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Background and Objective: Resistance to antibiotics is a public health threat. A number of studies confirm the relationship between antibiotic use and the resistance rate. As a whole, physicians represent a large proportion of the health professionals involved in the use of this therapeutic group. Our study therefore sought to ascertain the opinions and attitudes of GPs in Spain with respect to antibiotics and resistance.Methods: We used the focus group (FG) method, with each group comprising 4-12 primary care physicians and a moderator. Based on a previous systematic review, we drew up an agenda to be followed during the holding of the sessions. Group proceedings were recorded and the transcriptions then analysed separately by two researchers.Results: Five FGs were formed, including a total of 33 physicians. The factors/attitudes that influenced the prescribing of antibiotics by GPs were fear, complacency, insufficient knowledge and external responsibility of the pharmaceutical industry, patients and over-the-counter antibiotics. The groups felt that antibiotic resistance was not a problem at a community level.Conclusions: Identification of attitudes/knowledge related with inappropriate antibiotic prescribing will enable specific interventions to be designed, with the aim of targeting these shortcomings to improve antibiotic use and help reduce resistance. [ABSTRACT FROM AUTHOR]

Background: In patients undergoing oral anticoagulation treatment, correct control of the international normalized ratio (INR) is necessary. This study sought to assess the effectiveness of a pharmacotherapeutic follow-up programme (PTP) on achieving an optimal INR range, reducing the need for rescue medications and for monitoring the development of possible adverse events associated with poor oral anticoagulation therapy control (haemorrhagic events and thromboembolic disease).Objective: The aim of this study was to evaluate the effectiveness of a PTP targeted at the anticoagulated patient to ensure proper self-control of anticoagulation.Methods: This was a prospective, controlled, multicentre cohort study conducted at four primary care centres in Galicia (northwest Spain), covering a group of patients receiving anticoagulation treatment exposed to pharmacotherapeutic follow-up by a primary care pharmacist (n = 272), and a concurrent control group (n = 460). The intervention consisted of a patient health-education programme plus activities involving collaboration with the physician. The educational intervention exposure period was 12 months (starting from February 2006 and finishing in February 2007), during which time a minimum of one INR determination per month was performed. To assess the quality of haematological control, the British Committee for Standards in Haematology criteria were used, namely (i) 50% or more determinations per patient within a range of 0.5 units above or below the target INR; and (ii) 80% or more determinations per patient within a range of 0.75 units above or below the target INR. As an indicator of correct control of coagulation, we also assessed the occurrence of oral anticoagulation therapy-related adverse events, such as active bleeding, haematomas (jointly referred to as haemorrhagic events) and thromboembolic events. Depending on the type of response variable, negative binomial regression or Cox proportional risks models were fitted.Results: Compared with the control group, the PTP managed to improve correct INR ranges by (i) 25% (relative risk [RR] = 0.75; 95% CI 0.69, 0.82) in terms of the number of patients who had their determinations within ±0.5 units of the target range; and (ii) 26% (RR = 0.74; 95% CI 0.67, 0.81) in terms of the number of patients who had their determinations within ±0.75 units of the target range. Patients belonging to the intervention group registered a 75% reduction in bleeding (hazard ratio [HR] = 0.25; 95% CI 0.18, 0.36). For every 3.27 patients exposed to the PTP, one event would be prevented (number needed to treat = 3.27; 95% CI 2.73, 4.07).Conclusions: Including patients receiving oral anticoagulant treatment in a PTP enhances INR control, efficacy and safety of treatment, and efficiency of primary healthcare services. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is a major public health issue today. Therefore, it is essential to focus on the education of pharmacists as future dispensers. The objective of this study was to validate a questionnaire that assesses the knowledge, attitudes, and perceptions of pharmacy students regarding the education received during their university degree on the use and dispensation of antibiotics, as well as bacterial resistance., Methods: An online questionnaire was developed and distributed via RedCap v.13.7.1 to pharmacy students at the University of Santiago de Compostela using the WhatsApp social network. The questionnaire consisted of 28 items evaluating 5 dimensions: "quality of care", "communication skills", "antibiotic resistance", "teaching methodology", and "education on antibiotics at the faculty". The questionnaire validation was conducted in 2 steps: Step 1 involved content and appearance validation, and Step 2 involved reliability analysis., Results: A total of 61 completed questionnaires were received. The mean age was 21.82 ± 3.81 years, with 20 males (32.8%) and 41 females (67.2%). Content validation was performed through a nominal group of 5 experts, and appearance validation was conducted by a focus group of 6 university pharmacy students. The questionnaire demonstrated a Cronbach's alpha value of 0.80 and adequate item discrimination capability. Confirmatory factor analysis was performed to assess construct validity, confirming the 5 predefined dimensions., Conclusions: A questionnaire has been developed and validated with high reliability and validity. Its use will help identify areas for improvement in the university education of pharmacy students, ultimately contributing to better use and dispensation of antibiotics and thereby improving antimicrobial resistance.

