Antibiotic Self-Medication and Antibiotic Resistance: Multilevel Regression Analysis of Repeat Cross-Sectional Survey Data in Europe

Antibiotic resistance is a global public health issue with several anthropogenic drivers, including antibiotic consumption. Recent studies have highlighted that the relationship between antibiotic consumption and antibiotic resistance is contextualised by a variety of socioeconomic, cultural, and governance-related drivers of consumption behaviour and contagion that have been underexamined. A potential complication for research and policy is that measures of antibiotic consumption are often reliant on prescribing or sales data which may not easily take into account the dynamics of community consumption that include self-medication; for example, the preservation and use of leftover medication or the obtaining of antibiotics without a prescription. This study uses repeated cross-sectional survey data to fulfil two core aims: firstly, to examine the individual-level and national-contextual determinants of self-medication among antibiotic consumers in European countries, and secondly, to examine the relationship between self-medication behaviour and antibiotic resistance at the national level. This study is particularly novel in its application of a multilevel modelling specification that includes individual-level factors with both time-variant and persistent national characteristics to examine antibiotic consumption behaviours. The key findings of the study are that survey respondents in countries with persistently higher levels of inequality, burdens of out-of-pocket health expenditure, and corruption have an increased probability of self-medicating with antibiotics. The study also highlights that overall levels of antibiotic consumption and antibiotic self-medication do not correlate and are associated heterogeneously with changes in different pathogen/antibiotic pairs. In summary, the study emphasises that antibiotic stewardship and antibiotic resistance, whilst related by biological mechanisms, are also inherently social issues. Attempts to improve antibiotic stewardship and address the challenge of antibiotic resistance should also attend to structural challenges that underlie challenges to antibiotic stewardship in the community, such as the effects of inequality and reduced access to healthcare services.

Download Full-text

Knowledge of antibiotics and antibiotic usage behavior among the people of Dhaka, Bangladesh

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v6i3.49803 ◽

2020 ◽

Vol 6 (3) ◽

pp. 519-524

Author(s):

Iftekhar Ahmed ◽

Md Bodiuzzaman Rabbi ◽

Marufa Rahman ◽

Rehnuma Tanjin ◽

Sharmin Jahan ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Cross Sectional Survey ◽

Self Medication ◽

Cross Sectional ◽

The People ◽

Usage Behavior ◽

Educational Campaigns ◽

Adherence To Therapy

Bangladesh is a developing country with a very high prevalence of antibiotic resistance where irrational use of antibiotics is very common. This cross-sectional survey was conducted to assess the knowledge of antibiotics and antibiotic usage behavior (Antibiotic use, self-medication, adherence to therapy) among the people of Bangladesh. The association between participants’ knowledge of antibiotics and their antibiotic usage behavior was also analyzed. A cross-sectional survey based on a structured questionnaire was conducted in the Dhaka district. The questionnaire included questions about demographic information, participants’ knowledge of antibiotics, and their recent antibiotic usage. The data analysis involved the use of descriptive statistics and multivariable logistic regression. Very few participants knew that antibiotics are not effective against most common colds (16.8%), viruses (22.5%), and pains (41.7%). Most respondents (>75%) knew that excessive use of antibiotics and failing to complete a course may render antibiotics less effective in the future. However, only 56.1% were aware of antibiotic resistance. About half (46.6%) of the participants took antibiotics in the last six months, 20.5% of whom resorted to self-medication and 23.1% reported non-adherence to therapy. Greater knowledge of antibiotics was significantly associated with lower rates of self-medication (p=0.037). Misconceptions about antibiotics and antibiotic misuse are very common in Bangladesh. The findings suggest that misconceptions about antibiotics and antibiotic misuse are very common in Bangladesh. To mitigate these problems, interventions comprised of educational campaigns and redesigning of the healthcare system and policies should be undertaken. Asian J. Med. Biol. Res. September 2020, 6(3): 519-524

Download Full-text

Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway

BMC Public Health ◽

10.1186/s12889-021-12054-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rune Jonassen ◽

Eva Hilland ◽

Catherine J. Harmer ◽

Dawit S. Abebe ◽

Anne Kristine Bergem ◽

...

