Misprescription of antibiotics in primary care: a critical systematic review of its determinants

Background Antibiotic resistance is one of the principal public health problems worldwide. Currently, inappropriate use of antibiotics is regarded as the principal determinant of resistance, with most of these drugs being prescribed outside a hospital setting. This systematic review sought to identify the factors, attitudes and knowledge linked to misprescription of antibiotics. Methods A systematic review was conducted using the MEDLINE-PubMed and EMBASE databases. The selection criteria required that papers: (1) be published in English or Spanish; (2) designate their objective as that of addressing attitudes/ knowledge or other factors related with the prescribing of antibiotics; and (3) use quality and/or quantity indicators to define misprescription. The following were excluded: any paper that used qualitative methodology and any paper that included descriptive analysis only. Results A total of 46 papers that met the inclusion criteria were included in the review. They were very heterogeneous and displayed major methodological limitations. Doctors’ socio-demographic and personal factors did not appear to exert much influence. Complacency (fulfilling what professionals perceived as being patients’/parents’ expectations) and, to a lesser extent, fear (fear of possible complications in the patient) were the attitudes associated with misprescription of antibiotics. Conclusions Before designing interventions aimed at improving the prescription and use of antibiotics, studies are needed to identify precisely which factors influence prescribing

Attitudes of primary care physicians to the prescribing of antibiotics and antimicrobial resistance: a qualitative study from Spain.

BACKGROUND AND OBJECTIVE: Resistance to antibiotics is a public health threat. A number of studies confirm the relationship between antibiotic use and the resistance rate. As a whole, physicians represent a large proportion of the health professionals involved in the use of this therapeutic group. Our study therefore sought to ascertain the opinions and attitudes of GPs in Spain with respect to antibiotics and resistance. METHODS: We used the focus group (FG) method, with each group comprising 4-12 primary care physicians and a moderator. Based on a previous systematic review, we drew up an agenda to be followed during the holding of the sessions. Group proceedings were recorded and the transcriptions then analysed separately by two researchers. RESULTS: Five FGs were formed, including a total of 33 physicians. The factors/attitudes that influenced the prescribing of antibiotics by GPs were fear, complacency, insufficient knowledge and external responsibility of the pharmaceutical industry, patients and over-the-counter antibiotics. The groups felt that antibiotic resistance was not a problem at a community level. CONCLUSIONS: Identification of attitudes/knowledge related with inappropriate antibiotic prescribing will enable specific interventions to be designed, with the aim of targeting these shortcomings to improve antibiotic use and help reduce resistance

Mobbing: Antecedentes psicosociales y consecuencias sobre la satisfacción laboral

Este trabajo analiza el papel de algunos factores psicosociales como antecedentes de mobbing (exigencias psicológicas cuantitativas, claridad de rol, apoyo social, calidad de liderazgo e influencia) y, a su vez, la relación entre el mobbing y la satisfacción laboral de los trabajadores, en una organización del sector de la hostelería y la restauración. De los factores psicosociales considerados, únicamente las exigencias psicológicas cuantitativas, la claridad de rol y la calidad del liderazgo, predicen la aparición de procesos de mobbing. Por su parte, el número de conductas de mobbing se relaciona de forma negativa con dos de las dimensiones de la satisfacción laboral consideradas (la supervisión y las prestaciones), mientras que el índice global de acoso psicológico lo hace con la satisfacción con el ambiente físico. Las implicaciones de estos hallazgos son discutidas

Magnitude and determinants of antibiotic dispensing without prescription in Spain: a simulated patient study

OBJECTIVES: Excessive and inappropriate use of antibiotics increases antimicrobial resistance. The aim of this study was to determine the magnitude and determinants of antibiotic dispensing without prescription in Spain by the simulated patient technique. METHODS: A cross-sectional study was conducted with all the pharmacies in a region of north-west Spain (n = 977), between December 2016 and January 2017. Four actors visited the pharmacies simulating a respiratory infection. Four incremental levels of pressure were used to obtain an antibiotic. The education and sex of the person who was dispensing and the area where the pharmacy was located were recorded. The effect of these independent variables on the dispensing of an antibiotic without prescription (1 = yes, 0 = no) was modelled by logistic regression. RESULTS: An antibiotic was obtained in 18.83% (95% CI = 16.5%-21.41%) of the visits. The area influenced the dispensing of antibiotics without a medical prescription, with a greater likelihood of dispensing in rural (OR = 1.79; 95% CI = 1.20-2.68) or semi-rural (OR = 1.66; 95% CI = 1.13-2.44) areas than in urban areas. No association was found with the sex or the training of the person who dispensed the antibiotic. In the pharmacies in urban areas, a lower level of pressure was needed to obtain the antibiotic. CONCLUSIONS: This study shows that one-fifth of the pharmacies still dispense antibiotics without prescription, especially under patient pressure. A rural setting has been identified as a risk factor for dispensing without prescription, so it must be taken into account for future interventions.Fondo de Investigación SanitariaInstituto de Salud Carlos II

Determinants of antibiotic dispensing without a medical prescription: a cross-sectional study in the north of Spain

