Non-Clinical Factors Determining the Prescription of Antibiotics by Veterinarians: A Systematic Review

The misuse of antibiotics in humans, animals, and plants is related to the spread of resistant antibiotic strains among humans and animals. In this paper, we carry out a bibliographic search of Medline, Web of Knowledge, and Cab Abstracts with the main objective of ascertaining the available evidence on non-clinical factors and attitudes that could influence the prescription of antibiotics by veterinarians. A total of 34 studies fulfilled the inclusion criteria. Whereas, veterinary health professionals’ prescribing habits did not appear to be influenced by their socio-demographic characteristics, they were influenced by different attitudes, such as fear (identified in 19 out of 34 studies), self-confidence (19/34), business factors (19/34), and by complacency (16/34). Certain owner-related factors, such as lack of awareness (16/34) and demand for antibiotics (12/34), were also important, as were concurrent factors, ranging from a lack of appropriate regulations (10/34) to the expense and delays involved in performing culture and sensitivity tests (10/34) and inadequate farm hygiene (8/34). Our results appear to indicate that the non-clinical factors are potentially modifiable. This may be useful for designing interventions targeted at improving antibiotic use in animals, as part of an overall strategy to reduce the global spread of multi-resistant strainsS

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

Case-crossover design: Basic essentials and applications

El diseño de casos cruzados es un diseño epidemiológico observacional propuesto por Maclure en 1991 para valorar si alguna exposición intermitente o inusual ha desencadenado un evento agudo a muy corto plazo. En este trabajo se presentan los fundamentos de los diseños de casos cruzados, con sus aplicaciones y limitaciones. El diseño de casos cruzados se basa en seleccionar sólo sujetos caso. Para calcular el riesgo relativo se compara la exposición durante el periodo de tiempo previo al evento (periodo caso) con la exposición del mismo sujeto en uno o varios periodos control. Este método únicamente es adecuado cuando las exposiciones son cambiantes en el tiempo, con efectos a corto plazo, y el efecto es agudo. Para exposiciones en que no existe tendencia, el planteamiento unidireccional es el más frecuente, y consiste en seleccionar uno o varios periodos control previos al momento caso. Cuando la exposición tiene una tendencia temporal (por ejemplo las de contaminación atmosférica), el planteamiento unidireccional proporciona estimaciones sesgadas, por lo que se utilizan diseños de casos cruzados bidireccionales, que seleccionan periodos de tiempo control anteriores y posteriores al del evento. Es un método que cuenta con una creciente utilización en amplios campos: desencadenantes de accidentes de tráfico, laborales y domésticos, o de infarto agudo de miocardio, contaminación atmosférica y salud, farmacoepidemiología, etc. Para el análisis de datos, generalmente se pueden considerar los diseños de casos cruzados como estudios de casos y controles emparejados, por lo que se aplica regresión logística condicional. Finalmente, en este trabajo se analizan ejemplos prácticos de diferentes aplicaciones del diseño de casos cruzadosCase-crossover analysis is an observational epidemiological design that was proposed by Maclure in 1991 to assess whether a given intermittent or unusual exposure may have triggered an immediate short-term, acute event. The present article outlines the basics of case-crossover designs, as well as their applications and limitations. The case-crossover design is based on exclusively selecting case subjects. To calculate relative risk, exposure during the period of time prior to the event (case period) is compared against the same subject's exposure during one or more control periods. This method is only appropriate when the exposures are transient in time and have acute short-term effects. For exposures in which there is no trend, a unidirectional approach is the most frequent and consists of selecting one or more control periods prior to the case period. When the exposure displays a time trend (e.g., air pollution), a unidirectional approach will yield biased estimates, and therefore bidirectional case-crossover designs are used, which select control time intervals preceding and subsequent to that of the event. The case-crossover design is being increasingly used across a wide range of fields, including factors triggering traffic, occupational and domestic accidents and acute myocardial infarction, and those involved in air pollution and health and pharmacoepidemiology, among others. Insofar as data-analysis is concerned, case-crossover designs can generally be regarded as matched case-control studies and consequently conditional logistic regression can be applied. Lastly, this study analyzes practical examples of distinct applications of the case-crossover designEste trabajo se ha financiado por una acción específica del CIBERESP (CIBERESP-MET-007) y por el proyecto intramural del ISCIII: SEPY1106/07S

