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Background: Hyperkinetic disorder is one of the most frequently used psychiatric diagnoses among children and adolescents in Norway. It has previously been shown that use of the diagnosis varies widely by county., Material and Method: We estimated the proportion of children with hyperkinetic disorder using patient data from the Norwegian Patient Registry and population data from the Norwegian Population Registry. The estimations were made for both Norway as a whole and by county. Assessment and documentation of the diagnosis were surveyed by linking the Norwegian Patient Registry and the Norwegian Mother and Child Cohort Study. We reviewed medical records from specialist mental health services for children and adolescents and assessed whether the diagnoses met the research criteria for hyperkinetic disorder., Results: At 12 years of age, 5.4 % of Norwegian boys and 2.1 % of Norwegian girls had been diagnosed with hyperkinetic disorder by specialist health services. The proportion of children varied between 1.4 % and 5.5 % among the counties. A review of medical records for 549 children showed that 49 % of the diagnoses were reliably documented in the records. The main reasons that the diagnosis was not documented were a discrepancy between the information in the medical record and diagnostic criteria (38 %) and inadequate differential diagnostic assessment (46 %)., Interpretation: There was considerable geographic variation in the proportions of children and adolescents with hyperkinetic disorder. A large percentage of the diagnoses were not reliably documented in medical records. The guideline for evaluation, diagnostics and medical recordkeeping should be reviewed.

Bakgrunn: Astma kan være vanskelig å diagnostisere hos barn. For barn under skolealder finnes det få tilgjengelige objektive diagnostiske undersøkelser, og retningslinjene for diagnose og behandling er basert på sykehistorie og klinisk undersøkelse. Dette kan gi rom for varierende behandlingspraksis., Materiale Og Metode: Data fra Reseptregisteret ble brukt til å studere forskrivning av legemidler mot astma til barn i aldersgruppene 0-4 år og 5-9 år fordelt på fylker fra 2004-15., Resultater: Det var stor variasjon mellom fylkene i andelen per 1 000 barn som fikk forskrevet legemidler mot astma i perioden 2012-14 (aldersgruppen 0-4 år: median: 104/1 000; ekstremverdier: 64-147, aldersgruppen 5-9 år: 68/1000; 46-86). Inhalasjonssteroider var hyppigst forskrevet, og det var her variasjonen mellom fylkene var størst i begge aldersgruppene (aldersgruppen 0-4 år: 85/1 000; 42-116, aldersgruppen 5-9 år: 51/1 000; 31-70). De fleste fikk kun en eller få forskrivninger med inhalasjonssteroider over en treårsperiode. Endring i forskrivningen av inhalasjonssteroider fra 2004 til 2015 varierte betydelig mellom fylkene, mest for aldersgruppen 0-4 år., Fortolkning: Stor forskjell i forskrivning av legemidler mot astma fylkene imellom, høy andel sporadisk bruk og endring over tid, særlig i den yngste aldersgruppen, kan tyde på en unaturlig variasjon i behandlingen som ikke kan forklares av forskjeller i astmaforekomst. Uklare retningslinjer som ikke er tilstrekkelig innarbeidet i klinisk praksis kan være én årsak.

Background: New rules for absence with stricter requirements for documentation were introduced in upper secondary schools in the autumn of 2016. We investigated the use of general practice services and dispensing of prescription drugs among 16 – 18-year-olds in the autumn of 2016 and compared this with equivalent figures for the period 2013 – 15., Material and Method: We retrieved information on consultations in general practice (GP) and dispensing of prescription drugs to 15 – 18-year-olds in the period 2013 – 16 from the Directorate of Health’s system for control and payment of health reimbursements (KUHR) and the Norwegian Prescription Database respectively. The number of consultations and dispensing of drugs were compared to previous years using Poisson regression (reference year 2015). The incidence rate ratio (IRR) was used as an outcome measure., Results: The number of GP consultations for 16 – 18-year-olds was 30 % higher in the autumn of 2016 than in the autumn of 2015 (IRR 1.30, 95 % confidence interval (CI) 1.29 – 1.31). In the same period, the dispensing of drugs to this age group increased by 8 % (IRR 1.08, 95 % CI 1.08 – 1.09). Among the diagnosis groups, respiratory tract infections had the largest increase (IRR 2.21, 95 % CI 2.17 – 2.25). The largest increase in drug dispensing was found for remedies for coughs and colds (IRR 1.73, 95 % CI 1.65 – 1.80)., Interpretation: The increase in consultations in general practice and dispensing of drugs to 16 – 18-year-olds coincided in time with the introduction of new rules for absence from school. We hold it to be highly likely that the changes were caused by the stricter rules for documentation of absence from school.

Lower respiratory tract infections are common in small children, and are often associated with obstruction of the respiratory tract and coughing. In Norway, symptomatic treatment with ephedrine is common in children. The clinical effect of such treatment is not sufficiently documented and serious adverse drug reactions have been reported in small children administered sympathomimetic medication. This article presents current knowledge of clinical effects and adverse drug reactions of ephedrine in infants and children, and discusses the practical implications of these findings.

