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The association between the use of acid-suppressive drugs and occurrence of community-acquired pneumonia is examined. The result indicates that the use of gastric acid-suppressive therapy was associated with an increase risk of community-acquired pneumonia.

The impact of disease on the ability of a person to perform work should be part of an economic evaluation when a societal viewpoint is used for the analysis. This impact is reflected by calculating productivity costs. Measurement of these costs is often performed retrospectively. The purpose of our study was to study precision and accuracy of a retrospective self-administered questionnaire on sick leave. Employees of a company were asked to indicate the number of days absent from work due to illness during the past 2 weeks, 4 weeks, 2 months, 6 months, and the past 12 months. The percentage of respondents with an absolute difference of a maximum of respectively 0, 1, 2, 3, 4, 5, 6, 7, 8, and 9 or more days between reported, and company-registered absence due to illness was determined. Besides this, the proportional difference was calculated. A systematic difference was tested with a signed rank test. Of the reported data, 95% matched the registered data perfectly when the recall period was limited to 2 and 4 weeks. This percentage decreased to 87%, 57%, and 51% for 2 months, 6 months, and 12 months. The weighted mean proportional differences for the recall periods were respectively 32.9, 35.2, 45.3, 34.9, and 113.6%. No systematic positive or negative difference was found between registered and reported sick leave. The results suggest that the recall period for retrospective measurement of sick leave is limited according to the precision level, which seems to be appropriate for the subject and the purpose of the study. We recommend using a recall period of no more than 2 months.

Background: Pragmatic randomised controlled trials are often used in primary care to evaluate the effect of a treatment strategy. In these trials it is difficult to achieve both high internal validity and high generalisability. This article will discuss several methodological challenges in designing and conducting a pragmatic primary care based randomised controlled trial, based on our experiences in the DIAMOND-study and will discuss the rationale behind the choices we made. From the successes as well as the problems we experienced the quality of future pragmatic trials may benefit. Discussion: The first challenge concerned choosing the clinically most relevant interventions to compare and enable blinded comparison, since two interventions had very different appearances. By adding treatment steps to one treatment arm and adding placebo to both treatment arms both internal and external validity were optimized. Nevertheless, although blinding is essential for a high internal validity, it should be warily considered in a pragmatic trial because it decreases external validity. Choosing and recruiting a representative selection of participants was the second challenge. We succeeded in retrieving a representative relatively large patient sample by carefully choosing (few) inclusion and exclusion criteria, by random selection, by paying much attention to participant recruitment and taking the participant's reasons to participate into account. Good and regular contact with the GPs and patients was to our opinion essential. The third challenge was to choose the primary outcome, which needed to reflect effectiveness of the treatment in every day practice. We also designed our protocol to follow every day practice as much as possible, although standardized treatment is usually preferred in trials. The aim of this was our fourth challenge: to limit the number of protocol deviations and increase external validity. Summary: It is challenging to design and conduct a pragmatic trial. Thanks to thorough preparation, we were able to collect highly valid data. To our opinion, a critical deliberation of where on the pragmatic - explanatory spectrum you want your trial to be on forehand, in combination with consulting publications especially on patient recruitment procedures, has been helpful in conducting a successful trial. [ABSTRACT FROM AUTHOR]

Aims: Alcohol misuse is now regarded as an important risk factor for development of chronic pancreatitis (CP). However, not every alcohol misuser develops CP and it therefore might be suggested that susceptibility could be further influenced by inter-individual variations in the activities of alcohol-metabolizing enzymes. Several genetic polymorphisms that may affect the activities of alcohol-metabolizing enzymes have been described. Therefore we determined whether polymorphisms in the genes for alcohol dehydrogenase 3 (ADH3) or cytochrome P450 2E1 (CYP2E1) predispose to the development of CP. Methods: DNA samples were obtained from 142 adult CP patients with hereditary (n = 21), alcoholic (n = 82) or idiopathic (n = 39) CP. DNA from 128 healthy controls and from 93 alcoholic controls was analysed for comparison. Patients and controls were all of Caucasian origin. Genetic polymorphisms in ADH3 and CYP2E1 were determined by PCR, followed by restriction-fragment-length-polymorphism analyses in all subjects. Results: The frequencies of ADH3 and CYP2E1 c1c2 genotypes did not differ between CP patients and alcoholic and healthy controls. However, a trend for a higher frequency of the CYP2E1 intron 6 D allele was demonstrated in patients with alcohol-induced CP, compared to that of healthy controls (OR = 3.03, 95%CI = 1.0-9.1) or alcoholic controls (OR = 2.76, 95%CI = 0.9-8.7). Conclusions: These data suggest that the presence of the CYP2E1 intron 6 DD genotype might confer a higher risk of alcoholic CP. [ABSTRACT FROM AUTHOR]

The aim of this work was to study abstinence rates and withdrawal effects of rapid detoxification of opioid-dependents under general anesthesia (RD-GA) compared to standard methadone tapering (SMT) using a prospective clinical trial with a follow-up of 3 months, as a preliminary study at the Novadic addiction centre in St Oedenrode and St Joseph Hospital in Veghel, the Netherlands. Thirty opioid-dependent patients took part. Outcome measures included urine toxicology screening for opiates to determine abstinence and presence of objective and subjective opioid withdrawal distress symptoms. Statistically significant differences in abstinence rate between RD-GA and SMT were present after one (RD-GA 100% vs. SMT 40%, p< 0.01) and 2 months (RD-GA 93% vs. SMT 33%, p <0.01). After 3 months the difference in abstinence was still substantial, but no longer statistically significant (RD-GA 67% vs. SMT 33%, p= 0.14). Objective and subjective withdrawal symptoms showed largely identical outcomes and were equally low in the two groups for those who remained in the study. There was a considerably higher percentage of abstinence in the RD-GA group after 1, 2 and 3 months of follow-up accompanied by relatively mild withdrawal symptoms of shorter duration. However, if one completes SMT the data suggest a greater chance of staying clean in the long term than those completing RD-GA. [ABSTRACT FROM AUTHOR]

Offers letters to the editor on a variety of medical topics as of December 5, 2001. Brain injury resulting from falls among elderly persons; Perceptions of graduating residents of their preparedness for practice; Physical activity counseling in primary care; Meningococcal disease in college students; Use of meta-analysis to answer clinical questions; Politics and medicare; More.

Examines the importance of magnetic resonance imaging and mammography to women with breast cancer in the Netherlands. Risk of breast cancer carriers; Detection of cancer; Use of multivariate analysis.

We examined the prevalence of vitamin B12 deficiency and its association with medication use and characteristics, including infection with Helicobacter pylori (H. pylori), in 255 patients hospitalized for cardiovascular disease. In almost half of the study population, vitamin B12 deficiency was found; patients using acetylsalicylic acid were more frequently vitamin B12 deficient in comparison to nonusers (p = 0.02). Fifty-one percent of the patients were infected with H. pylori, and fewer infected patients were vitamin B12 deficient. [Copyright &y& Elsevier]