Keyword(s):

Psychological Distress ◽

Survey Data ◽

Population Based ◽

Mixed Effects ◽

Anxiety And Depression ◽

Cross Sectional Survey ◽

Self Medication ◽

Cross Sectional ◽

Over The Counter ◽

Psychological Predictor

Abstract Background Over-the-counter analgesics (OTCA) such as Paracetamol and Ibuprofen are frequently used by adolescents, and the route of administration and access at home allows unsupervised use. Psychological distress and pain occur simultaneously and are more common among females than among males. There is a dynamic interplay between on-label pain indications and psychological distress, and frequent OTCA use or misuse can exacerbate symptoms. No studies have to date provided an overview of frequent OTCA use in a larger population-based study. The current study used survey data to explore associations between and the relative predictive value of on-label pain indication and measures of psychological distress, together with sex differences for weekly OTCA use. Methods This study included 349,528 adolescents aged 13–19. The data was collected annually between January 2014 and December 2018 as part of the Norwegian Young Data survey. Performance analysis was conducted to explore the relative roles and associations between on-label pain indication and psychological distress in weekly OTCA use. A mixed-effects logistic regression model was used to explore the unique contributions from four domains of on-label pain indication and psychological distress as measured by a combined measure of anxiety and depression (HSCL-10) and peer-bullying involvement as victims or bullies. Results Thirty percent of females and 13 % of males use OTCA weekly. Headache is the strongest on-label pain predictor of weekly OTCA use, followed by abdominal pain. Depression and anxiety are the strongest psychological predictor of weekly OTCA use, and higher symptom levels and being female increase the strength of this association. Anxiety and depression also predict weekly OTCA use after controlling for physiological pain. Conclusions Sex, pain and anxiety and depression are inter-correlated and strong predictors of frequent OTCA use. Frequent OTCA use in the context of psychological distress may be a form of self-medication that can exacerbate symptoms and decrease psychosocial function. Longitudinal studies that explore causal trajectories between frequent on-label OTCA use and psychological distress are required. OTCA use among adolescents, and particularly among females, with anxiety and depression should be administered with caution and closely monitored.

Download Full-text

The Internet: Friend or Foe of Antibiotic Resistance? Results of a Cross-Sectional Study among Italian University Students

Antibiotics ◽

10.3390/antibiotics10091091 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1091

Author(s):

Francesca Licata ◽

Silvia Angelillo ◽

Alessandra Oliverio ◽

Aida Bianco

Keyword(s):

Antibiotic Resistance ◽

University Students ◽

Health Care Providers ◽

Internet Use ◽

Antibiotic Consumption ◽

The Internet ◽

Care Providers ◽

Online Questionnaire ◽

Self Medication ◽

Cross Sectional

The study aims were to investigate knowledge and attitudes towards antibiotics and antibiotic resistance (ABR), and to assess the extent of practices regarding antibiotic consumption and Internet use among university students in Southern Italy. Data were collected through an anonymous online questionnaire from 1 April to 14 April 2021. The eligibility criteria for the study were: (i) age between 18 and 30 years and (ii) registered as an undergraduate student at the university. Among the 1051 sampled students, only 7.4% gave the correct answer to all 7 knowledge statements about antibiotics and ABR. The main determinants of knowledge were being younger and attending to medical or life sciences majors. Almost two-thirds took an antibiotic in the previous 12 months and 24.6% reported having self-medicated with antibiotics. More than half of the sample used the Internet to seek information about antibiotics and/or ABR, and it was the strongest predictor of self-medication with antibiotics. The study findings highlighted gaps in knowledge, considerable antibiotic consumption, sometimes without prescription, together with an extensive Internet use to seek health-related information. To facilitate the health-promoting use of the Internet in conjunction with health care providers, we could make young adults aware of the rational use of antibiotics.

