<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0871-3413</journal-id>
<journal-title><![CDATA[Arquivos de Medicina]]></journal-title>
<abbrev-journal-title><![CDATA[Arq Med]]></abbrev-journal-title>
<issn>0871-3413</issn>
<publisher>
<publisher-name><![CDATA[ArquiMed - Edições Científicas AEFMUP ]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0871-34132008000200006</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Drug Utilization Studies]]></article-title>
<article-title xml:lang="pt"><![CDATA[Estudos de Utilização de Medicamentos]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gama]]></surname>
<given-names><![CDATA[Helena]]></given-names>
</name>
<xref ref-type="aff" rid="A01"/>
</contrib>
</contrib-group>
<aff id="A01">
<institution><![CDATA[,Bial Departamento de Investigação e Desenvolvimento ]]></institution>
<addr-line><![CDATA[S. Mamede do Coronado ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2008</year>
</pub-date>
<volume>22</volume>
<numero>2-3</numero>
<fpage>69</fpage>
<lpage>74</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0871-34132008000200006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0871-34132008000200006&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0871-34132008000200006&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Drug utilization studies aim to evaluate factors related to the prescribing, dispensing, administering and taking of medication, and its associated events (either bene&#64257;cial or adverse). Since the early 1960&#8217;s the interest in Drug Utilization Studies has been increasing, &#64257;rst with market-only purposes, then for evaluating the quality of medical prescription and comparing patterns of use of speci&#64257;c drugs. Presently drug utilization studies are an evolving area. Their scope is to evaluate the present state and future trends of drug usage, to estimate crudely disease prevalence, drug expenditures, appropriateness of prescriptions and adherence to evidence-based recommendations. The increasing importance of drug utilization studies as a valuable investigation resource in pharmacoepidemiology has been bridging it with other health related areas, such as public health, pharmacovigilance, pharmacoeconomics, eco-pharmacovigilance or pharmacogenetics.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Os estudos de utilização de medicamentos têm como objectivo avaliar factores relacionados com a prescrição, dispensa, administração e toma de medicamentos, e os eventos associados (tanto benéficos como adversos). Desde o início dos anos 60 que o interesse pelos estudos de utilização de medicamentos tem vindo a crescer, primeiro com objectivos apenas de marketing, depois para avaliar a qualidade da prescrição médica e comparar os padrões de utilização de medicamentos específicos. Actualmente a área de estudos de utilização de medicamentos está em evolução. O seu objectivo é avaliar o estado presente e as futuras tendências na utilização de medicamentos, estimar a prevalência aproximada de uma doença, gastos com medicação, adequação das prescrições e adesão às recomendações baseadas na evidência. A importância crescente dos estudos de utilização de medicamentos como recurso investigacional válido em farmacoepidemiologia tem sido uma ponte de ligação com outras áreas da saúde, como a saúde pública, farmacovigilância, farmacoeconomia, eco-farmacovigilância ou farmacogenética.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[epidemiology]]></kwd>
