1
|
Shen YJ, Lien CE, Chou YJ, Tsai T, Huang N. Prescribing antibiotics for children with dengue infection in Taiwan: who are at risk and who are high prescribers? Int J Qual Health Care 2024; 36:mzae052. [PMID: 38878061 PMCID: PMC11197962 DOI: 10.1093/intqhc/mzae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/28/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study.
Collapse
Affiliation(s)
- Yi-Jung Shen
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, United States
| | - Chia-En Lien
- Medigen Vaccine Biologics Corporation, Taipei 114, Taiwan
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County 260, Taiwan
| | | | - Nicole Huang
- Institute of Hospital and Health Care Administration, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| |
Collapse
|
2
|
Ibrahim RB, Ona H, Chokkalla AK, Tam E, Devaraj S. Validation of a whole blood machine learning strategy for distinguishing between bacterial and viral infection in a pediatric hospital setting. Pract Lab Med 2024; 39:e00387. [PMID: 38511106 PMCID: PMC10952075 DOI: 10.1016/j.plabm.2024.e00387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024] Open
Abstract
Similar symptoms between viral and bacterial diseases often make diagnosis difficult. This study assessed the clinical performance of the newly cleared whole-blood Bacterial versus Viral Score assay in our pediatric cohort to the previously validated serum assay and emergency department physician diagnosis. This assay shows excellent agreement (R = 0.997) with the serum assay and has great diagnostic accuracy when compared to physician diagnosis.
Collapse
Affiliation(s)
- Ridwan B. Ibrahim
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Herda Ona
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Anil K. Chokkalla
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Estella Tam
- Department of Pathology, Texas Children's Hospital, Houston, TX, USA
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Pierantoni L, Lo Vecchio A, Lenzi J, Corsi V, Campana L, Luca Trobia G, Amendolea A, Di Felice B, Alighieri G, Fabrizio GC, Bisceglia M, Peia F, Chiale F, Bartolomei B, Siciliano C, Di Battista C, Passone E, di Giovanni C, Piergentili E, Donà D, Buonsenso D. Parents' Perspective of Antibiotic Usage in Children: A Nationwide Survey in Italy. Pediatr Infect Dis J 2021; 40:906-911. [PMID: 34437339 DOI: 10.1097/inf.0000000000003221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Luca Pierantoni
- From the Pediatric Emergency Department, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Napoli, Italy
| | - Jacopo Lenzi
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Vincenza Corsi
- Department of Pediatrics, PO San Francesco Nuoro, Nuoro, Italy
| | - Lara Campana
- Department of Pediatrics, A. Cardarelli Hospital, Campobasso, Italy
| | - Gian Luca Trobia
- Pediatric and Pediatric Emergency Room Unit, "Cannizzaro" Emergency Hospital Catania, Catania, Italy
| | | | | | - Giovanni Alighieri
- Family Pediatrician, Unità di Pediatria e TIN, Azienda Ospedaliera Cardinale Giovanni Panico, Tricase, Italy
| | - Giovanna Carmela Fabrizio
- Unità Operativa Complessa Pediatria e Neonatologia Ospedale Madonna delle Grazie, ASM Matera, Matera, Italy
| | - Massimo Bisceglia
- Neonatal Intensive Care Unit, San Giovanni di Dio Hospital, Crotone, Calabria
| | - Francesco Peia
- Neonatal Intensive Care Unit and Paediatric Department, ASST Lecco, Lecco, Italy
| | - Federica Chiale
- Regina Margherita Children's Hospital, Postgraduation School of Pediatrics, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | | | | | - Eva Passone
- Department of Pediatrics, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" di Udine, Friuli Venezia Giulia, Italy
| | | | | | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Ge-melli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
4
|
Zeru T, Berihu H, Buruh G, Gebrehiwot H, Zeru M. Parental knowledge and practice on antibiotic use for upper respiratory tract infections in children, in Aksum town health institutions, Northern Ethiopia: a cross-sectional study. Pan Afr Med J 2020; 35:142. [PMID: 32655756 PMCID: PMC7335260 DOI: 10.11604/pamj.2020.35.142.17848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction worldwide, antibiotics are the most commonly prescribed and abused drugs for upper respiratory tract infections. Acute upper respiratory infections are common in children who attend childcare and preventing transmission of disease in health setting depends on actions by parents and staff. Therefore the objective of this study is to assess the parental knowledge and practice on antibiotic use for upper respiratory tract infections in children, in Aksum town health institutions, northern Ethiopia, 2018. Methods a facility-based cross-sectional study design was adopted involving 384 parents of children visited governmental health facilities in Aksum town from February to March, 2018. Respondents were selected based on the proportion of nurses in the health facilities. SPSS version 22 was applied for data entry and analysis. Results the total number of questionnaires was 384 resulting in a 100% response rate. Almost half of the parents had poor knowledge of the use of antibiotics in children for URTIs 183(47.7%), followed by 156(40.6%) moderate knowledge and 45(11.7%) good knowledge. Practices regarding antibiotic use in children with URTI varied. Only 12.8% of the parents did not always follow the doctors´ advice regarding antibiotic use. In this study has reported many areas in which parental awareness on antibiotic use for acute URTI is considered inadequate, consequently inappropriate knowledge and practices. Conclusion nearly half of the parents attending the physicians for their children with URTI expected to get antibiotics.