Factors associated with underreporting of adverse drug reactions by health care professionals: a systematic review update

Introduction Underreporting is a major limitation of the voluntary reporting system of adverse drug reactions (ADRs). A 2009 systematic review showed the knowledge and attitudes of health professionals were strongly related with underreporting of ADRs. Objective Our aim was to update our previous systematic review to determine factors (sociodemographic, knowledge and attitudes) associated with the underreporting of ADRs by healthcare professionals. Methods We searched the MEDLINE and EMBASE databases for studies published between 2007 and 2021 that met the following inclusion criteria: (1) published in English, French, Portuguese or Spanish; (2) involving health professionals; and (3) the goal was to evaluate factors associated with underreporting of ADRs through spontaneous reporting. Results Overall, 65 papers were included. While health professional sociodemographic characteristics did not influence underreporting, knowledge and attitudes continue to show a significant effect: (1) ignorance (only serious ADRs need to be reported) in 86.2%; (2) lethargy (procrastination, lack of interest, and other excuses) in 84.6%; (3) complacency (the belief that only well tolerated drugs are allowed on the market) in 46.2%; (4) diffidence (fear of appearing ridiculous for reporting merely suspected ADRs) in 44.6%; and (5) insecurity (it is nearly impossible to determine whether or not a drug is responsible for a specific adverse reaction) in 33.8%, and the absence of feedback in 9.2%. In this review, the non-obligation to reporting and confidentiality emerge as new reasons for underreporting. Conclusions Attitudes regarding the reporting of adverse reactions continue to be the main determinants of underreporting. Even though these are potentially modifiable factors through educational interventions, minimal changes have been observed since 2009Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This study has been funded in part by the Instituto de Salud Carlos III (ISCIII) through the project PI19/01006, cofinanced by FEDER, European UnionS

Knowledge, attitudes, perceptions and habits towards antibiotics dispensed without medical prescription: a qualitative study of Spanish pharmacists

Objective To investigate community pharmacists’ knowledge, attitudes, perceptions and habits with regard to antibiotic dispensing without medical prescription in Spain. Methods A qualitative research using focus group method (FG) in Galicia (north-west Spain). FG sessions were conducted in the presence of a moderator. A topic script was developed to lead the discussions, which were audiorecorded to facilitate data interpretation and transcription. Proceedings were transcribed by an independent researcher and interpreted by two researchers working independently. We used the Grounded Theory approach. Setting Community pharmacies in Galicia, region Norwest of Spain. Participants Thirty pharmacists agreed to participate in the study, and a total of five FG sessions were conducted with 2–11 pharmacists. We sought to ensure a high degree of heterogeneity in the composition of the groups to improve our study's external validity. Pharmacists’ participation had no gender or age restrictions, and an effort was made to form FGs with pharmacists who were both owners and non-owners, provided in all cases that they were Official Colleges of Pharmacists-registered community pharmacists. For the purpose of conducting FG discussions, the basic methodological principle of allowing groups to attain their ‘own structural identity’ was applied. Main outcome measurements Community pharmacists’ habits and knowledge with regard to antibiotics and identification of the attitudes and/or factors that influence antibiotic dispensing without medical prescription. Results Pharmacists attributed the problem of antibiotics dispensed without medical prescription and its relationship to antibiotic resistance to the following attitudes: external responsibility (doctors, dentists and the National Health Service (NHS)); acquiescence; indifference and lack of continuing education. Conclusions Despite being a problem, antibiotic dispensing without a medical prescription is still a common practice in community pharmacies in Galicia, Spain. This practice is attributed to acquiescence, indifference and lack of continuing education. The problem of resistance was ascribed to external responsibility, including that of patients, physicians, dentists and the NHS.S

Efecto a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto ENECAM en la ciudad de Vigo, 1991-1994