Background: Breastfeeding is the optimal nourishment for infants and it is recommended that children commence breastfeeding within the first hour of birth and be exclusively breastfed for the initial 6 months of life. Our objective was to determine which factors related to mothers could influence the degree of exclusive breastfeeding during hospitalization, as well as to assess breastfeeding mothers' attitudes towards breastfeeding., Methods: A multicenter cross-sectional study was undertaken in the healthcare area of Santiago de Compostela, Spain. The necessary variables were collected using a specially designed ad hoc questionnaire. The researcher responsible for recruitment conducted the interviews with the participants. The reduced Iowa Infant Feeding Attitude Scale (IIFAS-s) was employed to gauge maternal attitudes toward feeding their baby., Results: In total, 64 women were studied. The overall score of IIFAS-s (mean ± standard deviation) was 36.95 ± 5.17. A positive attitude towards breastfeeding was therefore observed in our sample. No use of a pacifier by the newborn was associated with a positive attitude for breastfeeding. Having previous children (Ora = 6.40; IC95% 1.26-32.51) and previous experience with breastfeeding (Ora = 6.70; IC95% 1.31-34.27) increased the likelihood of exclusive breastfeeding during admission., Conclusions: In our study, exclusive breastfeeding during hospitalization is associated with having previous children and prior breastfeeding experience.

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.

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., Competing Interests: The authors have declared that no competing interests exist.

Objective: To identify drug-related problems using the STOPP/START criteria of patients over 64 years polymedicated with 12 or more drugs., Method: Descriptive cross-sectional. We analysed 172 cases randomly selected from the register of 1500 polymedicated patients of the Quality Improvement Programme for Chronic and Polymedicated Patients of the Galician Health Service for the area of Santiago in 2017. Drug-related problems and the negative results associated with medication were recorded. Treatment compliance was assessed by the Morisky-Green-Levine test. Nursing interventions were recorded based on the Programme's nursing report. Bivariate analysis of the data was performed and the association between the variables was estimated by calculating the odds ratio (OR)., Results: The 56.4% of the patients were women. The mean age was 77.34±10.11 years. The most common problem was the likelihood of presenting adverse effects, observed in 64.1% of the patients. Women were more likely to have this problem than men (OR: 1.37; 95% CI: 1.06-1.78). Eighteen percent of the patients were considered non-compliant with the prescribed treatment, according to the Morisky-Green-Levine test. Of the patients, 25.6% had received health education interventions., Conclusions: Nurses must periodically re-evaluate patient medication to check adherence to treatment and determine whether it is causing any type of adverse effect, as well as incorporate health education interventions in this field into their activity., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

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., (© 2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Antibiotic resistance is one of the principal public health problems worldwide. Currently, inappropriate use of antibiotics is regarded as the principal determinant of resistance, with most of these drugs being prescribed outside a hospital setting. This systematic review sought to identify the factors, attitudes and knowledge linked to misprescription of antibiotics., Methods: A systematic review was conducted using the MEDLINE-PubMed and EMBASE databases. The selection criteria required that papers: (1) be published in English or Spanish; (2) designate their objective as that of addressing attitudes/knowledge or other factors related with the prescribing of antibiotics; and (3) use quality and/or quantity indicators to define misprescription. The following were excluded: any paper that used qualitative methodology and any paper that included descriptive analysis only., Results: A total of 46 papers that met the inclusion criteria were included in the review. They were very heterogeneous and displayed major methodological limitations. Doctors' socio-demographic and personal factors did not appear to exert much influence. Complacency (fulfilling what professionals perceived as being patients'/parents' expectations) and, to a lesser extent, fear (fear of possible complications in the patient) were the attitudes associated with misprescription of antibiotics., Conclusions: Before designing interventions aimed at improving the prescription and use of antibiotics, studies are needed to identify precisely which factors influence prescribing., (© 2011 Blackwell Publishing Ltd.)