapy, in contrast with the newer AEDs, for which the opposite was true. The 50% survival probability (= time period when 50% of children had stopped using AEDs) was around 2 years, with a significantly lower discontinuation of treatment for girls than boys (P = 0.04).ConclusionThe overall cumulative incidence of AEDs was determined to be 0.67 per 1000 children, and the prevalence 4.0 per 1000 children. The most frequently prescribed drug is valproic acid, followed by carbamazepine and lamotrigine. The prescribing of AEDs seems to be in conformity with the overall recommendations of the guidelines on the treatment of epilepsy in children.

Effect of mass media campaign to reduce socioeconomic differences in women's awareness and behaviour concerning use of folic acid: cross sectional study

In September 1995, a mass media campaign on the use of folic acid to reduce the risk of fetal neural tube defects started in the Netherlands.1 Special emphasis was placed on reaching women in low socioeconomic categories. We describe the effect of the campaign on awareness and use of folic acid in relation to socioeconomic status We measured the effect of the campaign by comparing two cross sectional studies—one conducted before the campaign and one conducted after the campaign We asked pregnant women in four regions of the Netherlands attending their first or second antenatal visit to fill out a questionnaire; all did so. We took highest fulfilled education, a recognised indicator of socioeconomic status, and merged it into three levels: low, middle, and high. We used multivariate logistic regression to calculate adjusted odds ratios for high versus low education. The methodology has been described elsewhere.2 In both studies, 90% of the pregnancies …

Auditing GPs' prescribing habits: Cardiovascular prescribing frequently continues medication initiated by specialists

Objective:To determine to what extent general practitioners’ (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists.Method:During a 4-week period, pharmacists identified GPs’ prescriptions for a large group of cardiovascular drugs. Next, questionnaires were sent to the prescribing GPs to find out whether the prescriptions were in fact repeat prescriptions. If they were, the GPs were asked whether or not they had originally been prescribed by a specialist.Setting:Six pharmacies in the northeastern part of the Netherlands.Subjects:Fourty-four GPs, 39 of whom responded.Results:Of 1648 questionnaires, 1342 (81%) were returned. Of drugs for cardiovascular therapy that the GPs prescribed, 66% had originally been prescribed by specialists.Conclusions:For many cardiovascular drugs, GPs’ prescriptions predominantly originated from specialists’ prescribing. For more reliable attribution of prescription data or prescribing behaviour to either specialists or to GPs, similar studies should be made for other drug groups. Since the extent of repeat prescribing is high, qualitative studies should be made of the appropriateness of chronic medication, initiated by specialists and continued in repeat prescribing by GPs.

Increasing awareness of and behaviour towards periconceptional folic acid consumption in The Netherlands from 1994 to 1995

AbstractObjective: In November 1993, Dutch health authorities advised that women planning a pregnancy should take folic acid in the periconceptional period to reduce the risk of fetal neural tube defects. In the autumn of 1995 a national campaign was organized to inform women and health care professionals in a systematic way. Methods: We assessed the awareness and behaviour of women at their first or second antenatal visit in two surveys in the spring of 1994 and the autumn of 1995, in order to evaluate the impact of non-systematic information during that period, and to collect baseline data to evaluate the effect of the national folic acid campaign. The two surveys were carried out in the north and the west of The Netherlands. Results: The proportion of women who had heard of folic acid increased from 28% to 78%. The proportion that used folic acid during any period in pregnancy increased from 7.8% to 26%. The proportion that took folic acid tablets during the whole of the recommended period increased from 0.8 to 4.4%. In the group of women who did not take folic acid, the proportion who did “not like to use anything during pregnancy” decreased, as did the proportion who did “not think it is useful”. Conclusion: In The Netherlands, non-systematic information about periconceptional folic acid use has already led to significant changes in awareness and behaviour before the start of the national folic acid campaign.

Growing Gap in Folic Acid Intake with Respect to Level of Education in the Netherlands

Objective: To evaluate the prevalence of the awareness of and the behaviour towards folic acid in 2003 and the trend of folic acid use among pregnant Dutch women between 1995 and 2003 with regard to socio-economic status (SES). Method: We conducted 2-yearly cross-sectional studies among pregnant women who filled in a questionnaire during the first or second antenatal visit. The highest achieved level of education was taken as a proxy for SES. Results: In 2003 the general level of folic acid awareness was high but with significant differences relating to SES; a quarter of the lower educated women did not know about folic acid before pregnancy. Of the subjects with a lower SES 20% knew the correct period of use compared with nearly 50% in the higher SES group. The reported correct use of folic acid among the lower educated women has decreased over the past 3 years (22% in 2003), while it has increased for the higher SES groups (59% in 2003), implying larger differences in health. Conclusion: In 2003, 8 years after a mass media campaign, awareness and use of folic acid were increased considerably in comparison with the start of the campaign. However, differences in knowledge and use of folic acid with respect to the level of education had never been so impressive in the Netherlands as in 2003. A once-only campaign has a short-term effect especially for lower educated women. Implementing strategies to promote folic acid use in daily structural health care systems are needed.Objective: To evaluate the prevalence of the awareness of and the behaviour towards folic acid in 2003 and the trend of folic acid use among pregnant Dutch women between 1995 and 20

Reported adverse drug reactions during the use of inhaled steroids in children with asthma in the Netherlands.