<kwd lng="en"><![CDATA[pharmacology]]></kwd>
<kwd lng="en"><![CDATA[pharmacoepidemiology]]></kwd>
<kwd lng="en"><![CDATA[drug utilization]]></kwd>
<kwd lng="pt"><![CDATA[epidemiologia]]></kwd>
<kwd lng="pt"><![CDATA[farmacologia]]></kwd>
<kwd lng="pt"><![CDATA[farmacoepidemiologia]]></kwd>
<kwd lng="pt"><![CDATA[utilização de medicamentos]]></kwd>
</kwd-group>
</article-meta>
</front><body><![CDATA[ <p><B>Drug Utilization Studies</b> </p >     <P   align="justify" >Helena Gama </P >     <P   align="justify" ><I>Departamento de Investiga&ccedil;&atilde;o e Desenvolvimento, Bial, Porto </I></P >     <P   >Drug utilization studies aim to evaluate factors related to the prescribing,    dispensing, administering and taking o</B>f medication, and its associated events    (either bene&#64257;cial or adverse). Since the early 1960&rsquo;s the interest    in Drug Utilization Studies has been increasing, &#64257;rst with market-only    purposes, then for evaluating the quality of medical prescription and comparing    patterns of use of speci&#64257;c drugs. Presently drug utilization studies    are an evolving area. Their scope is to evaluate the present state and future    trends of drug usage, to estimate crudely disease prevalence, drug expenditures,    appropriateness of prescriptions and adherence to evidence-based recommendations.    The increasing importance of drug utilization studies as a valuable investigation    resource in pharmacoepidemiology has been bridging it with other health related    areas, such as public health, pharmacovigilance, pharmacoeconomics, eco-pharmacovigilance    or pharmacogenetics.</P >     <P   > <B>Key-words:</B> epidemiology; pharmacology; pharmacoepidemiology; drug utilization.  </P >     <P   >&nbsp;</P >     <P   ><b>Estudos de Utiliza&ccedil;&atilde;o de Medicamentos</b></P >     <P   >Os estudos de utiliza&ccedil;&atilde;o de medicamentos t&ecirc;m como objectivo    avaliar factores relacionados com a prescri&ccedil;&atilde;o, dispensa, administra&ccedil;&atilde;o    e toma de medicamentos, e os eventos associados (tanto ben&eacute;ficos como    adversos). Desde o in&iacute;cio dos anos 60 que o interesse pelos estudos de    utiliza&ccedil;&atilde;o de medicamentos tem vindo a crescer, primeiro com objectivos    apenas de marketing, depois para avaliar a qualidade da prescri&ccedil;&atilde;o    m&eacute;dica e comparar os padr&otilde;es de utiliza&ccedil;&atilde;o de medicamentos    espec&iacute;ficos. Actualmente a &aacute;rea de estudos de utiliza&ccedil;&atilde;o    de medicamentos est&aacute; em evolu&ccedil;&atilde;o. O seu objectivo &eacute;    avaliar o estado presente e as futuras tend&ecirc;ncias na utiliza&ccedil;&atilde;o    de medicamentos, estimar a preval&ecirc;ncia aproximada de uma doen&ccedil;a,    gastos com medica&ccedil;&atilde;o, adequa&ccedil;&atilde;o das prescri&ccedil;&otilde;es    e ades&atilde;o &agrave;s recomenda&ccedil;&otilde;es baseadas na evid&ecirc;ncia.    A import&acirc;ncia crescente dos estudos de utiliza&ccedil;&atilde;o de medicamentos    como recurso investigacional v&aacute;lido em farmacoepidemiologia tem sido    uma ponte de liga&ccedil;&atilde;o com outras &aacute;reas da sa&uacute;de,    como a sa&uacute;de p&uacute;blica, farmacovigil&acirc;ncia, farmacoeconomia,    eco-farmacovigil&acirc;ncia ou farmacogen&eacute;tica. </P >     <P   ><b>Palavras-chave:</b> epidemiologia; farmacologia; farmacoepidemiologia; utiliza&ccedil;&atilde;o    de medicamentos.</P >     <P   >&nbsp;</P >     ]]></body>