Background: Since 2004, glucosamine has been available as a prescription drug for symptomatic treatment of mild to moderate osteoarthritis. The aim of this study was to characterize glucosamine utilization patterns, and patients' concomitant use of other analgesics, as well as the prescribers' medical specialty., Material and Methods: We searched the Norwegian Prescription Database for all glucosamine prescriptions dispensed during the years 2004, 2005 and 2006, and prescriptions for analgesics with codeine, and non-steroidal anti-inflammatory drugs (NSAIDs) reimbursed for arthrosis for the same patients., Results: In the three-year period, 91,107 patients received 297,558 prescriptions for glucosamine-corresponding to a total cost for patients of 70 mill. NOK. 86 % of patients were more than 50 years old, 69 % were women. Among physicians with a known specialty, 84 % of prescribers were specialists in general practice. 33.3 % of patients used glucosamine all three years. Among the patients who used glucosamine regularly 19 % were prescribed NSAIDs, while 22 % of them used analgesics containing codeine. Patients who started taking glucosamine did not reduce their use of analgetics containing codeine. A positive correlation was seen between use of glucosamine and use of NSAIDs., Interpretation: Glucosamine use is not associated with use of less other pain-relieving drugs. This may reflect insufficient clinical effect of glucosamine.

Background: Use of antidepressants (especially selective serotonin reuptake inhibitors (SSRIs) and venlafaxine) for treatment of children and adolescents with major depression, anxiety disorders or obsessive-compulsive disorders (OCD) has been discussed, because of marginal effects and an increased risk for suicidal thoughts and actions. The European and Norwegian health authorities issued a series of warnings and recommendations from the summer 2003 till the summer of 2005. The newly established Norwegian Prescription Database was used to investigate whether these warnings have had an effect., Material and Methods: The number of SSRI users was compared monthly to the number of venlafaxine users in the period 2004 to 2006. Users below 18 of age were compared to those aged 18 or above. New users of SSRIs and venlafaxine in 2005 and 2006 were characterized according to age, gender and the medical specialty of the doctor giving the first prescription for the drugs., Results: The SSRIs/venlafaxine user proportion for those below 18 years of age was 17% lower in 2005 than in 2004. Among older users the number rose by 2%. Fluoxetin was the most frequently prescribed drug among young first time users. Non-specialist MDs prescribed most of the drugs., Interpretation: Antidepressants are used less by children and adolescents in Norway than in many other countries, but the warnings against SSRIs and venlafaxine seem to have had an effect anyway. Also the official recommendation to use fluoxetine seems to have been followed.

Background: Stimulants are an important part of the treatment of ADHD. The present study examines the prescribing of stimulants for ADHD in Nordland County in 2004 compared to data from 1999., Material and Methods: Individual prescription data were retrieved from the Norwegian Prescription Database (NorPD) for 1.1.2004-30.06.2004. Sales figures for stimulants in Nordland and Norway as a whole were retrieved from the Norwegian Institute of Public Health for the period 1999-2004., Results: In 2004, 487 children aged 4-17 years (1.1% of the age-group) and 68 adults received at least one prescription of stimulants. The prevalence was highest among 10-13 year-olds; 0.8% in girls and 2.4% in boys. Boys represented 78% of the users <18 years. Child psychiatrists prescribed to half of the children, and adult psychiatrists prescribed to 74% of the adults. Sale of stimulants in defined daily doses has increased 5-fold from 1999 to 2004., Interpretation: This increase in stimulant prescribing must be viewed in the light of the increasing number of physicians working in child psychiatry coupled with the development of better neuropsychological services. These changes may have contributed to an increase in the number of children diagnosed with ADHD and consequently an increase in children treated with stimulants.

Background: In Norway there has in later years been much discussion of misuse of flunitrazepam. From 1 January 2003 the drug was moved up one level in the schedule of controlled substances. On 1 August 2004 the manufacturer of the Rohypnol brand withdrew it from the Norwegian market. How did these two events influence the sales and use of drugs containing flunitrazepam?, Materials and Methods: Sales figures for drugs containing flunitrazepam from the statistics database at the Norwegian Institute of Public Health were studied. The Norwegian prescription database was used to describe new (incident) users of flunitrazepam and the two brands of this drug sold in Norway in 2004., Results and Discussion: Restrictions on the prescription status of flunitrazepam lead to a decrease in sales from 7.2 defined daily doses (DDD) per 1000 inhabitants per day in 2002 to 3.0 DDD per 1000 inhabitants per day in 2003. This decrease was only partly compensated for by an increase in the sales of nitrazepam (from 5.0 to 6.0 DDD per 1000 inhabitants per day). During the years 1999 to 2004 there was a steady increase in the sales of benzodiazepine-related hypnotics (zopiclone and zolpidem). This shift could mean a change from flunitrazepam to zopiclone. The withdrawal of Rohypnol in August 2004 had only minor effects on the total sales of flunitrazepam. The decline in sales of Rohypnol was almost compensated for by the increase in the overall sales of Flunipam. This was reflected in the fact that in the later months of 2004 there were many new (incident) users of Flunipam, but few new users of flunitrazepam-containing drugs in total. It could be concluded that the restrictions on prescription status of flunitrazepam had a much higher impact than the withdrawal of the Rohypnol brand.

Background: Little information is available about Norwegian adolescents' use of medical drugs., Material and Methods: Self-reported drug use was recorded by means of a self-administered questionnaire handed out in classrooms to all 10th grade students in four counties. In all, 5846 boys and 5862 girls participated during the years 2000-2002., Results: Forty-one percent of boys and 64% of girls had used drugs during the last four weeks. Non-prescription analgesics had been used by 25% of the boys and by more than half of the girls. Daily use of prescription analgesics was reported by approximately 1% in both sexes, while more girls than boys had used these drugs during the last four weeks. In all, 15% of the boys and 16% of the girls reported use of allergy medicines during the last four weeks and 6% of the boys and 7% of the girls had used asthma medicines. During the same period, 1.4% of the boys and 1.8% of the girls had used hypnotics. Anxiolytics had been used by 1.9%, while 0.8% reported use of antidepressants., Interpretation: Drug use is common among adolescents in Norway. Except for analgesics, there were only minor sex differences in drug use. The proportion of drug users did not vary significantly between counties.