RESUMO
OBJECTIVES: To describe the rates of pediatric antibiotic use across 6 countries on 3 continents. STUDY DESIGN: Cross-national analysis of 7 pediatric cohorts in 6 countries (Germany, Italy, South Korea, Norway, Spain, and the US) was performed for 2008-2012. Antibiotic dispensings were identified and grouped into subclasses. We calculated the rates of antimicrobial prescriptions per person-year specific to each age group, comparing the rates across different countries. RESULTS: A total of 74 744 302 person-years from all participating centers were included in this analysis. Infants in South Korea had the highest rate of antimicrobial consumption, with 3.41 prescribed courses per child-year during the first 2 years of life. This compares with 1.6 in Lazio, Italy; 1.4 in Pedianet, Italy; 1.5 in Spain; 1.1 in the US; 1.0 in Germany; and 0.5 courses per child-year in Norway. Of antimicrobial prescriptions written in Norway, 64.8% were for first-line penicillins, compared with 38.2% in Germany, 31.8% in the US, 27.7% in Spain, 25.1% in the Italian Pedianet population, 9.8% in South Korea, and 8% in the Italian Lazio population. CONCLUSIONS: We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Alemanha , Humanos , Incidência , Lactente , Internacionalidade , Itália , Masculino , Noruega , República da Coreia , Estudos Retrospectivos , Espanha , Estados UnidosRESUMO
BACKGROUND/AIMS: Assessing secular trends of diet quality at the population scale is an important tool for health policymakers. The aim of this study was to describe secular trends in energy intake and diet quality in a representative Mediterranean population, accounting for energy underreporting. METHODS: We analyzed the dietary data from 4,061 men and 4,409 women who were included in 2 population-based cross-sectional studies conducted in northeast Spain in 2000 and 2005. The surveys included randomly selected free-living men and women between 35 to 74 years of age. RESULTS: No significant differences in reported energy intake between 2000 and 2005 were observed. Protein (p = 0.014) and carbohydrate (p = 0.02) consumption (expressed as percent of total energy intake) decreased in men and women, respectively. Energy density and intake of total, saturated and monounsaturated fat were significantly higher (p < 0.001) in 2005 than in 2000 in both genders. In contrast, lower consumption of fibre, fruit and meat (p < 0.001) was observed for both genders in 2005 compared to 2000. A significantly lower proportion of men and women met the recommended intake for carbohydrates, total fat, saturated fat, cholesterol and fruits in 2005 when compared to 2000. When energy underreporters were excluded from the analysis, a decline in energy intake (p < 0.001) and an increase in fish consumption (p < 0.001) between 2000 and 2005 was observed in men; no other significant differences were found in diet quality and food consumption trends among non-underreporters. CONCLUSIONS: Whereas energy intake remained stable from 2000 to 2005, overall diet quality showed an unfavourable trend during this timeframe. Secular dietary trends did not change their magnitude or direction, with the exception of energy and fish consumption in men, after excluding energy underreporters from the analysis.
Assuntos
Dieta Mediterrânea/estatística & dados numéricos , Dieta/tendências , Ingestão de Energia , Adulto , Idoso , Viés , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Estudos Transversais , Dieta/normas , Inquéritos sobre Dietas , Ingestão de Alimentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Política Nutricional , Espanha , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate the prescription pattern of antiemetic medications in 0- to 9-year-old children with infectious gastroenteritis in several industrialized countries during 2005. STUDY DESIGN: We retrospectively retrieved data from 4 national and international databases (IMS MIDAS, IMS disease analyzer, WIdO databases). RESULTS: Between 2% and 23% of children with gastroenteritis (International Classification of Diseases code A08.X or A09) received prescriptions for antiemetic medications (United States, 23%; 95% CI, 15-31; Germany, 17%; 95% CI, 15-20; France, 17%; 95% CI, 14-19; Spain, 15%; 95% CI, 10-19; Italy, 11%; 95% CI, 7-16; Canada, 3%; 95% CI, 0-16; United Kingdom, 2%; 95% CI, 1-2). The antihistamines dimenhydrinate and diphenhydramine were most frequently used in Germany and Canada, whereas promethazine was prescribed preferentially in the United States. In France, Spain, and Italy, the dopamine receptor antagonist domperidone was preferred as antiemetic treatment. Ondansetron was used in a minor proportion of antiemetic prescriptions (Germany, Canada, Spain, and Italy, 0%; United States, 3%; United Kingdom, 6%). CONCLUSION: Antiemetic drugs are frequently used in children with gastroenteritis. In different industrialized countries, prescription of antiemetic medication varies considerably. Ondansetron, the only drug with evidence-based antiemetic efficacy, plays a minor role among antiemetic prescriptions.