Dentists' knowledge, attitudes and perceptions of antibiotic prescribing: A systematic review.

OBJECTIVE: This study aims to explore dentists' knowledge, attitudes, and perceptions regarding antibiotic use. METHODS: We conducted a systematic review of dentists' knowledge, attitudes and perceptions regarding antibiotic use, by searching the MEDLINE, EMBASE and Web of Science for all original paper published from January 1990 to July 2023, in accordance with the Preferred Reporting Items for systematic Reviews and Meta-analyses (PRISMA 2020) guidelines. RESULTS: The review included 37 papers, (7 qualitative and 30 quantitative studies). Modifiable factors (knowledge, attitudes) were reported as being associated with antibiotic prescribing by dentists which were cited in 30 of the 37. These attitudes most frequently identified by dentists were: complacency (22/29); lack of trust (16/29); the need to postpone the dental procedure (17/29); and fear (8/29). Gaps in knowledge were also identified (15/29). Only one of the included articles quantified the influence between the reported modifiable factors and antibiotic prescribing. CONCLUSIONS: The review emphasizes that dentists' antibiotic prescribing is predominantly influenced by modifiable factors. This insight informs the potential for targeted interventions to curtail inappropriate antibiotic use, contributing to global efforts in reducing antibiotic resistance. The protocol of this systematic review can be found in PROSPERO under registration no. CRD42021253937.

Elevated Troponins after COVID-19 Hospitalization and Long-Term COVID-19 Symptoms: Incidence, Prognosis, and Clinical Outcomes-Results from a Multi-Center International Prospective Registry (HOPE-2).

Background: Acute cardiac injury (ACI) after COVID-19 has been linked with unfavorable clinical outcomes, but data on the clinical impact of elevated cardiac troponin on discharge during follow-up are scarce. Our objective is to elucidate the clinical outcome of patients with elevated troponin on discharge after surviving a COVID-19 hospitalization. Methods: We conducted an analysis in the prospective registry HOPE-2 (NCT04778020). Only patients discharged alive were selected for analysis, and all-cause death on follow-up was considered as the primary endpoint. As a secondary endpoint, we established any long-term COVID-19 symptoms. HOPE-2 stopped enrolling patients on 31 December 2021, with 9299 patients hospitalized with COVID-19, of which 1805 were deceased during the acute phase. Finally, 2382 patients alive on discharge underwent propensity score matching by relevant baseline variables in a 1:3 fashion, from 56 centers in 8 countries. Results: Patients with elevated troponin experienced significantly higher all-cause death during follow-up (log-rank = 27.23, p < 0.001), and had a higher chance of experiencing long-term COVID-19 cardiovascular symptoms. Specifically, fatigue and dyspnea (57.7% and 62.8%, with p-values of 0.009 and <0.001, respectively) are among the most common. Conclusions: After surviving the acute phase, patients with elevated troponin on discharge present increased mortality and long-term COVID-19 symptoms over time, which is clinically relevant in follow-up visits.

Post-COVID-19 syndrome and diabetes mellitus: a propensity-matched analysis of the International HOPE-II COVID-19 Registry.

