The effects of the primary health care providers’prescription behavior interventions to improve the rational use of antibiotics:a systematic review

Background:Irrational antibiotics use in clinical prescription,especially in primary health care(PHC)is accelerating the spread of antibiotics resistance(ABR)around the world.It may be greatly useful to improve the rational use of antibiotics by effectively intervening providers’prescription behaviors in PHC.This study aimed to systematically review the interventions targeted to providers’prescription behaviors in PHC and its’effects on improving the rational use of antibiotics.Methods:The literatures were searched in Ovid Medline,Web of Science,PubMed,Cochrane Library,and two Chinese databases with a time limit from January 1st,1998 to December 1st,2018.The articles included in our review were randomized control trial,controlled before-and-after studies and interrupted time series,and the main outcomes measured in these articles were providers’prescription behaviors.The Cochrane Collaboration criteria were used to assess the risk of bias of the studies by two reviewers.Narrative analysis was performed to analyze the effect size of interventions.Results:A total of 4422 studies were identified in this study and 17 of them were included in the review.Among 17 included studies,13 studies were conducted in the Europe or in the United States,and the rest were conducted in low-income and-middle-income countries(LMICs).According to the Cochrane Collaboration criteria,12 studies had high risk of bias and 5 studies had medium risk of bias.There was moderate-strength evidence that interventions targeted to improve the providers’prescription behaviors in PHC decreased the antibiotics prescribing and improved the rational use of antibiotics.Conclusions:Interventions targeted PHC providers’prescription behaviours could be an effective way to decrease the use of antibiotics in PHC and to promote the rational use of antibiotics.However,we cannot compare the effects between different interventions because of heterogeneity of interventions and outcome measures.

Prevalence and Associated Factors of Suicidal Behaviors Among Community-Dwelling Individuals with Serious Mental Disorders—Shandong Province,China,2022

Summary What is already known about this topic?Serious mental disorders(SMD)are significant risk factors for suicide,and individuals with SMD are crucial target populations for suicide prevention efforts.While numerous studies have examined the prevalence of suicidal behaviors among psychiatric inpatients,fewer reports have addressed the occurrence of such behaviors in community-based patients.What is added by this report?The prevalence of suicidal ideation,planning,and attempts among community-dwelling individuals with SMD was found to be 36.8%,17.9%,and 15.0%,respectively.A significant association was observed between the severity of psychiatric symptoms and the presence of suicidal behaviors.Notably,patients within the 55–59 age range demonstrated the highest rates of both suicidal planning and attempts.What are the implications for public health practice?Particular attention to the risk of suicide is crucial,especially for community-dwelling individuals with SMD of middle age,those with religious beliefs,living alone,and exhibiting more severe depressive and psychiatric symptoms.

Diagnostic Value of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Patients with Severe COVID-19—7 PLADs,China,January 21–February 10,2020

Summary What is already known about this topic?Coronavirus disease 2019(COVID-19)causes symptoms ranging from mild to severe.Indicators for identifying severe COVID-19 infection have not been well identified,especially for young patients.What is added by this report?Both neutrophil-lymphocyte ratio(NLR)[area under curve(AUC):0.80;the odds ratios(OR)and 95%confidence intervals(95%CI):1.30(1.13–1.50)]and platelet-lymphocyte ratio(PLR)[AUC:0.87;OR(95%CI):1.05(1.01–1.09)]were determined to be indicators for recognition of patients with severe COVID-19 in young patients less than age 40.What are the implications for public health practice?NLR and PLR are useful indicators for identifying patients with severe COVID-19,especially in young patients less than age 40.

Age-Specific Pulmonary Tuberculosis Notification Rates—China,2008–2018

What is already known about this topic?The incidence of tuberculosis(TB)was declining in China but has plateaued in recent years.What is added by this report?Notifications of pulmonary TB declined by 27.7%between 2008 and 2018,with an average crude decline of 3.4%per year and an average age-adjusted decline of 4.3%per year.Notifications decreased faster among older people,but slower in western China;the combination of trends led to an inflection in 2016 in the overall notification trend from decreasing to stable.What are the implications for public health practice?Population ageing and geographic disparities slowed tuberculosis control progress in China.Enhanced,targeted,and proactive responses are recommended to achieve the End TB targets.