Nonprescribed antimicrobial drugs in Latino community, South Carolina.We investigated in a sample of Latinos the practices of antimicrobial antimicrobial /an·ti·mi·cro·bi·al/ (-mi-kro´be-al) 1. killing microorganisms or suppressing their multiplication or growth. 2. an agent with such effects. drug importation and use of nonprescribed antimicrobial drugs. In interviews conducted with 219 adults, we assessed health beliefs and past and present behaviors consistent with acquiring antimicrobial drugs without a prescription in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . Many (30.6%) believed that antimicrobial drugs should be available in the United States without a prescription. Furthermore, 16.4% had transported nonprescribed antimicrobial drugs into the United States, and 19.2% had acquired antimicrobial agents Antimicrobial agents Chemical compounds biosynthetically or synthetically produced which either destroy or usefully suppress the growth or metabolism of a variety of microscopic or submicroscopic forms of life. in the United States without a prescription. A stepwise stepwise incremental; additional information is added at each step. stepwise multiple regression used when a large number of possible explanatory variables are available and there is difficulty interpreting the partial regression logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. analysis showed that the best predictors of having acquired nonprescribed antimicrobial drugs in the United States were beliefs and behavior consistent with limited regulations on such drugs. Many persons within the Latino community self-medicate with antimicrobial drugs obtained without a prescription both inside and outside the United States, which adds to the reservoir of antimicrobial drugs in the United States. ********** The amount of antimicrobial drugs consumed in a community is directly related to the amount of antimicrobial drug resistance found in the community (1,2). Inappropriate use of antimicrobial drugs, particularly for respiratory infections Noun 1. respiratory infection - any infection of the respiratory tract respiratory tract infection infection - the pathological state resulting from the invasion of the body by pathogenic microorganisms , has contributed to the major public health problem of antimicrobial resistance. Interventions in the United States have decreased inappropriate antimicrobial drug prescribing in general and for respiratory infections in particular (3-5). In many nonindustrialized countries, antimicrobial resistance is an even greater problem than it is in the United States; however, many of these countries have few restrictions on the sale of antimicrobial agents, or laws are unevenly enforced (6-9). The dispensation DISPENSATION. A relaxation of law for the benefit or advantage of an individual. In the United States, no power exists, except in the legislature, to dispense with law, and then it is not so much a dispensation as a change of the law. of antimicrobial drugs without a prescription is particularly problematic in Latin America Latin America, the Spanish-speaking, Portuguese-speaking, and French-speaking countries (except Canada) of North America, South America, Central America, and the West Indies. (9,10). Persons in countries with few regulations on antimicrobial agents tend to have cultural norms that encompass self-diagnosis and buying of antimicrobial drugs in subtherapeutic sub·ther·a·peu·tic adj. Below the dosage levels used to treat diseases: subtherapeutic feeding of penicillin to livestock. sub quantities (8,10,11). More than 320 million persons cross the border into the United States each year from Latin American countries List of American countries Nations:
Health beliefs and practices are integrated into one's ethnic and cultural orientation (13 15). Limited evidence indicates that even after moving to the United States, persons from countries with limited or no restrictions on antimicrobial drugs are more likely than persons born in the United States to use them for inappropriate indications, such as common colds, and use them without a prescription (16,17). Initiatives to increase judicious ju·di·cious adj. Having or exhibiting sound judgment; prudent. [From French judicieux, from Latin i use of antimicrobial drugs to address antimicrobial resistance have focused primarily on changing prescribing patterns of US physicians and have failed to account for antimicrobial drug importation and concomitant concomitant /con·com·i·tant/ (kon-kom´i-tant) accompanying; accessory; joined with another. concomitant adjective Accompanying, accessory, joined with another inappropriate self-medication within immigrant communities. The pool of nonprescribed antimicrobial drugs entering the United States is currently unknown as is the extent of acquisition of nonprescribed antimicrobial drugs within communities whose health beliefs and practices may be inconsistent with those of the US public health community. Thus, the