ObjectivesInhaled corticosteroids (ICS) are widely used in the treatment of asthma. We studied the suspected adverse drug reactions (sADRs) reported during the use of ICS in the Netherlands.MethodsIn the Netherlands, health professionals and patients can report suspected ADRs to the Pharmacovigilance Centre Lareb. All reported sADRs on ICS were categorised and assessed as to whether these were likely to be associated with use of the steroid. Age and gender adjusted Reported Odds Ratios (RORs) and Naranjo Scores (NS) were computed for sADRs reported more than 3 times.ResultsSince 1984, sADRs of ICS were reported in 89 children (mean age 6 years), 48 (54%) were boys. Suspected drugs were fluticasone in 46 children (52%), budesonide in 21 (24%), and beclomethasone in 22 cases (24%). Psychiatric symptoms were reported in 19 children (21%; ROR 3.8, NS 3.6), growth retardation in 6 children (7%; ROR 47.8, NS 3.0) and rashes in 6 cases (7%; ROR 0.7, NS 2.4). There were 7 reports (8%; ROR 2.1, NS 3.4) concerning abnormalities of the teeth, 4 reports of alopecia (4%; ROR 3.3, NS 3.5), and 3 reports of hirsutism and hypertrichosis (NS 4.0). Non-fatal adrenal insufficiency was reported once.ConclusionsAlteration of behaviour was the most frequently reported sADR. There are more indications that alterations of behaviour could be a real sADR of ICS. Non-fatal adrenal insufficiency was the only reported possible life threatening sADR. The association of hypertrichosis and teeth abnormalities after ICS in children has not been reported in the literature before.

Oral contraceptive use before and after the latest pill scare in the Netherlands - Changes in oral contraceptive use and how users change

Abstract In October 1995, a “pill scare” developed in Europe. In the Netherlands, the recommendations given were 1) to not alarm women without risk for deep vein thrombosis (DVT), and 2) to be reserved in prescribing third generation oral contraceptives (OC) for young women who were beginning OC use. To determine whether there is a change in the prescription of third generation OC after the latest pill scare, prescription data from 1/10/94 to 1/10/96, covering a population of ±120,000 persons, were studied with respect to OC use before and after the pill scare. Trend analyses revealed a significant decline in third generation compared with total OC prescribing only in the youngest age category (p = 0.0034). Further, switch behavior was studied. Switches from third to second generation OC were more prevalent after the pill scare than before (odds ratio = 2.63; 95% confidence interval 1.84–3.75) and switches from second to third generation OC were significantly less prevalent after the pill scare. This indicates that Dutch prescribers have reacted to the pill scare in the way that the government recommended.

Effect of a minimal pharmacy intervention on improvement of adherence to asthma guidelines

Objective To study the effectiveness of a minimal intervention strategy to improve adherence to paediatric asthma guidelines. Design and setting A group of pharmacists was encouraged to discuss essential elements of asthma care with the general practitioners they normally worked with. Adherence to guidelines was evaluated by studying prescriptions for children with asthma. We compared the treatment of children registered at pharmacies which participated in the study (intervention group) with a control group of children registered at other, non-participating pharmacies (reference group) and with the results of an earlier study. Main outcome measures The numbers of children who had no short-acting betamimetics, no inhaled corticosteroids while on long-acting betamimetics, and more than one type of inhaler. Results The number of children who had no shortacting betamimetics was significantly lower in the intervention group (176/1447 vs 534/3527; p<0.01) and fewer children had no inhaled corticosteroid although on long-acting betamimetics (6/219 vs 41/477; p=0.03). The number of children who had more than one type of inhaler was equal in both groups (5.1%), but this was significantly lower compared with the earlier study (119/2311 vs 239/3217; p<0.01). Conclusions The assistance of pharmacists with adherence to paediatric asthma guidelines is beneficial. Pharmacists should be involved actively in the care of children with asthma.

Are antibiotics related to oral combination contraceptive failures in the Netherlands? A case-crossover study

To investigate whether there is an association between use of antibiotics and breakthrough pregnancy.

Low use of medication in home deliveries in the Netherlands

Objectives: In view of the growing concern for de‐medicalizing childbirth, the aim of this study is to give detailed figures on the use of medication during home deliveries in the Netherlands. Methods: A prospective study of medication use by 68 community midwives during 716 home births in the Netherlands. Results: Medication was used in 58.4% of the home deliveries, with an average of 1.4 drugs per delivery. The drugs used were mostly oxytocin (in 35.6% of all deliveries) and local anesthetics (in 32.9%). When medication was used, it was administered before cutting the umbilical cord in 16.7% of the cases. Prophylactic or routine administration of local anesthesia, postpartum hemorrhages, and retained placenta were the most frequent indications for using medication. Conclusions: The use of medication during home deliveries in the Netherlands is low and newborns are minimally exposed to medication. This illustrates the Dutch birth culture, which tends to minimize the medical aspect of childbirth.