Why do paediatricians prescribe antibiotics? Results of an Italian regional project

<p>Abstract</p> <p>Background</p> <p>To investigate determinants of antibiotic prescription in paediatric care, as a first step of a multilevel intervention to improve prescribing for common respiratory tract infections (RTIs) in a northern Italian region with high antibiotic prescription rate.</p> <p>Methods</p> <p>A two-step survey was performed: in phase I, knowledge, and attitudes were explored involving all family and hospital paediatricians of Emilia-Romagna and a sample of parents. In phase II, patient care practices were explored in a stratified random sample of visits, both in hospitals and family physician's clinics; parent expectations were investigated in a sub-sample of these visits.</p> <p>Results</p> <p>Out of overall 4352 visits for suspected RTIs, in 38% of children an antibiotic was prescribed. Diagnostic uncertainty was perceived by paediatricians as the most frequent cause of inappropriate prescription (56% of 633 interviewed paediatricians); but, rapid antigen detecting tests was used in case of pharyngitis/pharyngotonsillitis by 36% and 21% of family and hospital paediatricians only. More than 50% of paediatricians affirmed to not adopt a "wait and see strategy" in acute otitis. The perceived parental expectation of antibiotics was not indicated by paediatricians as a crucial determinant of prescription, but this perception was the second factor most strongly associated to prescription (OR = 12.8; 95% CI 10.4 - 15.8), the first being the presence of othorrea. Regarding parents, the most important identified factors, potentially associated to overprescribing, were the lack of knowledge of RTIs and antibiotics (41% of 1029 parents indicated bacteria as a possible cause of common cold), and the propensity to seek medical care for trivial infections (48% of 4352 children accessing ambulatory practice presented only symptoms of common cold).</p> <p>Conclusion</p> <p>A wide gap between perceived and real determinants of antibiotic prescription exists. This can promote antibiotic overuse. Inadequate parental knowledge can also induce inappropriate prescription. The value of this study is that it simultaneously explored determinants of antimicrobial prescribing in an entire region involving both professionals and parents.</p

Tectono-Stratigraphic Evolution of the Atuel Depocenter During the Late Triassic to Early Jurassic Rift Stage, Neuquén Basin, West-Central Argentina

The Neuquén basin presents an almost continuous record from the Late Triassic until the Paleocene,making it an excellent case study of the most relevant tectonic stages of southern South America during the Mesozoic. It was initiated in the Late Triassic to Early Jurassic times as a continental rift basin in the context of a widespread extensional stage that affected western Gondwana andculminated with the break-up of the supercontinent.The Atuel depocenter is located in the northern sector of the Neuquén basin. Synrift and sag units are represented by Upper Triassic to Lower Jurassic siliciclastic marine and continental sedimentary rocks including the oldest marine deposits of the basin, of Late Triassic age. The depocenter infill hasbeen deformed and exhumed during the Andean orogeny, being presently exposed in the northern sector of the Malargüe fold and thrust belt. In this review, we have integrated a large set of stratigraphic, sedimentologic, geochronologic and structural data in order to unravel the tectono-sedimentary evolution of the Atuel depocenter, and to evaluate the main controlling factors of thesynrift stage. We analyzed data from the synrift units, such as facies and thickness distribution, sandstone provenance, detrital zircon geochronology data, kinematic data from outcrop scale normal faults, angular and progressive unconformities and subsurface information. Reactivation of preexisting NNW-striking anisotropies under a regional NNE extension resulted in anoblique rift setting, which generated a bimodal distribution of NNW- and WNW-striking major normal faults. Strain and stress tensors obtained from the kinematic and dynamic analysis of structural data show a complex heterogeneity that we interpreted as a result of local stress permutations due to both activity of the larger faults, and to strain partitioning inside the Atueldepocenter.Sedimentologic and petrographic data revealed a complex evolution with strong lateral variations of the depositional environments during the synrift phase, which lasted from Rhaetian to Pliensbachian times. We identified several stages that were controlled by processes of initiation, propagation, growth, linkage and deactivation of new and reactivated faults along the depocenter evolution, in combination with sea level changes related to global eustatic variations. Sandstone provenance data suggest that an important basin reorganization by the Toarcian, probably related to the initiation of the sag stage in this depocenter.Fil: Bechis, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio. Universidad Nacional de Río Negro. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio; ArgentinaFil: Giambiagi, Laura Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla; ArgentinaFil: Tunik, Maisa Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Suriano, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla; ArgentinaFil: Lanés, Silvia. Cape Town; SudáfricaFil: Mescua, Jose Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla; Argentina. Universidad Nacional de Cuyo; Argentin