<body><![CDATA[<P   >&nbsp;</P >     <P   >Full text only available in PDF format.</P >     <P   >Texto completo dispon&iacute;vel apenas em PDF.</P >     <P   >&nbsp; </P >     <P   >&nbsp;</P >     <p   align="justify" ><B>REFERENCES </B></p >    <P   align="justify" >1 -WHO Expert Commitee. <I>The Selection of Essential Drugs</I>, technical Report Series no.615. Geneva: World Health Organization, 1977. </P >    <!-- ref --><P   align="justify" >2 -Lunde PK, Baksaas I. Epidemiology of drug utilization-basic concepts and methodology. Acta Med Scand Suppl 1988;721:7-11. </P >     &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;[&#160;<a href="javascript:void(0);" onclick="javascript: window.open('/scielo.php?script=sci_nlinks&ref=000020&pid=S0871-3413200800020000600001&lng=','','width=640,height=500,resizable=yes,scrollbars=1,menubar=yes,');">Links</a>&#160;]<!-- end-ref --><P   align="" >3 -Strom BL. Pharmacoepidemiology. Fourth ed: John Wiley & Sons, Ltd 2005.</P >     <P   align="" > 4 -Costa J, Rosa MM, Ferreira JJ, Sampaio C, Vaz Carneiro A. [Cardiac effects    of acute poisoning with tricyclic antidepressants: systematic review of the    literature. Part I]. Rev Port Cardiol 2001;20:671-8. </P >     ]]></body>
<body><![CDATA[<P   align="justify" >5 -Strom BL, Melmon KL, Miettinen OS. Postmarketing studies of drug ef&#64257;cacy. Arch Intern Med 1985;145:1791-4. </P >    <P   align="justify" >6 -Andersen M. Is it possible to measure prescribing quality using only prescription data? Basic Clin Pharmacol Toxicol 2006;98:314-9. </P >     <P   align="justify" >7 -Wettermark B, Hammar N, MichaelFored C, Leimanis A, Otterblad Olausson P,    Bergman U, et al. The new Swedish Prescribed Drug Register-opportunities for    pharmacoepidemiologicalresearch and experience from the &#64257;rst six months.    Pharmacoepidemiol Drug Saf 2007;16:726-35. </P >     <P   align="justify" >8 -Naqvi SH, Dunkle LM, Timmerman KJ, Reichley RM, Stanley DL, O&rsquo;Connor D. Antibiotic usage in a pediatric medical center. JAMA 1979;242:1981-4. </P >    <P   align="justify" >9 -Scheckler WE, Bennett JV. Antibiotic usage in seven community hospitals. JAMA 1970;213:264-7. </P >    <P   align="justify" >10 -Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the Food and Drug Administration, 19982005. Arch Intern Med 2007;167:1752-9. </P >    <P   align="justify" >11 -Baum C, Kennedy DL, Forbes MB, Jones JK. Drug use and expenditures in 1982. JAMA 1985;253:382-6. </P >    <P   align="justify" >12 -Cars O, Molstad S, Melander A. Variation in antibiotic use in the European Union. Lancet 2001;357:1851-3. </P >    <P   align="justify" >13 -Rosholm JU, Gram LF, Isacsson G, Hallas J, Bergman U. Changes in the pattern of antidepressant use upon the introduction of the new antidepressants: a prescription database study. Eur J Clin Pharmacol 1997;52:205-9. </P >    <P   align="justify" >14 -Shapiro M, Townsend TR, Rosner B, Kass EH. Use of antimicrobial drugs in general hospitals. II. Analysis of patterns of use. J Infect Dis 1979;139:698-706. </P >    ]]></body>