Collapse
Affiliation(s)
- Teklay Zeru
- School of Nursing, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Hagos Berihu
- School of Nursing, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Gerezgiher Buruh
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Haftom Gebrehiwot
- School of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mebrahtom Zeru
- Department of Biomedical Science, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| |
Collapse
|
5
|
Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
6
|
Farooqui HH, Mehta A, Selvaraj S. Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data. PLoS One 2019; 14:e0224848. [PMID: 31721809 PMCID: PMC6853304 DOI: 10.1371/journal.pone.0224848] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Abstract
The key objective of this research was to generate new evidence on outpatient antibiotic prescription rate and patterns in the private sector in India. We used 12-month period (May 2013 to April 2014) medical audit dataset from IQVIA (formerly IMS Health). We coded the diagnosis provided in the medical audit data to International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the prescribed antibiotics for the diagnosis to Anatomic Therapeutic Chemical (ATC) classification of World Health Organization (ATC index-2016). We calculated and reported antibiotic prescription rate per 1,000 persons per year, by age groups, antibiotic class and disease conditions. Our main findings are-approximately 519 million antibiotic prescriptions were dispensed in the private sector, which translates into 412 prescriptions per 1,000 persons per year. Majority of the antibiotic prescriptions were dispensed for acute upper respiratory infections (J06) (20.4%); unspecified acute lower respiratory infection (J22) (12.8%); disorders of urinary system (N39) (6.0%); cough (R05) (4.7%); and acute nasopharyngitis (J00) (4.6%) and highest antibiotic prescription rates were observed in the age group 0-4 years. To conclude our study reports first ever country level estimates of antibiotic prescription by antibiotic classes, age groups, and ICD-10 mapped disease conditions.
Collapse
Affiliation(s)
- Habib Hasan Farooqui
- Indian Institute of Public Health –Delhi, Public Health Foundation of India, Gurugram, Haryana, India
| | - Aashna Mehta
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, Haryana, India
| | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, Haryana, India
| |
Collapse
|
7
|
Kuo RN, Chen W, Lin Y. Do informed consumers in Taiwan favour larger hospitals? A 10-year population-based study on differences in the selection of healthcare providers among medical professionals, their relatives and the general population. BMJ Open 2019; 9:e025202. [PMID: 31101695 PMCID: PMC6530349 DOI: 10.1136/bmjopen-2018-025202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Exploring whether medical professionals, who are considered to be 'informed consumers' in the healthcare system, favour large providers for elective treatments. In this study, we compare the inclination of medical professionals and their relatives undergoing treatment for childbirth and cataract surgery at medical centres, against those of the general population. DESIGN Retrospective study using a population-based matched cohort data. PARTICIPANTS Patients who underwent childbirth or cataract surgery between 1 January 2004 and 31 December 2013. PRIMARY AND SECONDARY OUTCOMES MEASURES We used multiple logistic regression to compare the ORs of medical professionals and their relatives undergoing treatment at medical centres, against those of the general population. We also compared the rate of 14-day re-admission (childbirth) and 14-day reoperation (cataract surgery) after discharge between these groups. RESULTS Multivariate analysis showed that physicians were more likely than patients with no familial connection to the medical profession to undergo childbirth at medical centres (OR 5.26, 95% CI 3.96 to 6.97, p<0.001), followed by physicians' relatives (OR 2.68, 95% CI 2.20 to 3.25, p<0.001). Similarly, physicians (OR 1.63, 95% CI 1.21 to 2.19, p<0.01) and their relatives (OR 1.43, 95% CI 1.13 to 1.81, p<0.01) were also more likely to undergo cataract surgery at medical centres. Physicians also tended to select healthcare providers who were at the same level or above the institution at which they worked. We observed no significant difference in 14-day re-admission rates after childbirth and no significant difference in 14-day reoperation rates after cataract surgery across patient groups. CONCLUSIONS Medical professionals and their relatives are more likely than the general population to opt for service at medical centres. Understanding the reasons that medical professionals and general populations both have a preferential bias for larger medical institutions could help improve the efficiency of healthcare delivery.