purpose of this study was to investigate a sample of Latinos living in the United States in terms of their practices of antimicrobial drug importation and acquisition and use of nonprescribed antimicrobial drugs. Methods South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. , like many other cities and states that have historically had few Latinos, has experienced recent surges in immigration immigration, entrance of a person (an alien) into a new country for the purpose of establishing permanent residence. Motives for immigration, like those for migration generally, are often economic, although religious or political factors may be very important. and now has small informal enclaves and social structures. Many Latinos in these new communities may lack documentation for US residency A duration of stay required by state and local laws that entitles a person to the legal protection and benefits provided by applicable statutes. States have required state residency for a variety of rights, including the right to vote, the right to run for public office, the . Consequently, our sampling design took into account the fact that many probability-based sampling designs (e.g., random-digit dialing telephone survey, mail survey from a published list of addresses) would not adequately access this hard-to-reach population. Adult ([greater than or equal to] 18 years of age) Latinos attending 2 clinics in the greater Charleston, South Carolina, area that serve a primarily Latino population were approached for participation in a face-to-lace, structured, confidential interview in which no names were recorded. This Latino population was employed primarily in agriculture. Eligible persons included both those seeking care as well as those accompanying patients since the goal was to collect data from Latino adults regarding health behavior that was not necessarily linked to a current illness. Persons in the waiting rooms of the clinic were approached by an interviewer, who was introduced to the prospective respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. by clinic personnel. If persons did not consider themselves to be Latino, they were not included in the study. Data were collected in July and August 2004. The study was approved by the Medical University of South Carolina “MUSC” redirects here. For Abel Santa María airport in Santa Clara, Cuba (ICAO code MUSC), see Abel Santa María Airport. The Medical University of South Carolina Institutional Review Board. Instrument Previously used and validated surveys designed for use with Latino populations were accessed from the scientific literature and were consulted for question wording relevant to the present study's aims. An instrument was created in English, pretested initially in English for flow and comprehension, and following modifications was then translated into Spanish. Once in Spanish, the instrument was put through 2 levels of pretests. The first pretest pre·test n. 1. a. A preliminary test administered to determine a student's baseline knowledge or preparedness for an educational experience or course of study. b. A test taken for practice. 2. was with medical center personnel who were fluent fluent /flu·ent/ (floo´int) flowing effortlessly; said of speech. with Spanish and dealt with Latino populations. Following modifications from the first pretest, the second pretest was conducted with Latino persons seen at a clinic different from the ones used in the study to provide pretest experience with the instrument with a similar population. After the second pretest, the instrument was translated back into English so that the wording of the questions could be checked for consistency in both English and Spanish. Two trained bilingual bi·lin·gual adj. 1. a. Using or able to use two languages, especially with equal or nearly equal fluency. b. interviewers administered the survey in a structured format in the participant's preferred language (Spanish or English) and reinforced to the potential respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. the anonymous nature of the survey. Variables The study focused on 3 general sets of information. First, questions were included that assessed acquiring antimicrobial drugs without a prescription while outside the United States and corresponding self-medication. These questions were asked to get an idea of health behavior in their home culture and society. In addition, we asked whether the respondents believed that antimicrobial drugs should be available in the United States without a prescription. Second, questions were included that provided an assessment of the importation of nonprescription non·pre·scrip·tion adj. Sold legally without a physician's prescription; over-the-counter. antimicrobial drugs into the United States and the context and circumstances related to this behavior. Third, a set of questions was included that assessed acquisition of nonprescribed antimicrobial drugs within the United States. We were