Download Full-text

A Tale of Two Autonomies

Professions and Professionalism ◽

10.7577/pp.1836 ◽

2017 ◽

Vol 7 (3) ◽

pp. e1836 ◽

Cited By ~ 1

Author(s):

Chris Rønningstad

Keyword(s):

Survey Data ◽

Personal Autonomy ◽

Empirical Support ◽

Professional Autonomy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Relationship ◽

Performance Demands

Despite comprehensive theoretical discussions on the nuances of autonomy, research tends to treat autonomy as a unidimensional concept. In contrast, this study of Norwegian welfare professionals presents empirical support for the multidimensional nature of autonomy, drawing on cross-sectional survey data from three datasets spanning six years. The findings show significant differences between welfare professionals’ experiences of professional and personal autonomy. An analysis of the relationship between professionals’ experience of performance demands and these two types of autonomy challenges the notion that increasing performance demands limits professional autonomy.

Download Full-text

Relative Income and Life Satisfaction among Chinese Adults

Sustainability ◽

10.3390/su11205651 ◽

2019 ◽

Vol 11 (20) ◽

pp. 5651 ◽

Cited By ~ 1

Author(s):

Chenghua Guan ◽

Yingjie Qiu ◽

Ruopeng An

Keyword(s):

Life Satisfaction ◽

Relative Income ◽

Well Being ◽

Subjective Well Being ◽

Chinese Adults ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Individual Level ◽

Self Rated Health ◽

The Relationship

Life satisfaction is a key component of people’s subjective well-being. This study assessed the relationship between relative income and life satisfaction among Chinese adults, using data from a cross-sectional survey. Individual-level data (N = 1369) came from the 2016 China Genuine Progress indicator Survey (CGPiS) conducted in Beijing and Chengdu, China. Ordered logistic regressions were performed to examine the relationship between relative income and life satisfaction among CGPiS adult respondents. Respondents’ life satisfaction was positively associated with relative income in comparison to their relatives and friends but not associated with relative income in comparison to their residing community and city. Subgroup analyses replicated the findings among male respondents and respondents with good or excellent self-rated health. In contrast, female respondents’ life satisfaction was positively associated with relative income in comparison to their city of residence, but not associated with relative income in comparison to their relatives, friends, and residing community. Life satisfaction among those with poor or fair self-rated health was not associated with any of the four dimensions of relative income. Relative income in comparison to relatives and friends was positively associated with life satisfaction in Chinese adults. Future studies adopting a longitudinal or experimental design are warranted to replicate the findings.

Download Full-text

Use of Over-The-Counter Analgesics for Pain and Psychological Distress Among Adolescents: A Mixed Effects Approach in Cross-Sectional Survey Data From Norway

10.21203/rs.3.rs-78057/v1 ◽

2020 ◽

Author(s):

Rune Jonassen ◽

Eva Hilland ◽

Catherine J. Harmer ◽

Dawit S. Abebe ◽

Anne Kristine Bergem ◽

...

Keyword(s):

Psychological Distress ◽

Survey Data ◽

Population Based ◽

Mixed Effects ◽

Anxiety And Depression ◽

Cross Sectional Survey ◽

Self Medication ◽

Cross Sectional ◽

Over The Counter ◽

Psychological Predictor

Abstract Background: Over-the-counter analgesics (OTCA) such as Paracetamol and Ibuprofen are frequently used by adolescents, and the route of administration and access at home allows unsupervised use. Psychological distress and pain occur simultaneously and are more common among females than among males. There is a dynamic interplay between on-label pain indications and psychological distress, and frequent OTCA use or misuse can exacerbate symptoms. No studies have to date provided an overview of frequent OTCA use in a larger population-based study. The current study used survey data to explore associations between and the relative predictive value of on-label pain indication and measures of psychological distress, together with sex differences for weekly OTCA use.Methods: This study included 349,528 adolescents aged 13-19. The data was collected annually between January 2014 and December 2018 as part of the Norwegian Young Data survey. Performance analysis was conducted to explore the relative roles and associations between on-label pain indication and psychological distress in weekly OTCA use. A mixed-effects logistic regression model was used to explore the unique contributions from four domains of on-label pain indication and psychological distress as measured by a combined measure of anxiety and depression (HSCL-10) and peer-bullying involvement as victims or bullies.Results: Thirty percent of females and thirteen percent of males use OTCA weekly. Headache is the strongest on-label pain predictor of weekly OTCA use, followed by abdominal pain. Depression and anxiety are the strongest psychological predictor of weekly OTCA use, and higher symptom levels and being female increase the strength of this association. Anxiety and depression also predict weekly OTCA use after controlling for physiological pain.Conclusions: Sex, pain and anxiety and depression are inter-correlated and strong predictors of frequent OTCA use. Frequent OTCA use in the context of psychological distress may be a form of self-medication that can exacerbate symptoms and decrease psychosocial function. Longitudinal studies that explore causal trajectories between frequent on-label OTCA use and psychological distress are required. OTCA use among adolescents, and particularly among females, with anxiety and depression should be administered with caution and closely monitored.