Collapse
Affiliation(s)
- Raymond N Kuo
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
- Innovation and Policy Centre for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Wanchi Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
| | - Yuting Lin
- National Health Insurance Administration, Taipei Division, Taipei City, Taiwan
| |
Collapse
|
8
|
Zav'yalov VP, Hämäläinen-Laanaya H, Korpela TK, Wahlroos T. Interferon-Inducible Myxovirus Resistance Proteins: Potential Biomarkers for Differentiating Viral from Bacterial Infections. Clin Chem 2018; 65:739-750. [PMID: 30593466 PMCID: PMC7108468 DOI: 10.1373/clinchem.2018.292391] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND In 2015, the 68th World Health Assembly declared that effective, rapid, low-cost diagnostic tools were needed for guiding optimal use of antibiotics in medicine. This review is devoted to interferon-inducible myxovirus resistance proteins as potential biomarkers for differentiating viral from bacterial infections. CONTENT After viral infection, a branch of the interferon (IFN)-induced molecular reactions is triggered by the binding of IFNs with their receptors, a process leading to the activation of mx1 and mx2, which produce antiviral Mx proteins (MxA and MxB). We summarize current knowledge of the structures and functions of type I and III IFNs. Antiviral mechanisms of Mx proteins are discussed in reference to their structural and functional data to provide an in-depth picture of protection against viral attacks. Knowing such a mechanism may allow the development of countermeasures and the specific detection of any viral infection. Clinical research data indicate that Mx proteins are biomarkers for many virus infections, with some exceptions, whereas C-reactive protein (CRP) and procalcitonin have established positions as general biomarkers for bacterial infections. SUMMARY Mx genes are not directly induced by viruses and are not expressed constitutively; their expression strictly depends on IFN signaling. MxA protein production in peripheral blood cells has been shown to be a clinically sensitive and specific marker for viral infection. Viral infections specifically increase MxA concentrations, whereas viruses have only a modest increase in CRP or procalcitonin concentrations. Therefore, comparison of MxA and CRP and/or procalcitonin values can be used for the differentiation of infectious etiology.
Collapse
Affiliation(s)
| | | | - Timo K Korpela
- Department of Future Technologies, University of Turku, Turku, Finland
| | - Tony Wahlroos
- Laboratory of Clinical Research, Labmaster Ltd., Turku, Finland
| |
Collapse
|
9
|
Chang LY, Lai CC, Chen CJ, Cho CY, Luo YC, Jeng MJ, Wu KG. Recent trends in prescribing antibiotics for acute tonsillitis in pediatric ambulatory care in Taiwan, 2000–2009: A nationwide population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:500-506. [DOI: 10.1016/j.jmii.2015.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/05/2015] [Accepted: 08/27/2015] [Indexed: 11/17/2022]
|
10
|
Azor-Martinez E, Cobos-Carrascosa E, Seijas-Vazquez ML, Fernández-Sánchez C, Strizzi JM, Torres-Alegre P, Santisteban-Martínez J, Gimenez-Sanchez F. Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections. THE JOURNAL OF SCHOOL HEALTH 2016; 86:873-881. [PMID: 27866386 DOI: 10.1111/josh.12454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 03/17/2016] [Accepted: 06/22/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). METHODS This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The experimental group (EG) washed their hands with soap and water, together with using hand sanitizer, and the control group followed their usual handwashing procedures. Absenteeism rates due to URIs were compared between the 2 groups through a multivariate Poisson regression analysis. The percent of days missed in both groups were compared with a z test. RESULTS Overall, 1271 cases of school absenteeism due to URIs were registered. Schoolchildren from the EG had a 38% lower risk of absenteeism due to URIs, incidence rate ratio: 0.62, 95% confidence interval: 0.55-0.70, and a decrease in absenteeism of 0.45 episodes/child/academic year, p < .001. Pupils missed 2734 school days due to URIs and the percentage of days absent was significantly lower in the EG, p < .001. CONCLUSIONS Use of hand sanitizer plus handwashing with soap accompanied by educational support is an effective measure to reduce absenteeism due to URIs.