Background: Diabetes mellitus (DM) is one of the most frequent comorbidities in patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a higher rate of severe course of coronavirus disease (COVID-19). However, data about post-COVID-19 syndrome (PCS) in patients with DM are limited. Methods: This multicenter, propensity score-matched study compared long-term follow-up data about cardiovascular, neuropsychiatric, respiratory, gastrointestinal, and other symptoms in 8,719 patients with DM to those without DM. The 1:1 propensity score matching (PSM) according to age and sex resulted in 1,548 matched pairs. Results: Diabetics and nondiabetics had a mean age of 72.6 ± 12.7 years old. At follow-up, cardiovascular symptoms such as dyspnea and increased resting heart rate occurred less in patients with DM (13.2% vs. 16.4%; p = 0.01) than those without DM (2.8% vs. 5.6%; p = 0.05), respectively. The incidence of newly diagnosed arterial hypertension was slightly lower in DM patients as compared to non-DM patients (0.5% vs. 1.6%; p = 0.18). Abnormal spirometry was observed more in patients with DM than those without DM (18.8% vs. 13; p = 0.24). Paranoia was diagnosed more frequently in patients with DM than in non-DM patients at follow-up time (4% vs. 1.2%; p = 0.009). The incidence of newly diagnosed renal insufficiency was higher in patients suffering from DM as compared to patients without DM (4.8% vs. 2.6%; p = 0.09). The rate of readmission was comparable in patients with and without DM (19.7% vs. 18.3%; p = 0.61). The reinfection rate with COVID-19 was comparable in both groups (2.9% in diabetics vs. 2.3% in nondiabetics; p = 0.55). Long-term mortality was higher in DM patients than in non-DM patients (33.9% vs. 29.1%; p = 0.005). Conclusions: The mortality rate was higher in patients with DM type II as compared to those without DM. Readmission and reinfection rates with COVID-19 were comparable in both groups. The incidence of cardiovascular symptoms was higher in patients without DM.

Magnitude and determinants of inappropriate prescribing of antibiotics in dentistry: a nation-wide study.

BACKGROUND: Dentist play an important role in misuse of antibiotics. Identification of the dental activities linked to the misuse of antibiotics is important for improving dentists' prescribing quality. The aim of the study was to quantify the magnitude of inappropriate antibiotic prescribing by dentists in Spain and identify the characteristics, knowledge and attitudes that influence prescribing quality. MATERIAL AND METHODS: We conducted a cross-sectional, questionnaire-based study on dentists in Spain, assessing prescribing quality (dependent variable) on the basis of their responses about the prescription of antibiotics in 14 clinical situations. As the independent variables, we assessed professional characteristics and attitudes (lack of knowledge, fear, complacency, scheduling problems, and economic benefit) measured on a Likert scale. Odds Ratios (OR) (95%CI) were calculated using logistic regression. RESULTS: A total of 878 participants were included in the analysis. Half of all dentists displayed inappropriate antibiotic prescribing habits in more than 28.6% (10/14) of the clinical situations posed (interquartile range 57-79%). Prescribing quality increased when resistance was perceived as a public health problem (OR 0.88, 95% CI: 0.79-0.97), and decreased in response to fear (OR 1.12, 95% CI:1.07-1.18) or the pursuit of economic benefit (OR 1.07, 95% CI 1.01-1.14). Having over 30 years' experience (OR 4.58, 95% CI:1.80-12.48) and/or practising in the field of prosthodontics as opposed to endodontics (OR 2.65, 95% CI:1.26-5.71) were associated with worse prescribing quality. CONCLUSIONS: Antibiotics are the most commonly prescribed drugs in dentistry, and in many cases this prescription is inappropriate. Our findings shows that modifiable factors influence prescribing quality among dentists in Spain. These may be use for designing educational and training programmes for dentists.

[Positivity of antigen test in healthcare workers in the first week after diagnosis of SARS-CoV-2 infection.] / Positividad de test de antígenos en trabajadores sanitarios en la primera semana tras el diagnóstico de infección por SARS-CoV-2.

OBJECTIVE: The Surveillance and Control Strategy against COVID-19 of the spanish Ministry of Health focuses, since December 2021, on actions aimed at vulnerable people and areas, including healthcare professionals. According to these protocols, a diagnostic test for acute infection (PDIA), with a negative result, is required prior to returning to work (at least five days after the start of clinical practice). The aim of the study was to analyze the proportion of positive antigen (Ag) test results in the first week of diagnosis among healthcare professionals in a university hospital belonging to the province of A Coruña (Spain). METHODS: We calculated the proportion of healthcare professionals who had symptoms on the 5th day after diagnosis of COVID-19 between January and March 2022, and the proportion of Ag tests performed after returning to work with positive results. These results were compared according to the month and 95% confidence intervals were calculated. RESULTS: 1,085 cases of COVID-19 were diagnosed among healthcare professionals. 18.62% (95%CI 16.34-21.63; n=202/1,085) were still symptomatic on the 5th day. 55.27% (95% CI 51.92-58.58; n=488/833) of the Ag tests performed after return to work were positive. The mean number of days to perform the Ag test after diagnosis was 6.76 days (SD 0.76). CONCLUSIONS: Our results show a high proportion of positive results one week after diagnosis of COVID-19 in asymptomatic patients. Taking into account that in the general population, discharge is based on clinical and temporal criteria, and assuming that not every positive test indicates infectivity, adopting a strategy similar to the rest of the population in healthcare workers would be considered plausible.