<body><![CDATA[<P   align="justify" >15 -Bergman U, Elmes P, Halse M, Halvorsen T, Hood H, Lunde PK, et al. The measurement of drug consumption. Drugs for diabetes in Northern Ireland, Norway and Sweden. Eur J Clin Pharmacol 1975;8:83-9. </P >    <P   align="justify" >16 -Boethius G, Wiman F. Recording of drug prescriptions in the county of Jamtland, Sweden. I. Methodologicalaspects. Eur J Clin Pharmacol 1977;12:31-5. </P >    <P   align="justify" >17 -Bergman U,Andersen M, VaccheriA, Bjerrum L, Wettermark B, Montanaro N. Deviations from evidence-based prescribing of non-steroidal anti-in&#64258;ammatory drugs in three European regions. Eur J Clin Pharmacol 2000;56:269-72. </P >    <P   align="justify" >18 -Hartz I, Sakshaug S, Furu K, Engeland A, Eggen A, Njolstad I, et al. Aspects of statin prescribing in Norwegian counties with high, average and low statin consumption -an individual-level prescription database study. BMC Clinical Pharmacology 2007;7:14. </P >    <P   align="justify" >19 -Psaty BM, Lee M, Savage PJ, Rutan GH, German PS, Lyles M.Assessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group. J Clin Epidemiol 1992;45:683-92. </P >    <P   align="justify" >20 -Duarte-Ramos F, Cabrita J. Using a pharmaco-epidemio-logical approach to estimate diabetes type 2 prevalence in Portugal. Pharmacoepidemiol Drug Saf 2006;15:269-74. </P >     <P   align="justify" >21 -Castle M, Wilfert CM, Cate TR, Osterhout S. Antibiotic use at Duke University    Medical Center. JAMA 1977;237:2819-22. </P >     <P   align="justify" >22 -Townsend TR, Shapiro M, Rosner B, Kass EH. Use of antimicrobial drugs in general hospitals: IV. Infants and children. Pediatrics 1979;64:573-8. </P >    <P   align="justify" >23 -Wettermark B, Pehrsson A, Jinnerot D, Bergman U. Drug utilisation 90% pro&#64257;les--a useful tool for quality assessment of prescribing in primary health care in Stockholm. Pharmacoepidemiol Drug Saf 2003;12:499-510. </P >    <P   align="justify" >24 -Sampaio C, Ferreira JJ, Costa J. Evidence-based medicine (EBM) applied to Parkinson&rsquo;s disease treatment. Parkinsonism Relat Disord 2002;9:7-13. </P >    ]]></body>
<body><![CDATA[<P   align="justify" >25 -MartinsAP,Ascens&atilde;o P, Ceia C, et al. Regimes terap&ecirc;uticos para a &uacute;lcera p&eacute;ptica e eradica&ccedil;&atilde;o do H pylori nos utentes da rede m&eacute;dicos-sentinela. Revista Portuguesa de Clinica Geral 2005;21:431-44. </P >    <P   align="justify" >26 -Pont LG, Sturkenboom MC, van Gilst WH, Denig P, Haai-jer-Ruskamp FM. Trends in prescribing for heart failure in Dutch primary care from 1996 to 2000. Pharmacoepidemiol Drug Saf 2003;12:327-34. </P >    <P   align="justify" >27 -WHO Collaborating Centre for Drug Statistics Methodology. ATC Index with DDDs 2002: Oslo, Norway. </P >    <P   align="justify" >28 -Neutel CI, Walop W. Comparing two different approaches to measuring drug use within the same survey. Chronic Dis Can 2000;21:150-6. </P >    <P   align="justify" >29 -Henriksson S, Boethius G, Hakansson J, Isacsson G. Indications for and outcome of antidepressant medication in a general population: a prescription database and medical record study, in Jamtland county, Sweden, 1995. Acta Psychiatr Scand 2003;108:427-31. </P >    <P   align="justify" >30 -Isacsson G, Boethius G, Bergman U. Lowlevelof antidepressant prescription for people who later commit suicide: 15 years of experience from a population-based drug database in Sweden. Acta Psychiatr Scand 1992;85:444-8. </P >     <P   align="justify" >31 -Hallas J. Conducting pharmacoepidemiologic research in Denmark. Pharmacoepidemiol    Drug Saf 2001;10:619-23. </P >     <P   align="justify" >32 -Gaist D, Hallas J, Hansen NC, Gram LF. Are young adults with asthma treated suf&#64257;ciently with inhaled steroids? A population-based study of prescription data from 1991 and 1994. Br J Clin Pharmacol 1996;41:285-9. </P >    <P   align="justify" >33 -Gaist D. Use and overuse of sumatriptan. Pharmacoepidemiological studies based on prescription register and interview data. Cephalalgia 1999;19:735-61. </P >    <P   align="justify" >34 -Olesen C, Steffensen FH, Sorensen HT, Nielsen GL, Olsen J, Bergman U. Low use of long-term hormone replacement therapy in Denmark. Br J Clin Pharmacol 1999;47:323-8. </P >    ]]></body>