Collapse
Affiliation(s)
- Ernestina Azor-Martinez
- Distrito Sanitario, Atención Primaria Almería, España, C) Haza de Acosta S/N 04009, Almería, Spain
| | - Elena Cobos-Carrascosa
- Servicio de Pediatría, Hospital Torrecárdenas, Almería, España, C) Ramon y Cajal N° 11 Villanueva Mesia 18369, Granada, Spain
| | | | - Carmen Fernández-Sánchez
- Servicio de Farmacia Hospital Torrecardenas, C) Hermandad de Donantes de Sangre S/N, CP 04009, Almería, Spain
| | - Jenna M Strizzi
- Roger Williams University, 1 Old Ferry Rd, Bristol, RI 02809
| | - Pilar Torres-Alegre
- Unidad de Formación, e Investigación Distrito Almería España, C) Pablo Neruda 2, portal 12, 6° 1, 04009, Almería, Spain
| | | | - Francisco Gimenez-Sanchez
- Servicio de Pediatría, Hospital Torrecárdenas, Almería, España, C) Pepe Isbert 55, 04007, Almería. Spain
| |
Collapse
|
11
|
Lee ML, Cho CY, Hsu CL, Chen CJ, Chang LY, Lee YS, Soong WJ, Jeng MJ, Wu KG. Recent trends in antibiotic prescriptions for acute respiratory tract infections in pediatric ambulatory care in Taiwan, 2000–2009: A nationwide population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:554-60. [DOI: 10.1016/j.jmii.2014.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/11/2014] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
|
12
|
Zanasi A, Lanata L, Saibene F, Fontana G, Dicpinigaitis PV, Venier V, De Blasio F. Prospective study of the efficacy of antibiotics versus antitussive drugs for the management of URTI-related acute cough in children. Multidiscip Respir Med 2016; 11:29. [PMID: 27298726 PMCID: PMC4904362 DOI: 10.1186/s40248-016-0059-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Acute cough is one of the most frequent symptoms prompting a visit to a health care provider, usually following a viral upper respiratory tract infection (URTI). The disproportionate use of antibiotics in children with URTIs, recently highlighted in the medical literature, could lead to associated side effects, without any beneficial effect. Although an early, albeit inappropriate, antibiotic prescription increases parental satisfaction, URTIs are predominantly viral infections and are generally self-limiting. Therefore the aim of this study was to analyze the effectiveness of antibiotics compared to symptomatic drugs (central and peripheral antitussives) on URTI-related cough in a pediatric population. Methods This is a prospective observational study of 330 children who required pediatric consultation for acute cough. Severity, frequency and type of cough were assessed at baseline and after 6 days of treatment (antitussives n = 123, antibiotics n = 89 or combination of them n = 38) or no treatment (n = 80). The outcome of cough management after 6 days was analyzed in terms of resolution, improvement, no change or worsening of symptoms. Study assessments were performed using a standardized questionnaire administered to parents. Results Between children treated with antitussives or antibiotics, there was a statistically significant difference in the resolution of cough. Moreover, if considering peripheral antitussives, the resolution of cough was significantly higher with antitussives than with antibiotics (p < 0.01). There was no difference in cough resolution between children treated with antitussives and those receiving a combination of antibiotics and antitussives, either central and peripheral antitussives. Conclusion Antibiotics are generally not useful nor appropriate in treating acute cough due to the common cold. Furthermore, inappropriate antibiotic use introduces the possibility of adverse side effects as well as promotion of antibiotic resistance. The findings of the present study suggest that antitussives, especially peripherally acting agents, represent an effective treatment option for acute pediatric cough caused by URTIs.
Collapse
Affiliation(s)
- Alessandro Zanasi
- Pneumology Unit, University of Bologna, S.Orsola Malpighi Hospital, Bologna, Italy
| | - Luigi Lanata
- Medical Department Dompè Farmaceutici SpA, Milan, Italy
| | | | | | - Peter V Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY USA
| | | | - Francesco De Blasio
- Respiratory Medicine and Pulmonary Rehabilitation Section, Clinic Center, Private Hospital, Naples, Italy
| |
Collapse
|
13
|
Sambursky R, Shapiro N. Evaluation of a combined MxA and CRP point-of-care immunoassay to identify viral and/or bacterial immune response in patients with acute febrile respiratory infection. Eur Clin Respir J 2015; 2:28245. [PMID: 26672961 PMCID: PMC4676840 DOI: 10.3402/ecrj.v2.28245] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background Challenges in the clinical differentiation of viral and/or bacterial respiratory infection lead to the misappropriation of antibiotics and increased healthcare costs. A tool to facilitate rapid and accurate point-of-care (POC) differentiation is needed. Methods and findings A prospective, single center, blinded, observational clinical trial was conducted at Beth Israel Deaconess Medical Center from December 2012 to August 2013 to determine the accuracy of a POC immunoassay to identify a clinically significant immune response to viral and/or bacterial infection. Sixty patients with acute febrile respiratory infection (19 pharyngitis and 41 lower respiratory tract infection [LRTI]) were enrolled. Participants provided fingerstick blood for immunoassay testing (myxovirus A [MxA] and c-reactive protein [CRP]) and four oropharyngeal samples for viral PCR and routine bacterial cell culture. A venous blood sample was collected. An ELISA was used to measure CRP and MxA. Paired serological testing was used to confirm atypical bacteria. A urine sample was provided for Streptococcus and Legionella antigen testing. Patients with suspected LRTI had sputum and blood cultures, chest X-ray, and WBC count measured. Viral infection was confirmed if oropharyngeal PCR was positive for viral pathogens. Bacterial infection was confirmed in positive throat or sputum cultures. Elevated immunoglobulin M antibodies or twofold increase in IgG antibodies between acute and convalescent phase indicated atypical bacteria. Positive Streptococcus or Legionella urine antigen assays also confirmed bacterial infection. The immunoassay correctly categorized subjects as 92% (22/24) negative, 80% (16/20) with bacterial infection, and 70% (7/10) with viral infection. Conclusions The interplay between an MxA value and a semi-quantitative CRP value can aid in the differentiation of infectious etiology. In isolation, neither MxA nor CRP alone is sensitive or specific. However, the pattern of results in a rapid immunoassay provides a sensitive and specific method to differentiate acute febrile respiratory infections. This diagnostic information may help reduce antibiotic misuse and resistance and lower healthcare costs.