OBJETIVO: La Estrategia de Vigilancia y Control frente a la COVID-19 del Ministerio de Sanidad se centra, desde diciembre de 2021, en actuaciones dirigidas a personas y ámbitos vulnerables, entre los que se encuentran los profesionales sanitarios. Atendiendo a dichos protocolos, se requiere una prueba diagnóstica de infección aguda (PDIA), con resultado negativo, previa a su reincorporación laboral (transcurridos al menos cinco días desde inicio de clínica). El objetivo del estudio fue analizar la proporción de resultados positivos de test de antígenos (Ag) en la primera semana del diagnóstico entre los profesionales sanitarios en un hospital universitario perteneciente a la provincia de A Coruña. METODOS: Se calculó la proporción de sanitarios que, tras diagnóstico de COVID-19 entre enero y marzo de 2022, tenían síntomas al 5º día y la proporción de test de Ag realizados previa reincorporación laboral con resultado positivo. Se compararon estos resultados en función del mes y se calcularon los intervalos de confianza al 95%. RESULTADOS: Se diagnosticaron 1.085 casos de COVID-19 entre los profesionales sanitarios. Un 18,62% (IC95% 16,34-21,63; n=202/1.085) continuaba con síntomas al 5º día. El 55,27% (IC95% 51,92-58,58; n=488/833) de los test de Ag realizados previa reincorporación laboral fueron positivos. La media de días para realizar el test de Ag tras el diagnóstico fue de 6,76 días (DE 0,76). CONCLUSIONES: Nuestros resultados muestran una alta proporción de resultados positivos tras una semana del diagnóstico de COVID-19 en asintomáticos. Teniendo en cuenta que en la población general el alta se basa en criterios clínicos y temporales, asumiendo que no todo test positivo indica infectividad, consideraríamos plausible adoptar una estrategia similar a la del resto de la población en estos profesionales.

Knowledge, Attitudes and Practice Regarding Antibiotic Prescription by Medical Interns: A Qualitative Study in Spain.

Antibiotic resistance is an issue of growing importance in the public health sphere. Medical interns are of great relevance when it comes to the source of this problem. This study therefore sought to ascertain which factors influence the management of antibiotic therapy by this population, in order to pinpoint the possible causes of misprescribing habits. We conducted a qualitative study based on focus group techniques, with groups consisting of medical interns from the Santiago de Compostela Clinical University Teaching Hospital. Our study identified factors which the participants considered to be determinants of antibiotic use and their relationship with the appearance of resistance. The single most repeated factor was the influence of the attending physician's judgement; other factors included a high healthcare burden or prescribing inertia. This stage is an opportunity to correct misprescribing habits, by implementing educational interventions aimed at modifying the identified factors.

Knowledge, Perceptions, and Perspectives of Medical Students Regarding the Use of Antibiotics and Antibiotic Resistance: A Qualitative Research in Galicia, Spain.