FUNDAMENTOS: En la Comunidad Autónoma Gallega no se ha realizado ningún estudio sobre las repercusiones de la contaminación atmosférica en la salud, a pesar de que hay varias ciudades grandes, con niveles de contaminación moderados. Por ello, nos hemos planteado la necesidad de realizar este estudio en la ciudad de Vigo. El objetivo principal de este trabajo es analizar el impacto a corto plazo de la contaminación atmosférica sobre la mortalidad diaria por todas las causas en la ciudad de Vigo durante los años 1991 a 1994, utilizando el protocolo de análisis del proyecto EMECAM. MÉTODO: Se relacionan las variaciones diarias del número de muertes por todas las causas, excepto las externas, con las variaciones diarias de dióxido de azufre y partículas, por medio de modelos de regresión de Poisson. Se utiliza también un modelo no paramétrico para ver si controla mejor las variables de confusión. RESULTADOS: Con el modelo de regresión de Poisson no se observan relaciones significativas entre los contaminantes y la mortalidad. En el modelo no paramétrico se observa relación entre la concentración de partículas del día anterior a la fecha de defunción y la mortalidad, efecto que se mantiene al incluir los términos autorregresivos. CONCLUSIONES: La contaminación atmosférica por partículas representa un riesgo para la salud, a pesar de que los niveles medios de este contaminante en la ciudad de Vigo están dentro de los niveles guía de calidad del aire.BACKGROUND: In the Autonomous Region of Galicia, no study has been made of the impacts of air pollution on human health, despite the fact that several of its major cities have moderate levels of pollution. Therefore, we have considered the need of making this study in the city of Vigo. The main objective of this analysis is that of analyzing the short-term impact of air pollution on the daily death rate for all reasons in the city of Vigo throughout the 1991-1994 period, by using the procedure for analysis set out as part of the EMECAM Project. METHOD: The daily fluctuations in the number of deaths for all causes with the exception of the external ones are listed with the daily fluctuations of sulfur dioxide and particles using Poisson regression models. A non-parametric model is also used in order to better control the confusion variables. RESULTS: Using the Poisson regression model, no significant relationships have been found to exist between the pollutants and the death rate. In the non-parametric model, a relationship was found between the concentration of particles on the day immediately prior to the date of death and the death rate, an effect which remains unchanged on including the autoregressive terms. CONCLUSIONS: Particle-based air pollution is a health risk despite the average levels of this pollutant falling within the air quality guideline levels in the city of Vigo

Efecto a corto plazo de la contaminación atmosférica sobre la mortalidad. Resultados del proyecto ENECAM en la ciudad de Vigo, 1991-1994

FUNDAMENTOS: En la Comunidad Autónoma Gallega no se ha realizado ningún estudio sobre las repercusiones de la contaminación atmosférica en la salud, a pesar de que hay varias ciudades grandes, con niveles de contaminación moderados. Por ello, nos hemos planteado la necesidad de realizar este estudio en la ciudad de Vigo. El objetivo principal de este trabajo es analizar el impacto a corto plazo de la contaminación atmosférica sobre la mortalidad diaria por todas las causas en la ciudad de Vigo durante los años 1991 a 1994, utilizando el protocolo de análisis del proyecto EMECAM. MÉTODO: Se relacionan las variaciones diarias del número de muertes por todas las causas, excepto las externas, con las variaciones diarias de dióxido de azufre y partículas, por medio de modelos de regresión de Poisson. Se utiliza también un modelo no paramétrico para ver si controla mejor las variables de confusión. RESULTADOS: Con el modelo de regresión de Poisson no se observan relaciones significativas entre los contaminantes y la mortalidad. En el modelo no paramétrico se observa relación entre la concentración de partículas del día anterior a la fecha de defunción y la mortalidad, efecto que se mantiene al incluir los términos autorregresivos. CONCLUSIONES: La contaminación atmosférica por partículas representa un riesgo para la salud, a pesar de que los niveles medios de este contaminante en la ciudad de Vigo están dentro de los niveles guía de calidad del aire