Download Full-text

Self-medication with antibiotics and knowledge about antibiotic resistance among nursing practitioners at a tertiary hospital in Northern Ghana: a cross-sectional survey study

10.21203/rs.3.rs-659723/v1 ◽

2021 ◽

Author(s):

Ismael Niadawe Issaka

Keyword(s):

Logistic Regression ◽

Antibiotic Resistance ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Health Concern ◽

Northern Ghana ◽

Primary Study ◽

Cross Sectional Survey ◽

Self Medication ◽

Cross Sectional

Abstract Background Antimicrobial resistance attributed to self-medication with antibiotics is a growing global health concern. Even among health-aware subgroups including medical and nursing practitioners, the prevalence of self-medication with antibiotics remains high. In Ghana, the extent of self-medication with antibiotics among health professionals is not yet fully known. This study draws from a primary cross-sectional study within a tertiary medical facility in Ghana to provide a first estimate of the proportion of nurses who had self-medicated with antibiotics within the last 12 months or longer at the time of the study. The primary study investigated associations between self-medication with antibiotics and socio-demographics, knowledge levels, perceived susceptibility, and perceived severity regarding antibiotic resistance- related conditions. Methods Cross-sectional survey design supported by a pre-tested, standardized, self-administered questionnaire was used to collect data among 170 nurses. Descriptive statistics was used to analyse variable distributions. Chi-square test was used for univariate analysis and logistic regression for multivariable analysis. A level of p < .05 was considered significant. IBM Statistical Package for the Social Sciences (SPSS) version 21 was used for data analysis. Results 77.1% of study participants recalled having practised self-medication with antibiotics within the last 12 months and longer. 72.9% of respondents obtained antibiotics from the medical store or pharmacy. In the multivariable logistic regression analysis, years of work ≤ 5 years (OR = 0.21, 95% CI: 0.061–0.708), knowledge of antibiotic resistance (OR = 0.178, 95% CI: 0.060–0.528), and high perceived personal severity of a disease related to antibiotic resistance (OR = 0.128, 95% CI: 0.046–0.357) were found significantly associated with the practice of self-medication with antibiotics. Conclusion To curb inappropriate use of antibiotics that increases the risk of antibiotic resistance, there is the need to promote education among nurses and stronger enforcement of laws which forbid sales without prescription.

Download Full-text

Sleep Reactivity and Psychological Health in Normal Sleepers: the moderating role of stress

10.31234/osf.io/nxz42 ◽

2018 ◽

Author(s):

Jason G. Ellis ◽

Sarah Allen ◽

Michael Perlis ◽

Michael Grandner ◽

Maria Gardani ◽

...

Keyword(s):

Life Events ◽

Psychological Health ◽

Public Health Campaign ◽

Health Campaign ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Dysfunctional Cognitions ◽

The Relationship ◽

Moderating Role

The aim of the present study was to determine whether normal sleepers with vulnerability to insomnia, via high sleep reactivity, demonstrate more sleep-related dysfunctional cognitions and behaviours and poorer psychological health compared to those who are not vulnerable. Further, the influence of stress on the relationship between sleep reactivity and psychological health was also examined. A cross-sectional survey of 737 young adult ‘normal’ sleepers from the general population was undertaken. Results indicated normal sleepers vulnerable to insomnia demonstrated more sleep-related dysfunctional cognitions and behaviours as well as poorer psychological health compared to those not vulnerable. Furthermore, the relationship between sleep reactivity and psychological health was moderated by perceived stress over the previous month and life events over the previous year. Therefore, identifying and supporting those who are vulnerable to insomnia may be a fruitful avenue for preventative public health campaign to mitigate both insomnia and poor psychological health.