<body><![CDATA[<P   align="justify" >35 -Nunes de Melo M, Madureira B, Nunes Ferreira AP, Mendes Z, Miranda Ada C, Martins AP. Prevalence of self-medication in rural areas of Portugal. Pharm World Sci 2006;28:19-25. </P >    <P   align="justify" >36 -Martins AP, Miranda Ada C, Mendes Z, Soares MA, Ferreira P, Nogueira A. Self-medication in a Portuguese urban population: a prevalence study. Pharmacoepidemiol Drug Saf 2002;11:409-14. </P >    <P   align="justify" >37 -Nunes de Melo M, Mendes Z, Martins P, Suissa S. Asthma mortality in portugal : impact of treatment with inhaled corticosteroids and leukotriene receptor antagonists. Treat Respir Med 2006;5:143-7. </P >    <P   align="justify" >38 -Nash. National Drug and Therapeutic Index. P&T 2002;27. </P >    <P   align="justify" >39 -Sturkenboom MC, Burke TA, Dieleman JP, Tangelder MJ, Lee F, Goldstein JL. Underutilization of preventive strategies in patients receiving NSAIDs. Rheumatology (Oxford) 2003;42(Suppl 3):iii23-31. </P >    <P   align="justify" >40 -Bromley SE, de Vries CS, Farmer RD. Utilisation of hormone replacement therapy in the United Kingdom. A descriptive study using the general practice research database. Bjog 2004;111:369-76. </P >     <P   align="justify" >41 -GPRD in <a href="http://www.gprd.com/home/" target="_blank">http://www.gprd.com/home/</a>,    accessessed online in 2007.10.26. </P >     <P   align="justify" >42 -Deckers JG, Schellevis FG, Fleming DM. WHO diagnostic criteria as a validation tool for the diagnosis of diabetes mellitus: a study in &#64257;ve European countries. Eur J Gen Pract 2006;12:108-13. </P >    <P   align="justify" >43 -Falc&atilde;o J, Pisco A, Sim&otilde;es J, Falc&atilde;o I, Pimenta Z, Nunes B. Prescri&ccedil;&atilde;o de antibacterianos em cl&iacute;nica geral: um estudo na Rede M&eacute;dicos-Sentinela. Revista Portuguesa de Clinica Geral 2003;19:315-29. </P >    <P   align="justify" >44 -Falc&atilde;o I, Monsanto A, Nunes B, Marau J, Falc&atilde;o J. Prescri&ccedil;&atilde;o de psicof&aacute;rmacos em medicina geral e familiar: um estudo na rede M&eacute;dicos-Sentinela. Revista Portuguesa de Cl&iacute;nica Geral 2007;23:17-30. </P >    ]]></body>
<body><![CDATA[<P   align="justify" >45 -Monsanto A, Dias J, Sanchez J, Sim&otilde;es A, Felgueiras M. Preval&ecirc;ncia de epilepsia em Portugal: estimativa populacionale per&#64257;s terap&ecirc;uticos: a partir da rede M&eacute;dicos-Sentinela, 1993. Direc&ccedil;&atilde;o Geral de Sa&uacute;de. 1997:39. </P >     <P   align="justify" >46 -Cabrita J, Ferreira H, Iglesias P, Baptista T, Rocha E, Lopes da Silva A,    et al. Patterns and determinants of psychoactive drug usein Lisbon University    students-a population-based study. Pharm World Sci 2004;26:79-82. </P >     <P   align="justify" >47 -Rocha O, Lunet N, Costa L, Barros H. [Osteoporosis treatment in Portugal: trends and geographical variation]. Acta Med Port 2006;19:373-80. </P >     <P   align="justify" >48 -de Oliveira Martins S, Soares MA, Foppe van Mil JW, Cabrita J. Inappropriate    drug use by Portuguese elderly outpatients--effect of the Beers criteria update.    