Objectives: Antibiotic resistance is a major public health concern and is greatly exacerbated by inappropriate antibiotic use at a community level. The aim of this study was to ascertain which attitudes of community pharmacists were related to inappropriate antibiotic dispensing. Methods: We conducted a cross-sectional study of community pharmacists in a region situated in northern Spain (n = 393). Personal interviews were conducted using a self-administered questionnaire. The degree of agreement with each item of knowledge and attitude was measured using an unnumbered, horizontal visual analogue scale, with replies being scored from 0 (total disagreement) to 10 (total agreement). The data were analysed using logistic regression. Results: Of the total of 286 pharmacists (72.8%) who completed the questionnaire, 185 (64.7%) acknowledged having undertaken dispensing of antibiotics without a medical prescription (DAwMP). Attitudes such as patient complacency, external responsibility, indifference and insufficient knowledge were shown to be related to DAwMP. In contrast, no association was found with any of the pharmacists' personal or professional traits. Conclusions: This study confirms that, albeit unlawful, DAwMP is a common practice in Spanish pharmacies. DAwMP was seen to be usually associated with some of the attitudes evaluated.Fondo de Investigación Sanitari

Effect of Physicians' Attitudes and Knowledge on the Quality of Antibiotic Prescription: A Cohort Study

Resistance increases with the use and abuse of antibiotics. Since physicians are primarily responsible for the decision to use antibiotics, ascertaining the attitudes and knowledge that underlie their prescribing habits is thus a prerequisite for improving prescription. Three-year follow-up cohort study (2008-2010) targeting primary-care physicians (n = 2100) in Galicia, a region in NW Spain. We used data obtained from a postal survey to assess knowledge and attitudes. A physician was deemed to have demonstrated Appropriate Quality Prescription of Antibiotics (dependent variable) in any case where half or more of the indicators proposed by the European Surveillance of Antimicrobial Consumption had values that were better than the reference values for Spain. The mail-questionnaire response rate was 68·0% (1428/2100). The adjusted increase in the interquartile OR of displaying good prescribing of antibiotics for each attitude was: 205% for fear ("When in doubt, it is better to ensure that a patient is cured of an infection by using a broad-spectrum antibiotic"; 95%CI: 125% to 321%); 119% for better knowledge ("Amoxicillin is useful for resolving most respiratory infections in primary care"; 95%CI: 67% to 193%); and 21% for complacency with patients' demands ("Antibiotics are often prescribed due to patients' demands"; 95%CI: 0% to 45%). Due to the fact that physicians' knowledge and attitudes are potentially modifiable, the implementation of purpose-designed educational interventions based on the attitudes identified may well serve to improve antibiotic prescription

Interplay between the Chd4/NuRD Complex and the Transcription Factor Znf219 Controls Cardiac Cell Identity

The sarcomere regulates striated muscle contraction. This structure is composed of several myofibril proteins, isoforms of which are encoded by genes specific to either the heart or skeletal muscle. The chromatin remodeler complex Chd4/NuRD regulates the transcriptional expression of these specific sarcomeric programs by repressing genes of the skeletal muscle sarcomere in the heart. Aberrant expression of skeletal muscle genes induced by the loss of Chd4 in the heart leads to sudden death due to defects in cardiomyocyte contraction that progress to arrhythmia and fibrosis. Identifying the transcription factors (TFs) that recruit Chd4/NuRD to repress skeletal muscle genes in the myocardium will provide important information for understanding numerous cardiac pathologies and, ultimately, pinpointing new therapeutic targets for arrhythmias and cardiomyopathies. Here, we sought to find Chd4 interactors and their function in cardiac homeostasis. We therefore describe a physical interaction between Chd4 and the TF Znf219 in cardiac tissue. Znf219 represses the skeletal-muscle sarcomeric program in cardiomyocytes in vitro and in vivo, similarly to Chd4. Aberrant expression of skeletal-muscle sarcomere proteins in mouse hearts with knocked down Znf219 translates into arrhythmias, accompanied by an increase in PR interval. These data strongly suggest that the physical and genetic interaction of Znf219 and Chd4 in the mammalian heart regulates cardiomyocyte identity and myocardial contraction.J.V. was supported by the Spanish Ministry of Science and Innovation (PGC2018-097019-B-I00 and PID2021-122348NB-I00), UE Funds and Micinn-Inst Carlos III (PMP21_00057) and “la Caixa” Banking Foundation (project codes HR17-00247 and HR22-00253). J.M.R. was supported by the La Caixa Banking Foundation (project code HR18-00068), the Spanish Ministry of Science and Innovation grant RTI2018-099246-B-I00 (MICIU/AEI/FEDER, UE); the Comunidad de Madrid and European Social Fund (ESF) grant AORTASANA-CM (B2017/BMD-3676); and the Instituto de Salud Carlos III (ISCIII) (CIBER-CVCB16/11/00264). PG-A was supported by Spanish Ministry of Science and Innovation (grants SAF2016-77816-P and PID2020-114773GB-I00). The CNIC is supported by Instituto de Salud Carlos III (ISCIII), the Spanish Ministry of Science and Innovation and the Pro CNIC Foundation and is a Severo Ochoa Center of Excellence (grant CEX2020-001041-S funded by Spanish Ministry of Science and Innovation AEI/10.13039/501100011033). FAS is supported by a Science and Innovation Fellowship (BES-2017-080629).S

