Parents' beliefs and knowledge about the management of acute otitis media: A qualitative study

BACKGROUND: Acute otitis media is a common reason for antibiotic prescribing, despite strong evidence that antibiotics provide minimal benefit. Studies have demonstrated that patients’ (or parents’) expectations of antibiotics often influence general practitioners’ (GPs) decision to prescribe antibiotics, but few have explored parents’ expectations of the management of infections in children, or which factors influence the development of these expectations. This study aimed to explore parents’ knowledge and beliefs about the management of acute otitis media in children. METHODS: Individual semi-structured interviews were conducted with 15 parents of children who had recently presented to their GP with acute otitis media. Parents were recruited at childcare centres or playgroups in Brisbane, Australia. RESULTS: Many parents did not have an accurate understanding of what causes acute otitis media. GPs were primarily consulted for the management of symptoms such as pain and fever. Others specifically wanted reassurance or were concerned about hearing loss. Most parents assumed that antibiotics were the best treatment option. Parents’ perceptions about the best treatment were mainly based on their previous experience and the advice of the GP. Pain relief medications, such as paracetamol and non-steroidal anti-inflammatory drugs, were not considered by parents to be sufficient treatment on their own. CONCLUSION: There is discrepancy between parents’ beliefs and expectations of management of acute otitis media and the evidence-based recommendations. This study provides insights into parents’ expectations of management of acute otitis media, which may help inform clinicians about perceptions and misperceptions that may be valuable to elicit and discuss

Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care:a systematic review of quality indicators

Objective: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. Design: A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs were organised into three categories: (1) QIs focusing on the diagnostic process; (2) QIs focusing on the decision to prescribe antibiotics; and (3) QIs concerning the choice of antibiotics. Results: Eleven studies were included in this review and a total of 130 QIs were identified. The majority (72%) of the QIs were focusing on choice of antibiotics, 22% concerned the decision to prescribe antibiotics, and few (6%) concerned the diagnostic process. Most QIs were either related to respiratory tract infections or not related to any type of infection. A consensus method (mainly the Delphi technique), based on either a literature study or national guidelines, was used for the development of QIs in all of the studies. Conclusions: The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed.KEY POINTS In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided. A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care. The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process. All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines

Emissionskonsekvenser af modeller for etablering af miljøzoner for mobile ikke-vejgående arbejdsmaskiner: Artikel