Download Full-text

Association between Social Media Use for Health Purpose and Depressive Symptoms: A Cross-Sectional Survey (Preprint)

10.2196/preprints.25007 ◽

2020 ◽

Author(s):

Hee Yun Lee ◽

Yan Luo ◽

Cho Rong Won ◽

Jiyoung Lee ◽

Jeongwon Baik

Keyword(s):

Social Media ◽

Depressive Symptoms ◽

Social Networking Sites ◽

Inverse Relationship ◽

Age Groups ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Use Of Social Media ◽

The Relationship ◽

Health Purpose

BACKGROUND The use of social media or social networking sites (SNS) is increasing across all age groups, and one of the primary motives of using SNS is to seek health-related information. Although previous research examining the effect of SNS use on depression exist, studies regarding the effect of SNS use for health purpose on depression is limited. OBJECTIVE Our study aims to explore the relationship between SNS use for health purpose and depression across the four age groups (18-34 years old, 35-49 years old, 50-64 years old, and above 65 years old). METHODS A sample of 6,789 adults aged 18 and older was extracted from a 2017 and 2018 Health Information National Trends Survey (HINTS). Univariate and bivariate analyses to examine the association between each variable and four age groups were conducted. Multiple linear regression analyses to predict depression level among participants with use of SNS for health purpose were conducted. RESULTS SNS use for health purpose and depression were positively associated for three age groups but not for those 65 years or older (=0.13, P<0.05; =0.08, P<0.05; =0.09, P<0.05). Income and self-reported health status indicated an inverse relationship for all age groups. The relationship with marital status differed based on age group with 18 and 34 years old showing an inverse relationship (=-0.13, P<0.01) while 65 years or older showing a positive relationship (=0.06, P<0.05). Gender was positively associated among those in the 35-49 years old (=0.09, P<0.05) and 65 years or older (=0.07, P<0.05). Being Non-Hispanic White was positively associated with depression among 50-64 years old (=0.07, P<0.001) and 65 years or older (=0.08, P<0.05). CONCLUSIONS Age-tailored education on determining accurate and reliable information shared via SNS is needed to reduce depressive symptoms.

Download Full-text

The Relationship between the Sense of Coherence of Dental Hygiene Students in Their Graduation Year and Their View of the Profession and Attitude to Work: A Cross-Sectional Survey in Japan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249594 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9594

Author(s):

Rumi Tano ◽

Hiroko Miura ◽

Katsuo Oshima ◽

Kanako Noritake ◽

Hideki Fukuda

Keyword(s):

Sense Of Coherence ◽

Dental Hygienist ◽

Dental Hygienists ◽

Future Prospects ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Dental Hygiene Students ◽

Training Institutions ◽

Level Of Significance ◽

The Relationship

Objective: The need to make sense of coherence in placement support for student dental hygienists has been shown. On this basis, this study investigated the relationship between the sense of coherence of student dental hygienists and their view of the profession and attitude to work in order to clarify how they perceive their prospects for employment. Methods: The subjects were graduation-year students at all of the dental hygienist training institutions in Japan, and anonymous, self-administered questionnaires were sent to the institutions by post in 2019. The results were analyzed by χ2 tests, as well as one-way analysis of variance and multiple comparisons using Tukey’s test, with the level of significance set at 5%. Results: Of 6270 questionnaires that were returned, 6264 were analyzed. The sense of coherence (SOC) component senses were manageability (F(26,221) = 5306.06, p < 0.01), meaningfulness (F(26,222) = 4373.48, p < 0.01), and comprehensibility (F(26,216) = 3986.12, p < 0.01), with meaningfulness scoring significantly higher than the other two (p < 0.01). Analysis with SOC scores divided into the low, medium, and high groups showed a relationship between the SOC of student dental hygienists and their view of the profession and attitude to work (p < 0.01), such that higher SOC scores were associated with a better view of the profession and a better attitude to work (F(26,225) = 282.18, p < 0.01). Conclusions: The results suggest that education that increases SOC in dental hygienist training programs may positively affect future prospects for student dental hygienists.

Download Full-text