Exploring analytical proteomics platforms toward the definition of human cardiac stem cells receptome

Human cardiac stem cells (hCSC) express a portfolio of plasma membrane receptors that are involved in the regulatory auto/paracrine feedback loop mechanism of activation of these cells, and consequently contribute to myocardial regeneration. In order to attain a comprehensive description of hCSC receptome and overcoming the inability demonstrated by other technologies applied in receptor identification, mainly due to the transmembrane nature, high hydrophobic character and relative low concentration of these proteins, we have exploited and improved a proteomics workflow. This approach was based on the enrichment of hCSC plasma membrane fraction and addition of prefractionation steps prior to MS analysis. More than 100 plasma membrane receptors were identified. The data reported herein constitute a valuable source of information to further understand cardiac stem cells activation mechanisms and the subsequent cardiac repair process. All MS data have been deposited in the ProteomeXchange with identifier PXD001117 (http://proteomecentral.proteomexchange.org/dataset/PXD001117).Authors acknowledge FP7 EU project CARE-MI (HEALTH-2009_242038) and the Portuguese Foundation for Science and Technology (PTDC/BBBBIO/1414) for financial support. PGA is a recipient of the FCT fellowship SFRH/BPD/86513/2012. MALDI-TOF/TOF analyses were performed at the Mass Spectrometry Unit (UniMS), ITQB/iBET, Oeiras, Portugal. The data deposition to the ProteomeXchange Consortium was supported by PRIDETeam, EBI.S

Efecto de la temperatura y tiempo de almacenamiento en la concentración de algunas fitohormonas y germinación de las semillas del chile piquín Capsicum annuum var. glabriusculum (Dunal) Heiser & Pickersgill

The genus Capsicum is an economically important plant around the world. In Mexico, chili cropping is a profitable agricultural business due to its demand in the national and international market. A species of interest is the bird pepper, Capsicum annuum var. glabriusculum (Dunal) Heiser & Pickersgill, whose exploitation is limited only to wild populations. There have been many unsuccessful attempts to cultivate it intensively because of its low germination percentage, since the seed shows non-deep physiological dormancy, a frequent feature in undomesticated wild species. In this study, the effect of temperature and age of bird pepper seed on the concentration of auxins (tryptophan), cytokinins (kinetin) and gibberellins (GA3) and their germinative capacity were analyzed. For this, the germinative capacity of pepper seeds stored at two temperatures (4 and 24°C) and five ages (0, 3, 6, 9 and 12 months) was evaluated. Also, quantification of the phytohormones auxins, cytokinins and gibberellins was performed using high performance liquid chromatography (HPLC). The results show that the content of the three phytohormones had increased through time according to the time of storage (p≤0.05). The highest germination percentage was at 9 months of storage (p≤0.05) and this was the highest content of the three phytohormones; therefore at this age, the seed reached its maturation point; however, at 12 months of storage, germination started diminishing as well as the phytohormone content, indicating that the seed quality and viability was starting to decrease.El género Capsicum es una hortaliza de importancia económica a nivel mundial. En México es una importante actividad económica en el sector agrícola, por ello la importancia del cultivo de variedades que permitan abrir nuevas áreas de oportunidad comercial tanto a nivel nacional como internacional. Una de estas variedades es el chile piquín Capsicum annuum var. glabriusculum (Dunal) Heiser & Pickersgill, cuyo aprovechamiento se reduce únicamente a poblaciones silvestres, ya que se han hecho varios intentos de cultivarla de manera intensiva teniendo como resultado bajos porcentajes de germinación, debido a que la semilla presenta latencia fisiológica no profunda, rasgo característico de especies que aún no han sido domesticadas. En este estudio se propuso conocer el efecto de la temperatura y el tiempo de almacenamiento, sobre el contenido de triptófano (aminoácido precursor de auxinas), citocininas (kinetina) y giberelinas (GA3) presentes en la semilla y su relación en el proceso de germinación. Para evaluar la capacidad de germinación de las semillas de chile piquín, estas se almacenaron a dos temperaturas (4 °C y 24 °C) y cinco tiempos de almacenamiento (0, 3, 6, 9 y 12 meses). Además, se cuantificó el contenido de fitohormonas, auxinas, citicininas y giberelinas utilizándose la técnica de Cromatografía Líquida de Alta Resolución (HPLC). Los resultados muestran que el contenido de las tres fitohormonas se incrementó con respecto al tiempo de almacenamiento. El más alto porcentaje de germinación y concentración de fitohormonas se presentó a los 9 meses de almacenamiento; mientras que, a los 12 meses, la germinación empieza a disminuir, así como el contenido de fitohormonas, indicando que la calidad y viabilidad de la semilla ha empezado a decrecer