Antibiotics and near-patient testing: Differences in habits between physicians completing or discontinuing a medical audit

Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always adhered to. The aim was to study if antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their participation. Method: A prospective cohort study where physicians participated in an APO (Audit Project Odense) process, making an audit registration for every appointment with a patient who had a respiratory tract infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations, a limited educationally oriented intervention was made. 18 Primary Health Care Centres located in three counties in southern of Sweden with 77 primary health care physicians participated. When comparing proportions the Chisquare test was used. Mann Whitney U-test was used when comparing independent groups and Wilcoxon’s signed-rank test was used when comparing dependent groups. Results: Of the 77 physicians, 38 participated only at baseline (group 1) and 39 participated in both registrations (group 2). The overall use of CRP near-patient tests was 37% in group 1 and 28% in group 2 (Chisquare p < 0.001), and the overall use of Strep-A near-patient tests was 31% and 20%, respectively (Chisquare p < 0.001). When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion: In conclusion, this study showed that physicians, who were more inclined to complete audit participation, used near-patient tests and prescribed antibiotics more correctly, according to the national guidelines for respiratory tract infections, than physicians who discontinued the participation. To achieve a rational use of antibiotics, near-patient tests and prescription of antibiotics must be used according to guidelines.

The social environment is most important for not using snus or smoking among adolescents

Aims: To identify factors, which were related to being smoke-free and snus-free, respectively, among adolescents in relation to adolescents who were smoking and/or using snus, and determine if there were any sex differences. Methods: A questionnaire study was performed among students in year two in upper secondary schools (17-years-old) in southern Sweden in 2009. More than 2200 students completed the questionnaire regarding health and living habits anonymously. The variables were tested by χ2-test, before selection into the logistic model. Because of the salutogenic approach in the study, the results of the logistic regression analyses were expressed as Positive Odds Ratio (POR). Results: The prevalence of being smoke- free was 75.6 percent for girls and 70.2 percent for boys, whilst the prevalence of being snus- free was 95.1 percent for girls and 70.2 percent for boys. Having a tobacco-free best friend was the most important factor that correlated with being smoke- and snus-free as an adolescent, for both boys and girls. Good living habits, such as drinking less alcohol, were also central to being smoke-free and snus-free. Conclusions: The results show that a tobacco-free environment has a great influence on whether or not adolescents stay tobacco-free. As the environment has a big impact, the school has a big challenge to work with the school environment and policies but also with family responsibility, norms and attitudes to tobacco.

Experiences of Being Non-Smoking among Adolescents in a Smoking Context

Introduction: A study among Greenlandic 13-year-old showed that 68 percent for boys and 55 percent for girls, and at age 15, 46 percent of the boys and 32 percent of the girls were non-smokers. A literature review showed that the behaviour of parents and peers, attitudes and expectations were crucial factors for the smoking habits of adolescents. Young adults would more likely start smoking if their parents, older siblings and/or friends were smokers. Parental support has been proven to be a preventive factor against smoking, especially if the school and leisure centers get involved. Group pressure, directly or indirectly, is often described as the most important reason why adolescents start smoking. The purpose was to study why some adolescents choose to be smoke-free in a society where the norm is to smoke. Methods: Adolescents who were non-smokers were interviewed in focus groups. The material was analysed using content analysis. Results: The contents analysis of the text resulted in eleven categories. Based on these, four themes were developed. These themes covered areas on the reasons for being smoke-free;how the smoke-free adolescents generally felt about smokers from a society or environment perspective, and also specifically from an individual perspective, such as how smokers took up space and did not show any consideration. There was a feeling among non-smokers of not belonging and of ambivalence, as well as a perspective of the future for adolescents in Greenland and an uncertainty about what would be required for a smoke-free environment. Conclusions: In a context where the norm is to smoke, the adolescents need to make a conscious choice to be smoke-free, and there were different reasons for this choice. This choice means becoming an outsider in their group of peers as well as the overall social culture. Smokers were seen as taking up too much space, as their needs ruled and this was deemed inconsiderate.