Collapse
|
14
|
Pediatric invasive pneumococcal disease in Taiwan following a national catch-up program with the 13-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J 2015; 34:e71-7. [PMID: 25247584 DOI: 10.1097/inf.0000000000000565] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seven-valent pneumococcal conjugate vaccine (PCV) has been available in Taiwan since late 2005. A national catch-up program was launched in Taiwan in 2013, providing 1 dose of 13-valent PCV to children aged 2-5 years. Here, we report the epidemiology of invasive pneumococcal disease (IPD) in children aged ≤5 years in this setting. METHODS We collected demographic and clinical information for pediatric patients (≤5 years) with IPD between 2008 and 2013. The incidence of IPD was estimated. The logs for PCV import into Taiwan were obtained to evaluate the impact of PCV usage on IPD epidemiology. RESULTS The overall incidence of IPD in children aged ≤5 years was 15.9 cases per 100,000 person-years. The IPD incidence caused by 7-valent PCV serotypes decreased significantly from 10.0 cases per 100,000 person-years in 2008 to 2.3 cases per 100,000 person-years in 2013. The incidence of IPD caused by serotype 19A increased substantially from 1.7 cases per 100,000 person-years in 2008 to 10.3 cases per 100,000 person-years in 2012, followed by a significant decrease to 5.6 cases per 100,000 person-years in 2013. The significant decrease in the incidence of serotype 19A IPD occurred primarily in children aged 2-5 years. CONCLUSIONS The 13-valent PCV catch-up program was associated with a significant decrease in serotype 19A IPD incidence in 2013, primarily in children eligible for the 13-valent PCV immunization. Continued surveillance is necessary to assess the further impact of the national catch-up program on pediatric IPD epidemiology in Taiwan.
Collapse
|
15
|
Chang JW, Jeng MJ, Yang LY, Chen TJ, Chiang SC, Soong WJ, Wu KG, Lee YS, Wang HH, Yang CF, Tsai HL. The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan. Kidney Int 2015; 87:632-9. [DOI: 10.1038/ki.2014.299] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 07/19/2014] [Accepted: 07/24/2014] [Indexed: 01/07/2023]
|
16
|
Azor-Martínez E, Gonzalez-Jimenez Y, Seijas-Vazquez ML, Cobos-Carrascosa E, Santisteban-Martínez J, Martínez-López JM, Jimenez-Noguera E, Galan-Requena MDM, Garrido-Fernández P, Strizzi JM, Gimenez-Sanchez F. The impact of common infections on school absenteeism during an academic year. Am J Infect Control 2014; 42:632-7. [PMID: 24837113 DOI: 10.1016/j.ajic.2014.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/18/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND School absenteeism because of infections is one of the most important problems facing both public and private primary schools. The aim of the study was to assess the impact of infections on school absenteeism and their reduction with a handwashing program using hand sanitizer. METHODS The study was an 8-month-long, randomized, controlled open study (N = 1,609 children, aged 4-12 years old) at 5 state schools in Almeria (Spain). The experimental group (EG) washed their hands with soap and water, complemented with the use of hand sanitizer, and the control group (CG) followed the usual handwashing procedure. The total number of episodes and days missed as well as those because of upper respiratory infections and gastrointestinal infections were compared in both groups with a Z-test. RESULTS The students were absent 12,386 days in 7,945 episodes. The incidence of total absent episodes and percent of missed days, including those because of upper respiratory infections and gastrointestinal infections, were significantly lower in the EG than the CG (P < .001), and this was maintained through the flu pandemic period. CONCLUSION School absenteeism because of infections in schools is reduced when a hand hygiene program utilizing sanitizing gels is properly carried out, especially during the flu season.