Emissionskonsekvenserne af at indføre miljøzoner for arbejdsmaskiner i Danmark er beregnet for årene 2025, 2027 og 2030 med DCE’s non-road emissionsmodel (DEMOS-NRMM). Beregningerne er udført for fire forskellige miljøzoneområder (a)-(d), og miljøscenarier med krav til enten maskinernes emissionsnorm eller afgiftsbetaling. Scenariernes bestandsfordelinger på EU-emissionstrin er bestemt af COWI i et forudgående projekt bl.a. ud fra DCE’s bestandsdata og analyser af virksomhedernes maskinvalg i de forskellige scenarier.NOx og PM2.5 basisemissionerne beregnet for arbejdsmaskiner i det samlede geografiske område (b+c+d) er ganske små, og udgør mellem 6 % og 7 % af den nationale basisemission i alle årene 2025, 2027 og 2030. De største NOx og PM2.5 emissionsreduktioner opnås i Scenarie 1.A i 2025 hvor kun stage V maskiner bruges. Emissionsreduktionerne er størst for PM2.5. For PM2.5[NOx] beregnes i 2025 en emissionsreduktion på 93 %[14 %], 88 %[12 %], 79 %[11 %] og 76 %[9 %] for hhv. Scenarie 1.A, 1.B, 3.A og 3.B ift. til basisemissionen i det samlede område (b+c+d). Pga. den naturlige udskiftning til stage V maskiner i basisbestanden falder især basisemissionerne af PM2.5 markant frem mod 2030, og PM2.5 emissionseffekterne af at indføre miljøzoner bliver derfor også gradvist mindre. PM2.5[NOx] basisemissionerne falder med 67 %[11 %] fra 2025 til 2030. For scenarie 1.A stiger PM2.5 emissionen med 4 %, mens NOx emissionen falder med 2 %. For scenarie 1.B, 3.A og 3.B falder PM2.5[NOx] emissionerne med hhv. 28 %[4 %], 33 %[3 %] og 46 %[5 %] fra 2025 til 2030.Arbejdsmaskinernes emissionsbidrag til NO2-og PM2.5-bybaggrundskoncentrationerne udgør i basis hhv. 1,25 % og 0,05 % af de årlige målte bybaggrundskoncentrationer i København. De lavere emissioner fra arbejdsmaskiner vil nedbringe de årlige bybaggrundskoncentrationer for NO2 med 0,2 % i både scenarie 1.A og 3.A, og for PM2.5 med hhv. 0,04 % og 0,03 % i scenarie 1.A og 3.A. Emissionsbidraget fra arbejdsmaskiner til spidsværdien for NO2-koncentrationen (19. største timemiddelværdi) og PM2.5-koncentrationen (4. største døgnmiddelværdi) i København og Frederiksberg i 2025 udgør i basis hhv. 13,2 % og 0,2 % af den højeste målte timemiddelværdi for NO2 og den 4. største døgnmiddelværdi for PM2.5 i bybaggrund. De lavere bidrag fra arbejdsmaskiner til spidsværdien af NO2-koncentrationen vil give reduktioner på 1,8 % og 1,4 % af den højeste målte timemiddelværdi i bybaggrund for hhv. scenarie 1.A og 3.A. For PM2.5 reduceres den 4. største døgnmiddelværdi i bybaggrundskoncentrationen med hhv. 0,18 % og 0,14 % i scenarie 1.A og 3.A

Changes in Antibiotic Prescribing Patterns in Danish General Practice during the COVID-19 Pandemic: A Register-Based Study

The World Health Organization expressed concern that antimicrobial resistance would increase during the COVID-19 pandemic due to the excessive use of antibiotics. This study aimed to explore if antibiotic prescribing patterns in general practices located in the North Denmark Region changed during the COVID-19 pandemic. The study was conducted as a registry-based study. Data was collected for every antibiotic prescription issued in general practices located in the North Denmark Region during the first year of the pandemic (1 February 2020 to 31 January 2021) and the year prior to the pandemic (1 February 2019 to 31 January 2020). Data were compared regarding antibiotic agents and the type of consultation linked to each antibiotic prescription. Results showed that antibiotic prescriptions decreased by 18.5% during the first pandemic year. The use of macrolides and lincosamides, along with combinations of penicillins and beta-lactamase -sensitive penicillins, was reduced the most. Face-to-face consultations related to an antibiotic prescription decreased by 28.5%, while the use of video consultations increased markedly. In Denmark, COVID-19 restrictions have contributed to both a lower consumption of antibiotics and a change in prescription patterns in general practice. Probably some of the COVID-19 -preventing initiatives could be of importance moving forward in the fight against antimicrobial resistance

The emission consequences of using biodiesel and bio ethanol as a fuel for road transport in Denmark

This article explains the emission consequences of using biodiesel and bio ethanol as a fuel for road transport in Denmark calculated in the REBECa project. For the years 2004, 2010, 2015, 2020, 2025 and 2030, two fossil fuel baseline scenarios (FS) are considered characterised by different traffic growth rates. For each FS, two biofuel scenarios (BS1, BS2) are considered with a 5.75 % biodiesel/bio ethanol share in 2010 as a common starting point. From 2010, linear growths are assumed for BS1 (10 % in 2020) and BS2 (25 % in 2030). The emissions presented in this study are vehicle based; a separate Well to Wheels (W-t-W) assessment of the total emission consequences of producing and using biofuels has been conducted in a different part of REBECa. The maximum CO2 emission difference between FS and BS2 becomes 26 % in 2030. The NOx and VOC emission variations between FS and both biofuel scenarios are 3 % or less. For CO and TSP the largest emission differences, 5 % and -12 %, respectively, occur between the FS and BS2 scenarios in 2030. The biofuel emission impacts are insignificant for NOx,VOC, CO and TSP compared to the generally large emission reductions predicted in all scenarios driven by the gradual strengthened emission standards for new vehicles, by far outweighing the emission influence from biofuels and traffic growth. The emission estimates for NOx, VOC, CO and TSP presented in this study are less certain than for CO2 due to the relatively scarce biofuel emission data implemented in the calculations. As a consequence, the obtained emission results must be assessed with care. Bearing in mind these uncertainties, the calculation approach for emissions from biofuel usage presented in this study can be used as a tool to carry out sensitivity analysis, environmental impact assessment studies, or for research purposes as such

