Parents' Perspective of Antibiotic Usage in Children: A Nationwide Survey in Italy

Background: Antibiotics represent the most widely prescribed drugs in children worldwide, both in hospital and community settings. A comprehensive approach to understanding the reasons and determinants of antibiotic prescription in the pediatric age is needed. This study aimed to assess parents' attitudes and perspectives about antibiotic use. Methods: Prospective observational study was conducted in all Italian Regions between February 1 and April 30, 2020, using a standardized questionnaire. Results: Six thousand six hundred twenty-five parents from all Italian regions completed the survey. Seventy-six percent of parents were aware that only bacteria are the target of antibiotics, but 92.9% knew that the antibiotic has no direct effect on fever. Antibiotic self-prescription (10.4%) or by remote consultation by phone call (19.9%) or message (9.6%) were relatively common. Ninety-three percent of parents were aware that excessive use of antibiotics could select resistant bacteria and 84.7% of them knew that they could actively fight antibiotic resistance. About two thirds of participants (66.1%) received information on antibiotic resistance from their family pediatrician. Parents born of Italy or those with lower income had a higher probability of having less information from pediatricians or knowledge of proper antibiotic use. Discussion: Our study suggests that parents' knowledge and attitudes toward antibiotic use and prescription are improving compared with previous studies, while there is still a gap regarding antibiotic resistance, particularly on practices that can reduce its burden. Our study's negative finding is that families from low-income settings or those born abroad have significantly more misconceptions about important antibiotic practices

Table_1_New evidence of predictive validity of SRSS-IE scores with middle and high school students.docx

IntroductionWe report predictive validity of the newly defined Student Risk Screening Scale – Internalizing and Externalizing (SRSS-IE 9, with 9 items) when used for the first time by middle and high school teachers from 43 schools.MethodsThe sample included 11,773 middle school-aged students representing four geographic regions, and 7,244 high school-aged students representing three geographic regions.ResultsResults indicated fall SRSS-IE externalizing and internalizing latent factors as well as subscale scores (SRSS-E5, SRSS-I4, respectively) predicted year-end behavioral (office discipline referrals and in school suspensions) and academic (course failures) outcomes for middle and high school students as well as referrals to special education for middle school students. Internalizing scores also predicted referrals to special education for high school students. Externalizing and internalizing scores predicted nurse visits at the middle and high school levels with all models except for subscale models of internalizing in middle school. SRSS-IE 12 subscale scores for externalizing (SRSS-E7) and internalizing (SRSS-I5) using the original 12 items were similarly predictive of these outcomes, with few variations.DiscussionWe discuss educational implications, limitations, and directions for future inquiry.</p