Collapse
|
17
|
Liou WS, Hsieh SC, Chang WY, Wu GHM, Huang HS, Lee C. Brand name or generic? What are the health professionals prescribed for treating diabetes? A longitudinal analysis of the National Health Insurance reimbursement database. Pharmacoepidemiol Drug Saf 2013; 22:752-9. [PMID: 23625864 DOI: 10.1002/pds.3445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/13/2013] [Accepted: 03/06/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to explore whether physicians prescribe more brand-name oral hypoglycemic agents (OHA) for diabetic patients with medical training background (MP) than for general patients (GP). RESEARCH DESIGN AND METHODS A longitudinal analysis of 1,000,000 National Health Insurance cohorts of 1998-2008 was conducted. Univariate and multivariate models were performed to assess the associations of the outcome (the ratio of brand-name/generic odds in the MP group to that in the GP group) and the covariates, including patient medical training background, characteristics of patient, prescriber, and medical settings, and market competition. A generalized estimating equation method was used to control the dependency of longitudinal data. RESULTS A total of 46,850 diabetic patients were prescribed with 2,703,149 OHA prescriptions during the study period. Compared with GP, MP had 1.37 times greater odds of being prescribed with brand-name instead of generic OHA, among whom pharmacists and physicians had the highest odds ratios of 2.78 (95%CI, 1.05-7.36) and 1.68 (95%CI, 0.99-2.85), respectively. Patients' diabetes severity, prescribers' level of experience, medical settings that were publicly owned, had a higher accreditation level, and were located in a higher urbanized area, lower market competition, and earlier dates of prescription were positively associated with brand-name prescription. Among all medical sub-specialties, cardiologists were more likely to prescribe brand-name OHA. CONCLUSIONS This study is the first to demonstrate how a patients' medical training background, in addition to the characteristics of patients, prescribers, and medical settings, and market competition might influence physicians' prescribing choice of brand-name or generic OHA.
Collapse
Affiliation(s)
- Wen-Shyong Liou
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | | | | |
Collapse
|
18
|
Kawamura M, Kusano A, Furuya A, Hanai N, Tanigaki H, Tomita A, Horiguchi A, Nagata K, Itazawa T, Adachi Y, Okabe Y, Miyawaki T, Kohno H. New sandwich-type enzyme-linked immunosorbent assay for human MxA protein in a whole blood using monoclonal antibodies against GTP-binding domain for recognition of viral infection. J Clin Lab Anal 2012; 26:174-83. [PMID: 22628233 DOI: 10.1002/jcla.21507] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To develop a clinically significant and practical enzyme-linked immunosorbent assay (ELISA) for the detection of MxA protein in human whole blood, a biological marker of viral infection. DESIGN AND METHODS A sandwich ELISA suitable for the measurement of human MxA protein in whole blood was developed using mouse monoclonal antibodies (mAbs) raised against the GTP-binding domain of human MxA protein. Prior to the assay, the whole blood sample was treated with special buffer to extract the MxA protein, improve its stability, and avoid interference from hemoglobin. RESULTS This ELISA meets all the requirements for use in routine clinical assays, especially in terms of sensitivity (detection limit: 1.3 ng/ml whole blood), accuracy (recovery: 93.0-100.0%), and rapidity (<1.5 h). The present ELISA had a sensitivity of 100% and a specificity of 100% for viral infection when compared to samples from healthy control and 87.1% and 90.9% when compared to samples from the bacterial infection group. CONCLUSION We have developed a new ELISA for measuring MxA protein in human whole blood using mAbs specific for the GTP-binding domain of MxA. This ELISA has analytical performance enough for routine clinical assay and can be used in detecting the possibility of viral infection.
Collapse
Affiliation(s)
- Mizuho Kawamura
- Fuji Research Laboratories, Kyowa Medex Co., Ltd., Shizuoka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Gender disparities in AMI management and outcomes among health professionals, their relatives, and non-health professionals in Taiwan from 1997 to 2007. Soc Sci Med 2012. [PMID: 23201191 DOI: 10.1016/j.socscimed.2012.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Numerous reports of gender differences in the management and mortality of acute myocardial infarction (AMI) patients have raised concerns on gender inequity in cardiac care. However, no study has explored whether gender disparity exists among health professionals and their relatives. Therefore, this study assesses gender disparity in the management and mortality of AMI patients in Taiwan, and determines whether such disparity exists among health professionals and their relatives. National Health Insurance (NHI) files were used to obtain information on a cohort of 79,360 AMI patients aged 30-85 years in Taiwan from 1997 to 2007. The use of catheterization and revascularization (CATH/RAVS) and one-year mortality were compared between men and women in all adult patients, health professionals and their relatives, and non-health professional patients. Taiwanese women with AMI were significantly less likely than their male counterparts to receive CATH/RAVS, and showed greater one-year mortality. Similarly, women in the professional group were significantly less likely to receive CATH/RAVS. However, they did not have worse survival outcomes (hazard ratio: 1.01; 95% CI: 0.68-1.50) compared to men. Regarding mortality following CATH/RAVS, no gender disparities against women were observed in health professionals and their relatives, whereas significant gender disparities persisted in non-health professional patients. In conclusion, this study shows a substantial gender disparity against women in the management and one-year survival of AMI patients in Taiwan. This research extends earlier studies by showing similar gender gaps in treatment uses among health professionals and their relatives without strong evidence on gender disparities against women in survival.