Antibiotic resistance is a significant public health concern, with numerous studies linking antibiotic consumption to the development of resistance. As medical students will play a pivotal role in prescribing antibiotics, this research aimed to identify their perceptions of current use and factors that could influence future inappropriate use of antibiotics. The study employed a qualitative research approach using Focus Group discussions (FGs) consisting of students from the final theoretical course of the Medicine degree. The FGs were conducted based on a pre-script developed from factors contributing to antibiotic misuse identified in previous studies. All sessions were recorded and transcribed for analysis by two independent researchers, with all participants signing informed consent. Seven focus groups were conducted, with a total of 35 participants. The study identified factors that could influence the future prescription of antibiotics, including the low applicability of knowledge, insecurity, clinical inertia, difficulties in the doctor-patient relationship, unawareness of available updates on the topic, and inability to assess their validity. The students did not perceive antibiotic resistance as a current problem. However, the study found several modifiable factors in medical students that could explain the misuse of antibiotics, and developing specific strategies could help improve their use.

Post-COVID-19 Symptoms and Heart Disease: Incidence, Prognostic Factors, Outcomes and Vaccination: Results from a Multi-Center International Prospective Registry (HOPE 2).

BACKGROUND: Heart disease is linked to worse acute outcomes after coronavirus disease 2019 (COVID-19), although long-term outcomes and prognostic factor data are lacking. We aim to characterize the outcomes and the impact of underlying heart diseases after surviving COVID-19 hospitalization. METHODS: We conducted an analysis of the prospective registry HOPE-2 (Health Outcome Predictive Evaluation for COVID-19-2, NCT04778020). We selected patients discharged alive and considered the primary end-point all-cause mortality during follow-up. As secondary main end-points, we included any readmission or any post-COVID-19 symptom. Clinical features and follow-up events are compared between those with and without cardiovascular disease. Factors with p < 0.05 in the univariate analysis were entered into the multivariate analysis to determine independent prognostic factors. RESULTS: HOPE-2 closed on 31 December 2021, with 9299 patients hospitalized with COVID-19, and 1805 died during this acute phase. Finally, 7014 patients with heart disease data were included in the present analysis, from 56 centers in 8 countries. Heart disease (+) patients were older (73 vs. 58 years old), more frequently male (63 vs. 56%), had more comorbidities than their counterparts, and suffered more frequently from post-COVID-19 complications and higher mortality (OR heart disease: 2.63, 95% CI: 1.81-3.84). Vaccination was found to be an independent protector factor (HR all-cause death: 0.09; 95% CI: 0.04-0.19). CONCLUSIONS: After surviving the acute phase, patients with underlying heart disease continue to present a more complex clinical profile and worse outcomes including increased mortality. The COVID-19 vaccine could benefit survival in patients with heart disease during follow-up.

Impact of the COVID-19 Pandemic on Antibiotic Prescribing by Dentists in Galicia, Spain: A Quasi-Experimental Approach.

BACKGROUND: Antibiotic resistance is one of the most pressing public health problems. Health authorities, patients, and health professionals, including dentists, are all involved in its development. COVID-19 pandemic restrictions on dental care may have had repercussions on antibiotic prescribing by dentists. The aim of this study was to assess the impact of the COVID-19 pandemic on antibiotic prescribing by dentists, and to review antibiotic consumption according to the WHO Access, Watch, Reserve classification. We conducted a natural, before-and-after, quasi-experimental study, using antibiotic prescription data covering the period from January 2017 to May 2021. A segmented regression analysis with interrupted time series data was used to analyse the differences between the numbers of defined daily doses (DDD) of antibiotics prescribed monthly. The outcomes showed an immediate significant decrease in overall antibiotic prescribing by primary-care dentists during lockdown, followed by a non-significant upward trend for the next year. This same pattern was, likewise, observed for Access and Watch antibiotics. COVID-19 pandemic restrictions on dental care influenced the prescription of antibiotics. During confinement, an initial decrease was observed, this trend changed when in person consultations were recovered. It might be beneficial to analyse the prescription of antibiotics using the WHO AWaRe classification, in order to monitor their appropriate use.

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain.

BACKGROUND: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. METHODS: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. RESULTS: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. CONCLUSIONS: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).