specifically interested in the scope of acquisition of nonprescribed antimicrobial drugs from bodegas, pharmacias, or other stores since this behavior had been suggested in a study in New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. (17). For both importing nonprescribed antimicrobial drugs and acquiring them within the United States, a series of questions was asked, based on the pretest information, to gain an understanding of why the respondents would engage in these practices. Analysis Initially, descriptive statistics descriptive statistics see statistics. were computed to gain an understanding of the extent of the acquisition and importation of nonprescribed antimicrobial drugs. We also computed chi-square values to examine bivariate bi·var·i·ate adj. Mathematics Having two variables: bivariate binomial distribution. Adj. 1. relationships between importation of nonprescribed antimicrobial drugs and acquisition of nonprescribed antimicrobial drugs in the United States by health beliefs and behavior in the home country, access to care in the United States, and demographic characteristics. Finally, a stepwise logistic regression model was computed on the dependent variable of acquisition of nonprescribed antimicrobial drugs with the same set of variables (acquired antimicrobial drugs without a prescription outside the United States, believe antimicrobial drugs should be available in the United States without a prescription, health insurance, age, sex, education, time in United States, country of birth, health status) to determine the best predictors of this behavior. Because no one born in the United States had acquired nonprescribed antimicrobial drugs in the United States, the category variable of country of birth was not used as a predictor of acquiring nonprescribed antimicrobial drugs. Instead, country of birth was coded for inclusion in the regression as 1) born in Mexico or 2) born elsewhere. Results A total of 277 adults were approached for participation. Four persons who were initially approached indicated that they did not consider themselves to be Latino. Of the remaining 273, 54 refused or provided incomplete information, leaving a sample of 219. The demographic characteristics of the sample are presented in Table 1. A large proportion of the sample (30.6%) believed that antimicrobial drugs should be available in the United States without a prescription. The behavior of acquiring antimicrobial drugs without a prescription while outside of the United States was quite common, with 45.2% indicating that they had done this. A substantial number of persons had transported nonprescribed antimicrobial drugs into the United States (16.4%). The primary illnesses for which they bought the antimicrobial drugs were primarily for what we believe to have been viral respiratory infections. Among respondents who reported bringing back antimicrobial drugs that they purchased without seeing a doctor first, the reported conditions they were trying to treat included cough (88.9%), ear infections (88.9%), sore throat Sore Throat Definition Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza. (69.4%), and colds (58.3%). When asked whether, on their next trip outside the United States, they would purchase antimicrobial drugs without seeing a doctor first and bring them back into the country, 23.7% of the sample reported "likely" or "very likely." Among persons who transported nonprescribed antimicrobial drugs into the United States, the primary reason reported for doing so was because they had a mistrust of medicines in the United States and were more comfortable with medicines from the home country (30.6%); other reasons included the following: to pay less for medicines bought in the home country than they would for those bought in the United States (19.4%), to avoid going to the doctor while in the United States (16.7%), to avoid the language barrier to care in the United States (13.9%), to prepare for future illness (13.9%), and to treat someone else's medical problem (5.6%). Acquiring antimicrobial drugs not prescribed pre·scribe v. pre·scribed, pre·scrib·ing, pre·scribes v.tr. 1. To set down as a rule or guide; enjoin. See Synonyms at dictate. 2. To order the use of (a medicine or other treatment). for the respondent within the United States was also a common behavior (19.2%). Among those who acquired antimicrobial drugs in the United States without a prescription, 92.9% reported that they had acquired them without prescription at stores in the United States. As with transportation of nonprescribed antimicrobial drugs into the United States, the primary illnesses for which they acquired the drugs without a prescription were what we believe to have been viral respiratory infections. Among respondents who reported acquiring antimicrobial drugs without a prescription, they reported attempting to treat "gripe gripe v. To have sharp pains in the bowels. n. 1. gripes Sharp, spasmodic pains in the bowels. 