Göran Sterky

SELF-PRESCRIBING BY WAY OF PHARMACIES IN THREE ASIAN DEVELOPING COUNTRIES

The pattern of advice given and drugs dispensed at 75 Asian pharmacies in response to the presentation of a fictitious infant with diarrhoea were studied. Only 16 of the 75 pharmacies gave the appropriate advice--oral rehydration or consultation with a health worker. 19 of 25 pharmacies in Bangladesh, 16 of 25 in Sri Lanka, and 24 of 25 in Yemen Arab Republic dispensed drugs, with or without oral rehydration solution. Fixed-dose combinations of antibiotics and antidiarrhoeal drugs were common. The results are discussed in relation to national drug and diarrhoeal control policies. After further development of the method it might become a useful monitoring instrument.

Effects of group detailing on the prescribing of lipid-lowering drugs : a randomized controlled trial in Swedish primary care

The objective was to study the effect of academic group detailing on the prescribing of lipid-lowering drugs in Swedish primary care. A randomized controlled trial was conducted, randomization being by group. Groups of doctors at 134 community health centres were randomly allocated to an intervention and a control group. The 67 intervention health centres were offered four sessions, conducted by a pharmacist, with group information on guidelines for the management of hyperlipidaemia. The number of prescriptions of lipid-lowering drugs per month increased in the intervention health centres and the increase was statistically different from the corresponding change in the control health centres among women in the age group 30-65 years (p = 0.03). The prescription of first-line lipid-lowering drugs increased by 20% in the intervention health centres (p = 0.03). Academic group detailing by pharmacists to primary care doctors can be an effective method for influencing prescribing practices.

The Effect of Routine Hospital Care on the Health of Hypothermic Newborn Infants in Zambia

A prospective cohort study was carried out at the University Teaching Hospital, Lusaka, Zambia, to investigate the prevalence of neonatal hypothermia, type of infant care and incidence of mortality. Two-hundred-and-sixty-one infants, aged 0-7 days, admitted to the pediatric unit during the warm season were recruited to the study. Forty-four per cent of the infants were hypothermic (< 36 degrees C) on admission, and admission hypothermia correlated to admission weight and home delivery in the youngest age group (0-24 hours). Exclusively breastfed infants (age group 1-7 days) were less likely to be hypothermic at admission. Hypothermia was not recorded as an admission diagnosis and no special attention was given to those infants in terms of clinical management. Mean time to reach a body temperature above 35.9 degrees C did not differ between infants kept in a cot and in an incubator. Total numbers of death was 82 (31 per cent) and the mortality was higher in infants who were hypothermic at admission compared to those who were not. This study demonstrates that a change of existing care routines is needed.

Drug use and the role of patients and prescribers.

In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded. Both the public and private sector have to be addressed. In the latter the pharmacists might be studied using a tracer, fictitious client. One important factor influencing prescribing, drug information, has rarely been assessed scientifically. Experimental studies using group randomization are, however feasible even in developing countries. The individual human being must be in the focus of drug studies and health care and health in the foreground. The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically sound.

HLA phenotypes and diabetic retinopathy.

SummaryThe incidence of HLA antigens B8, BW15, DW3 and DW4 was found to be significantly increased in 99 patients with growth onset, insulin-dependent diabetes of more than 15 years duration. Different degrees of retinopathy were seen in 75% of the patients. No significant correlation between the presence of specific HLA alleles and the stage of retinopathy was found. We have discussed the possibility that all patients who develop diabetes have identical disease-predisposing genes, irrespective of their HLA alleles. If this was the case, the HLA phenotype would not determine the risk of developing diabetic retinopathy.

Observations on intrauterine growth in urban Ethiopia.

ABSTRACT. A total of 3 144 deliveries comprising a wide range of socio‐economic groups in Addis Abeba were investigated. A positive correlation was found between family income and birth weight, with a difference of nearly 500 g between the extremes of socio‐economic classes. A seasonal variation in meart birth weight was also observed. The mean length of gestation was 7.4 days shorter, and the anthropometric measures at birth were significantly lower in the Ethiopian infants as compared with the Swedish norm. The median weight and length development in relation to gestational age in the Ethiopian newborns was similar to the Swedish standard up to approximately 34–35 weeks of gestation. After that time there was very little further intrauterine growth in Ethiopian infants. The possible reasons for the observed pattern of growth are discussed.

Effect of glucagon on the plasma level of free fatty acids.

The effect of intravenously administrated glucagon on the plasma level of free fatty acids (FFA) and on blood sugar was studied in 24 girls, 11–19 years old, of which 10 had diabetes, 8 had obesity and 6 were controls. Fasting levels of FFA were significantly higher in the diabetes and obesity groups than in the control group. After glucagon there was a decrease of FFA which was more evident in the control and obesity groups than in the diabetes group. The blood sugar response was moderate and identical among the obese and the controls, but more marked and more prolonged among the diabetics. The mechanism behind the effect of glucagon on plasma FFA is discussed.

Sociodemographic predictors of self-rated health in patients with diabetes of short duration.

Aims: To examine the impact of gender and socioeconomic factors on health-related quality of life (HRQoL) one year and eight years after diabetes diagnosis. Methods: Two national incidence cohorts who contracted diabetes between the ages of 15 and 34 years (n= 554) and matched control groups from the general population of Sweden (n= 1,029) were surveyed. Data on HRQoL, diabetes treatment, marital status, education, social class, and employment were collected via a questionnaire mailed to the younger cohort (aged 16-35) one year after diagnosis and to the older cohort (aged 23-42) eight years after diagnosis. Response rates were 73% among people with diabetes and 68% among the controls. Multivariable linear regression models were used to analyse the impact of gender and socioeconomic factors on HRQoL in the diabetic and control groups. The dependent variable was the ``general health perceptions score of the SWED-QUAL instrument, which corresponds to the ``global self-rated health concept. Results: A model including all the sociodemographicvariables explained 6% of the variance in self-rated health one year after diabetes diagnosis and 13% of the variance eight years after diagnosis. In the control groups, the level of explanation was 2-3%. Female gender was an independent predictor of poor self-rated health in the older diabetic cohort, but not in the younger cohort. Conclusions: Gender and socioeconomic factors were more closely associated with self-rated health eight years after diabetes diagnosis than one year after diagnosis, indicating early sociodemographic stratification in the health of the diabetic populations studied.

DIETARY COMPOSITSION AND DENTAL DISEASE IN ADOLESCENT DIABETICS.: A pilot study

In a group of adolescent diabetics there was a probable lower frequency of caries but a higher frequency of supragingival calculus than in the control group. The diabetics consumed relatively more protein and less refined carbohydrates, taken less frequently than nondia‐betics. The 24‐hour recalls showed good reproducibility but an unsatisfactory correspond‐ance to a 7‐day record among diabetics.

Determinants of Microangiopathy in Growth‐onset Diabetes

In a quasi‐experiment all diabetic children in a defined area were exposed either to an intense clinical treatment or served as a constructed control. The cohort of 146 diabetics was observed prospectively for at least 15 years as to diabetic control, mainly glycosuria, and cross‐sectionally examined for microangiopathy on four occasions. Data on family background, social situation, smoking, blood pressure, biochemical status, anthropometry, HLA factors and mortality were also gathered. Throughout the analysis duration was considered and treated as a concomitant variable.