[Evolution of the prevalence of electronic cigarette during 2014-2018 and IQOS use in 2018 in Galicia.] / Evolución de la prevalencia de consumo de cigarrillos electrónicos en el periodo 2014-2018 y consumo de IQOS en 2018 en Galicia.

OBJECTIVE: Despite the risks associated with the use of new forms of tobacco consumption, such as electronic cigarettes or heated tobacco products such as IQOS (I Quit Ordinary Smoking), few studies have estimated the prevalence of use at the population level. The aims of this study were to describe, in Galicia, the evolution of the prevalence of the use of electronic cigarettes and the reasons for its use in the period 2014-2018, and, the use and knowledge of IQOS in 2018. METHODS: The information analyzed comes from 4 cross-sectional surveys conducted in 2014 (n=7,874), 2015 (n=7,908), 2017 (n=7,841) and 2018 (n=7,853) within the framework of the Information System on Risk Behaviors (SICRI), being the target population Galicians aged 16 and over. Estimates of prevalence of consumption, the devices knowledge and reasons for use are shown accompanied with 95% confidence intervals (95% CI), globally, by gender, age group and tobacco consumption. RESULTS: In the period under study, the prevalence of electronic cigarette use remained stable. In 2018 it was estimated at 0.7% (0.5-0.9). In 2017, the only year in which changes were observed, it fell to 0.3% (0.2-0.4). Prevalence of electronic cigarette use among the population aged 16 to 24 increased from 0.8% in 2014 to 2.1% in 2018. The main reason for using electronic cigarettes was to quit smoking. The prevalence of the IQOS use at the time study (2018) was 0.1% (0.01-0.15) and 4.2% (3.7-4.7) of the Galicians knew what the IQOS was. CONCLUSIONS: In Galicia, the prevalence of electronic cigarette and IQOS use is low, although an increase was observed among the population aged 16-24 between 2014 and 2018. Surveillance of use at the population level should not be neglected.

OBJETIVO: A pesar de los riesgos asociados al uso de nuevas formas de consumo de tabaco, como los cigarrillos electrónicos o los productos de tabaco calentado como los IQOS (I Quit Ordinary Smoking), son pocos los estudios que han estimado su prevalencia de uso a nivel poblacional. Los objetivos de este trabajo fueron describir, en Galicia, la evolución de la prevalencia y las razones de uso de cigarrillos electrónicos en el periodo 2014-2018; y el uso y conocimiento del IQOS en 2018. METODOS: La información analizada procede de 4 estudios transversales que se realizaron en 2014 (n=7.874), 2015 (n=7.908), 2017 (n=7.841) y 2018 (n=7.853) en el marco del Sistema de Información sobre Conductas de Riesgo (SICRI), siendo la población objetivo la población gallega de 16 años y más. Se presentan estimaciones puntuales de prevalencia de consumo y de conocimiento de los dispositivos y razones de uso acompañadas de intervalos de confianza al 95% (IC95%), en global, en función del sexo, el grupo de edad y el consumo de tabaco. RESULTADOS: En el periodo a estudio la prevalencia de uso de cigarrillos electrónicos se mantuvo estable. En 2018 se estimó en el 0,7% (0,5-0,9). En 2017, único año en el que se observaron cambios, se redujo al 0,3% (0,2-0,4). La prevalencia de uso de cigarrillos electrónicos entre la población de 16 a 24 años pasó del 0,8% en 2014 al 2,1% en 2018. El principal motivo de su uso de cigarrillos electrónicos fue dejar de fumar. La prevalencia de uso de IQOS en el momento del estudio (2018) fue del 0,1% (0,01-0,15) y el 4,2% (3,7-4,7) de los gallegos sabían lo que era el IQOS. CONCLUSIONES: En Galicia, la prevalencia de uso de cigarrillos electrónicos e IQOS es baja, aunque se observó un aumento entre la población de 16 a 24 años entre 2014 y 2018. No se debe descuidar la vigilancia del uso a nivel poblacional.