2. A firm hold; a grasp. " (flu) (97.6%), ear infections (97.6%), cough (83.3%), and sore throat (80.9%). Additionally, 97.6% reported acquiring antimicrobial drugs to treat diarrhea diarrhea (dīərē`ə), frequent discharge of watery feces from the intestines, sometimes containing blood and mucus. It can be caused by excessive indulgence in alcohol or other liquids or foods that prove irritating to the stomach or . Among persons who had acquired antimicrobial drugs in the United States without a prescription, 64.3% suggested that doing so was preferable to going to the doctor, while 26.2% reported that it was cheaper than paying for the doctor visit in addition to paying for the prescription. Only 7.1% of this group reported acquiring antimicrobial drugs in this way because of language barriers. Tables 2 and 3 show the relationship between home country behaviors, health beliefs, access to care variables, and demographic characteristics to importing nonprescribed antimicrobial drugs and acquiring nonprescribed antimicrobial drugs in the United States. Persons who acquired nonprescribed antimicrobial drugs in the United States had beliefs and practices consistent with limited regulations on antimicrobial drugs. The best predictors of acquiring antimicrobial drugs in the United States without a prescription are shown in Table 4. Only 4 variables were significantly related. The strongest predictors were health beliefs and practices consistent with limited regulations on antimicrobial drugs. Discussion This study confirms the existence of a large reservoir of nonprescription antimicrobial drugs in the United States that are used for likely inappropriate self-medication in the Latino community. Besides being imported, many of these nonprescription drugs are acquired from small stores Noun 1. small stores - personal items conforming to regulations that are sold aboard ship or at a naval base and charged to the person's pay commissary - a retail store that sells equipment and provisions (usually to military personnel) , showing an organized system of nonprescription antimicrobial drug distribution within the Latino community in the United States The cultural beliefs and practice of obtaining antimicrobial drugs without prescriptions, particularly for what are likely viral respiratory infections, is reflected in the antimicrobial drug use patterns of the Latino community in this United States. Health beliefs and practices that were instilled in their countries of origin appear to be maintained even after living in the United States, as the relatively high frequency of acquisition of nonprescription antimicrobial drugs in the United States demonstrates. As previous research has shown, persons born in the United States are less likely to acquire antimicrobial drugs without a prescription within the United States (16). In fact, none of the Latino respondents born in the United States had acquired antimicrobial drugs without a prescription in the United States. Thus, a special emphasis with patient education should be made to target this population to instill in·still v. To pour in drop by drop. in  stil·la tion n. health beliefs that are more consistent with those
proposed by the US medical and public health communities.An additional issue that may play a role in the ability to encourage appropriate use of antimicrobial drugs in this community are problems associated with access to health care. More than 90% of the respondents reported that they had no health insurance. Although health insurance was not a distinguishing variable, common reasons given by the respondents for both importation and acquisition of nonprescribed antimicrobial drugs in the United States revolved re·volve v. re·volved, re·volv·ing, re·volves v.intr. 1. To orbit a central point. 2. To turn on an axis; rotate. See Synonyms at turn. 3. around the economics of doctor visits and costs of medication in the United States. A lack of health insurance may encourage Latinos to self-medicate with antimicrobial drugs. Our findings should be interpreted within the context of several limitations to our study. First, the sample was recruited from a single mid-sized community, thereby limiting the generalizability of the results. However, many areas in the United States have seen recent large increases in the Latino population. These new communities may reflect different practices than communities that have had generations of Latino immigrants (e.g., Miami, New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , San Antonio San Antonio (săn ăntō`nēō, əntōn`), city (1990 pop. 935,933), seat of Bexar co., S central Tex., at the source of the San Antonio River; inc. 1837. ). A second limitation concerns the location of data collection. By focusing on persons who sought treatment at a health clinic, Latinos who may not access care in the formal health care system would not be represented in this study. Those persons could be even more likely to acquire antimicrobial drugs without a