The Emission consequences of using biodiesel and bio ethanol as a fuel for road transport in Denmark

This article explains the emission consequences of using biodiesel and bio ethanol as a fuel for road transport in Denmark calculated in the REBECa project. For the years 2004, 2010, 2015, 2020, 2025 and 2030, two fossil fuel baseline scenarios (FS) are considered characterised by different traffic growth rates. For each FS, two biofuel scenarios (BS1, BS2) are considered with a 5.75 % biodiesel/bio ethanol share in 2010 as a common starting point. From 2010, linear growths are assumed for BS1 (10 % in 2020) and BS2 (25 % in 2030). The emissions presented in this study are vehicle based; a separate Well to Wheels (W-t-W) assessment of the total emission consequences of producing and using biofuels has been conducted in a different part of REBECa. The maximum CO2 emission difference between FS and BS2 becomes 26 % in 2030. The NOx and VOC emission variations between FS and both biofuel scenarios are 3 % or less. For CO and TSP the largest emission differences, 5 % and -12 %, respectively, occur between the FS and BS2 scenarios in 2030. The biofuel emission impacts are insignificant for NOx,VOC, CO and TSP compared to the generally large emission reductions predicted in all scenarios driven by the gradual strengthened emission standards for new vehicles, by far outweighing the emission influence from biofuels and traffic growth. The emission estimates for NOX, VOC, CO and TSP presented in this study are less certain than for CO2 due to the relatively scarce biofuel emission data implemented in the calculations. As a consequence, the obtained emission results must be assessed with care. Bearing in mind these uncertainties, the calculation approach for emissions from biofuel usage presented in this study can be used as a tool to carry out sensitivity analysis, environmental impact assessment studies, or for research purposes as such

Acute lower respiratory tract infections:Symptoms, findings and management in Danish general practice

Background: Acute lower respiratory tract infections (LRTIs) are among the most common infections managed in general practice.Objectives: To describe differences in reported symptoms, findings and management of patients diagnosed with acute LRTIs, and to explore possible associations between these findings and being diagnosed with pneumonia.Methods: During one winter season (2017 or 2018), a prospective registration of patients diagnosed with either acute bronchitis (ICPC-2: R78) or pneumonia (ICPC-2: R81) was conducted in Danish general practice for 20 days. A 42 item registration chart was filled in for each patient. Descriptive statistics, Pearson's chi-square test and multiple logistic regressions were used for data analysis.Results: In total, 70 general practices participated with 1384 patients registered. Patients diagnosed with pneumonia were more often reported as having a fever, dyspnoea, increased purulent sputum, abnormal pulmonary auscultation/chest retractions, and were more often assessed as unwell by the healthcare professional, than those diagnosed with acute bronchitis. Very few patients had a chest X-ray. Contrary, most patients had a C-reactive protein (CRP) test performed (pneumonia: 83%; acute bronchitis: 71%). Respectively, 93% and 20% of patients were treated with antibiotics. Having a fever, an abnormal pulmonary auscultation/chest retractions or being assessed as unwell increased the likelihood of the diagnosis pneumonia at least fivefold. Even a slightly elevated CRP (≥11 mg/L) was positively associated with being diagnosed with pneumonia.Conclusion: Danish healthcare professionals are highly influenced by symptoms, signs and CRP tests when diagnosing patients with acute LRTIs in general practice