Factors determining antibiotic use in the general population: A qualitative study in Spain.

BACKGROUND: Antibiotic resistance is an important Public Health problem and many studies link it to antibiotic misuse. The population plays a key role in such misuse. OBJECTIVE: The aim of this study was thus to explore the factors that might influence antibiotic use and resistance in the general population. METHODS: Qualitative research using the focus group (FG) method. Groups were formed by reference to the following criteria: age (over and under 65 years); place of origin; and educational/professional qualifications. FG sessions were recorded, transcribed and then separately analysed by two researchers working independently. Written informed consent was obtained from all participants. RESULTS: Eleven FGs were formed with a total of 75 participants. The principal factors identified as possible determinants of antibiotic misuse were: (i) lack of knowledge about antibiotics; (ii) doctor-patient relationship problems; (iii) problems of adherence; and, (iv) use without medical prescription. Antibiotic resistance is a phenomenon unknown to the population and is perceived as an individual problem, with the term "resistance" being confused with "tolerance". None of the groups reported that information about resistance had been disseminated by the health care sector. CONCLUSIONS: The public is unaware of the important role it plays in the advance of antimicrobial resistance. There is evidence of diverse factors, many of them modifiable, which might account for antibiotic misuse. Better understanding these factors could be useful in drawing up specific strategies aimed at improving antibiotic use.

Does the problem begin at the beginning? Medical students' knowledge and beliefs regarding antibiotics and resistance: a systematic review.

BACKGROUND: Studies have detected that prescribers display gaps in knowledge and inappropriate attitudes regarding antibiotics and resistances, but it is not known whether these are generated during professional practice or derive from the undergraduate stage of their education. Accordingly, the aim of this study was to identify medical students' knowledge, beliefs and attitudes regarding antibiotic use and antibiotic resistance, and whether these change over the course of their time at medical school. METHODS: We conducted a search of the MEDLINE and EMBASE databases, and included studies that measured knowledge and/or beliefs and/or attitudes regarding antibiotic prescribing and/or resistance, among medical students. RESULTS: Of the 509 studies retrieved, 22 met the inclusion criteria. While medical students perceived resistance as posing a major public health problem, both worldwide and in their own countries, students in the last two course years were more aware of overprescription of antibiotics in general, and of broad-spectrum antibiotics, at their teaching hospital. There was a considerable lack of knowledge about the treatment of high-incidence infections, and upper respiratory tract infections in particular (41-69% of participants believed antibiotics to be useful for treating these), without any differences by course year. Students were conscious of their personal shortcomings and thus showed willing to improve their education. CONCLUSIONS: Future physicians display important gaps in knowledge, particularly in terms of treatment of high-incidence infections. This finding may be of use when it comes to designing more effective training in antibiotic stewardship for undergraduates.

Parent-related factors influencing antibiotic use in a paediatric population: A qualitative study in Spain.

AIM: To explore the parent-related factors underlying antibiotic misuse/overuse and their implication in the development of resistance in the paediatric population. METHODS: Qualitative study using the focus group (FG) method in Galicia (Spain). FG sessions were conducted with the parents, 27 mothers and three fathers, of children under 12 years old. A discussion topic guide was developed to lead the sessions, which were then transcribed by the researcher and independently interpreted by two researchers working separately. The grounded theory approach was used. RESULTS: Five FG sessions were conducted. The principal factor detected among parents was fear, associated with the perception of poor parent-paediatrician communication. This factor was related to the following behaviours: (a) pressure on physicians; (b) lack of adherence to treatment; and (c) search for other ways of accessing antibiotics. No group highlighted antibiotic resistance as posing a real problem. All groups considered certain external agents to be responsible for such resistance. Four groups also acknowledged that patient behaviour can influence antibiotic resistance. CONCLUSION: Our study points to poor communication between the healthcare system and the population. Identifying the factors underlying the problem enables more efficient, tailor-made interventions to be designed for the purpose of improving antibiotic use and resistance.