Collapse
|
20
|
Batton B, Verhulst S, Batton D, Davis A, Collin M, Walsh M. Perspectives of Physician Parents in the NICU. CHILDRENS HEALTH CARE 2011. [DOI: 10.1080/02739615.2011.617257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
21
|
Lin MC, Lai MS. Pediatricians' role in caring for preschool children in Taiwan under the national health insurance program. J Formos Med Assoc 2010; 108:849-55. [PMID: 19933028 DOI: 10.1016/s0929-6646(09)60416-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE The National Health Insurance (NHI) covers more than 98% of the 22 million people in Taiwan. Referral is not mandated, therefore, competition among specialties exists in caring for preschool children. The aim of this study was to analyze the utility of outpatient services among preschool children to investigate the pediatricians role in their care. We also analyzed how the density of specialists induces demand by using the NHI database. METHODS We used the systematic sampling file, CD20040, from the bureau of NHI, Taiwan, as the data source for our analysis. We linked the file to the registries for medical personnel and the board-certified specialists to analyze the specialty distribution. We also linked to the registry for contracted medical facilities to analyze the distribution in different levels of hospitals. RESULTS In total, 56,144 outpatient visits for preschool children were analyzed. Among these, 59.1% of outpatient services for preschool children were provided by pediatric specialists, 20.7% by otolaryngologists, 13.5% by family medicine specialists, and the other 6.7% by general practitioners. Most of the visits occurred in a primary care setting (84.1%). As children grew older, a significant decline in the pediatric specialists visit rate and an increase in the otolaryngologists visit rate were observed in the primary care setting. Young children visited pediatric specialists more frequently. The pediatric specialists visit rate was higher in the northern urban areas. It was also significantly correlated with the density of pediatricians. CONCLUSION Otolaryngologists compete with pediatricians in the primary care of preschool children in Taiwan. The proportion of visits to pediatric specialists was correlated significantly with the density of pediatricians in different counties. The NHI should modify its policy to make the medical system more equitable.
Collapse
Affiliation(s)
- Ming-Chih Lin
- Institute of Preventive Medicine, National Taiwan University, School of Medicine, National Yang-Ming University, Taipei, and Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | | |
Collapse
|
22
|
Moro ML, Marchi M, Gagliotti C, Di Mario S, Resi D. Why do paediatricians prescribe antibiotics? Results of an Italian regional project. BMC Pediatr 2009; 9:69. [PMID: 19895678 PMCID: PMC2777860 DOI: 10.1186/1471-2431-9-69] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 11/06/2009] [Indexed: 11/25/2022] Open
Abstract
Background 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. Methods 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. Results 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). Conclusion 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.
Collapse
Affiliation(s)
- Maria Luisa Moro
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Area di Programma Rischio Infettivo, Viale Aldo Moro, 21, 40127 Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
23
|
Hoan LT, Chuc NTK, Ottosson E, Allebeck P. Drug use among children under 5 with respiratory illness and/or diarrhoea in a rural district of Vietnam. Pharmacoepidemiol Drug Saf 2009; 18:448-53. [DOI: 10.1002/pds.1730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
24
|
Mansourian A, Saifi A, Vakili M, Marjani A, Ghaemi E, Moradi A, Ahmadi A. Prescribing Antibiotics by General and Specialist Physicians:A Pharmacist Administrated Survey. JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.427.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Chen CY, Liu CY, Su WC, Huang SL, Lin KM. Factors associated with the diagnosis of neurodevelopmental disorders: a population-based longitudinal study. Pediatrics 2007; 119:e435-43. [PMID: 17272605 DOI: 10.1542/peds.2006-1477] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We investigated the occurrence of newly diagnosed mental retardation, attention-deficit/hyperactivity disorder, and autism and sociodemographic factors associated with their distribution in Taiwan, and we examined urbanicity- and socioeconomic status-associated differences in the age at first diagnosis. METHODS The data for this study were derived from the 1996-2004 National Health Insurance Research Database in Taiwan. Approximately 1.8 million beneficiaries born between 1996 and 2001 were identified, with follow-up periods ranging from 3 to 8 years. RESULTS Each of the 3 neurodevelopmental disorders had distinct incidence rates and associated factors. For example, as compared with the birth years of 1996-1999, the rate of autism increased 14% during the period 2000-2004, whereas the rate of newly diagnosed mental retardation decreased 42% to 50% over the same period. An elevated incidence rate for attention-deficit/hyperactivity disorder and autism was observed in later birth cohorts. The risk of receiving a diagnosis of mental retardation for children in rural areas and of lower socioeconomic status was reduced in early childhood and increased in school ages as compared with their urban and higher socioeconomic status counterparts. CONCLUSIONS Variation in the rate of newly diagnosed mental retardation, attention-deficit/hyperactivity disorder, and autism among children in Taiwan depended on age, birth year, period, and socioeconomic status. The extent of the association linking age with the first diagnosis of mental retardation varies across different urbanicity level and socioeconomic status.