Pharm World Sci 2006;28:296-301. </P >     <P   >49 -Marques-Vidal P, Dias CM. Hypnotic consumption in the Portuguese population: data from the NationalHealth Survey 1998-1999. Pharmacoepidemiol Drug Saf 2006;15:63-9. </P >    <P   >50 -Johnson RE, Vollmer WM. Comparing sources of drug data about the elderly. J Am Geriatr Soc 1991;39:1079-84. </P >    <P   >51 -Lau HS, de Boer A, Beuning KS, Porsius A. Validation of pharmacy records in drug exposure assessment. J Clin Epidemiol 1997;50:619-25. </P >     <P   >52 -Klungel OH, de Boer A, Paes AH, Herings RM, Seidell JC, Bakker A. In&#64258;uence    of question structure on the recall of self-reported drug use. J Clin Epidemiol    2000;53:273-7. </P >     <P   >53 -Van den Brandt PA, Petri H, Dorant E, Goldbohm RA, Van de Crommert S. Comparison    of questionnaire information and pharmacy data on drug use. Pharm Weekbl Sci    1991;13:91-6. </P >     <P   >54 -West SL, Savitz DA, Koch G, Strom BL, Guess HA, Hartzema A. Recall accuracy    for prescription medications: self-report compared with database information.    Am J Epidemiol 1995;142:1103-12. </P >     ]]></body>
<body><![CDATA[<P   >55 -Goodman MT, NomuraAM, Wilkens LR, KolonelLN.Agreement between interview information    and physician records on history of menopausal estrogen use. Am J Epidemiol    1990;131:815-25. </P >     <P   >56 -Beers MH, Munekata M, Storrie M. The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc 1990;38:1183-7. </P >    <P   >57 -Heerdink ER, Leufkens HG, Koppedraaijer C, Bakker A. Information on drug use in the elderly: a comparison of pharmacy, general-practitioner and patient data. Pharm World Sci 1995;17:20-4. </P >     <P   >58 -Klungel OH, de Boer A, Paes AH, Herings RM, Seidell JC, Bakker A. Agreement    between self-reported antihypertensive drug use and pharmacy records in a population-based    study in The Netherlands. Pharm World Sci 1999;21:217-20. </P >     <P   >59 -Sjahid SI, van der Linden PD, Stricker BH. Agreement between the pharmacy medication history and patient interview for cardiovascular drugs: the Rotterdam elderly study. Br J Clin Pharmacol 1998;45:591-5. </P >    <P   >60 -Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based &ldquo;detailing&rdquo;. N Engl J Med 1983;308:1457-63. </P >    <P   >61 -Ray WA, Schaffner W, Federspiel CF. Persistence of improvement in antibiotic prescribing in of&#64257;ce practice. JAMA 1985;253:1774-6. </P >     <P   >62 -Schaffner W, Ray WA, Federspiel CF, Miller WO. Improving antibiotic prescribing    in of&#64257;ce practice. A controlled trial of three educational methods. JAMA    1983;250:1728-32. </P >     <P   >&nbsp;</P >     <P   ><B>Correspondence: </B></P >     ]]></body>
<body><![CDATA[<P   >Dr.&ordf; Helena Gama </P >     <P   >Departamento de Investiga&ccedil;&atilde;o e Desenvolvimento </P >     <P   >BIAL</P >     <P   > 4475-457 S. Mamede do Coronado </P >     <P   >e-mail: <a href="mailto:helena.gama@bial.com">helena.gama@bial.com</a></P >      ]]></body><back>
<ref-list>
<ref id="B1">
<nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lunde]]></surname>
<given-names><![CDATA[PK]]></given-names>
</name>
<name>
<surname><![CDATA[Baksaas]]></surname>
<given-names><![CDATA[I.]]></given-names>
</name>
</person-group>
<article-title xml:lang="en"><![CDATA[Epidemiology of drug utilization-basic concepts and methodology]]></article-title>
<source><![CDATA[Acta Med Scand]]></source>
<year>1988</year>
<volume>721</volume>
<page-range>7-11</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