Collapse
Affiliation(s)
- Chuan-Yu Chen
- National Health Research Institutes, Division of Mental Health and Substance Abuse Research, Floor 5, Campus 2, No. 309, Sung-Te Road, Taipei 110, Taiwan.
| | | | | | | | | |
Collapse
|
26
|
Gibson JL. Lessons learned from a student-initiated antibiotic awareness program. Am J Health Syst Pharm 2007; 63:1590, 1592. [PMID: 16914626 DOI: 10.2146/ajhp060192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
27
|
Nakabayashi M, Adachi Y, Itazawa T, Okabe Y, Kanegane H, Kawamura M, Tomita A, Miyawaki T. MxA-based recognition of viral illness in febrile children by a whole blood assay. Pediatr Res 2006; 60:770-4. [PMID: 17065575 DOI: 10.1203/01.pdr.0000246098.65888.5b] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Febrile children are often given antibiotics empirically and unnecessarily. MxA is a protein induced in peripheral lymphoid cells by type 1 interferons during active viral infection. The ability of a whole blood ELISA assay for MxA to identify children with viral illness was studied in 122 children who presented with acute onset fever and 52 age-matched healthy controls. The febrile children were divided into three groups according to their final diagnoses: etiologically diagnosed viral infection, clinically diagnosed viral infection, and bacterial infection. MxA levels in the bacterial infection group and controls were similar and low (90.9 +/- 69.7 and 76.9 +/- 63.2 ng/mL, respectively). In contrast, mean MxA levels in the two viral infection groups were higher than in both the bacterial and control groups (719.2 +/- 386.4 and 827.0 +/- 651.1, respectively). A receiver operating characteristic analysis showed that the area under the curve of the MxA level was greater than under the curves of both the white blood cell count and the C-reactive protein concentration. Whole blood assay of MxA is a clinically useful tool for diagnosing viral illness in febrile children and should help reduce use of unnecessary antibiotics.
Collapse
Affiliation(s)
- Motokazu Nakabayashi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Ciofi degli Atti ML, Massari M, Bella A, Boccia D, Filia A, Salmaso S. Clinical, social and relational determinants of paediatric ambulatory drug prescriptions due to respiratory tract infections in Italy. Eur J Clin Pharmacol 2006; 62:1055-64. [PMID: 17021889 DOI: 10.1007/s00228-006-0198-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 08/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Collecting information on patterns of drug prescriptions and on factors influencing prescribing decisions is fundamental for supporting the rational use of drugs. This study was aimed at investigating patterns of drug prescription in paediatric outpatients and at evaluating determinants of prescriptions for respiratory tract infections (RTIs). METHODS We conducted a national cross-sectional survey involving primary care paediatricians and parents. Diagnoses and prescriptions made at each consultation were described. Poisson regression models were used to analyse determinants of drug and antibiotic prescriptions for visits due to RTIs. RESULTS A total of 4,302 physician and parent questionnaires were analysed. These corresponded to 2,151 visits, 792 of which were due to RTIs. Drugs were prescribed in 83.4% of RTI visits, while antibiotics were prescribed in 40.4%. According to paediatricians' perceptions, 84.2% of parents of children with a RTI expected to receive a drug prescription. Paediatricians' perception of parental expectations was the strongest determinant for prescription of drugs and specifically of antibiotics [adjusted relative risk (RR): 1.7 and 3.6, respectively; P < 0.001]. However, in 77.1% of RTI visits, paediatricians judged themselves as not being influenced at all by parents' expectations in their decision to prescribe. CONCLUSIONS This study underscores that relational factors, in particular perceived parental expectations, are one of the leading factors of drug prescriptions in paediatric ambulatory care settings, reinforcing the opinion that communication between physicians and parents can affect prescription patterns.
Collapse
Affiliation(s)
- Marta Luisa Ciofi degli Atti
- Reparto Malattie Infettive, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanita', Viale Regina Elena 299, 00161 Rome, Italy.
| | | | | | | | | | | |
Collapse
|