prescription. A direction for future research would be to investigate these issues about antimicrobial drug use in a broader community sampling frame. Third, the results are based on self-reports of behavior, some of which may be somewhat threatening to relate to an interviewer. Thus, the reports of antimicrobial drug importation and acquisition of nonprescribed antimicrobial drugs may be an underreport un·der·re·port tr.v. un·der·re·port·ed, un·der·re·port·ing, un·der·re·ports To report (income or crime statistics, for example) as being less than actually is the case. of actual behavior. Several strategies were used to try and obtain valid reports, including multiple pretests and having the clinic staff introduce the interviewers to the potential participants. Persons may also have been confused about which medications are antimicrobial drugs. Following the pretests, the interview was modified to contain several instances of descriptions of antimicrobial drugs and names that would be recognizable to the Latino community. Moreover, each time a respondent reported acquiring antimicrobial drugs, the respondent was asked by the interviewer to name the drug to make sure that the respondent had actually acquired antimicrobial drugs. If in fact the results represent underreporting, the findings are even more dramatic because nearly 20% acknowledged getting antimicrobial drugs without a prescription in the United States. Our findings suggest that a large public health problem is at hand. However, because this study is one of the first to document the problem and the first, to our knowledge, to specifically focus on both importation and US acquisition of nonprescribed antimicrobial drugs, government agencies have not yet responded to this problem. The South Carolina Department of Health and Environmental Control The South Carolina Department of Health and Environmental Control (also known as "SC DHEC" or simply "DHEC") is the government agency responsible for health and environment control in the American state of South Carolina. has a judicious antibiotic antibiotic, any of a variety of substances, usually obtained from microorganisms, that inhibit the growth of or destroy certain other microorganisms. Types of Antibiotics use initiative (South Carolina Careful Antibiotic Use, http://www.scdhec.gov/ health/disease/sccause). Their initiatives are similar to many other initiatives that focus on both physician and patient education, but thus far have not focused on Latinos and nonprescription antimicrobial drug importation and local acquisition. A substantial number of persons within the US Latino community self-medicate with antimicrobial drugs obtained without a prescription both inside and outside the United States, which adds to the reservoir of these drugs in the United States. The public health system and clinicians should be aware of the different health belief systems and practices in ethnic minority communities. Patient education materials should communicate in a culturally competent way the dangers of self-medication and antimicrobial misuse to both recent immigrants and others in the Latino community. US health policies also may need to be revised, with consideration given to tightening regulations to reduce the presence of nonprescribed antimicrobial drugs and to increasing access to care for many Latinos.
Table 1. Characteristics of sample *
Characteristic No. persons (%)
Country of birth
Mexico 164 (74.8)
Other Central American country 24 (11.0)
South American country 24 (11.0)
United States (US) 7 (3.2)
Age, y (mean [+ or -] SD) 29.8 [+ or -] 8.1
Health status
Excellent 30 (13.7)
Very good 64 (29.2)
Good 96 (43.8)
Fair 22 (10.1)
Poor 7 (3.2)
Sex
Male 76 (34.7)
Female 143 (65.3)
Years in US
<1 18 (8.2)
1-3 71 (32.4)
4-6 68 (31.1)
>6 62 (28.3)
Insurance
None 200 (91.3)
Medicaid 14 (6.4)
Other 5 (2.3)
Education
Did not graduate from high school 107 (48.9)
High school graduate or more 112 (51.1)
* N = 219.
Table 2. Relationship between home country behavior, health beliefs,
and access to care variables to importation of nonprescribed
antimicrobial drugs into United States *
Brought antimicrobial
drugs into
United States, n (%)
Variable Yes No p
Bought outside the United States <0.01
without prescription
Yes 27 (27.3) 72 (72.7)
No 9 (7.5) 111 (92.5)
Should antimicrobial drugs be 0.11
available without
prescription?
Yes 15 (22.4) 52 (77.6)
No 21 (13.8) 131 (86.2)
Age (y) <0.01
<30 11 (9.2) 109 (90.8)
[greater than or equal to] 30 25 (25.2) 74 (74.8)
Health status
Excellent-good 30 (15.8) 160 (84.2) 0.51
Fair-poor 6 (20.7) 23 (79.3)
Sex 0.85
Male 13 (17.1) 63 (82.9)
Female 23 (16.1) 120 (83.9)
Years in United States 0.33
<4 12 (13.5) 77 (86.5)
[greater than or equal to] 4 24 (18.5) 106 (81.5)
Insurance
None 33 (16.5) 167 (83.5) 0.94
Insured 3 (15.8) 16 (84.2)
Education
Did not graduate from 13 (12.2) 94 (87.8) 0.09
high school
High school graduate or more 23 (20.5) 89 (79.5)
County of birth
Mexico 24 (14.6) 140 (85.4) 0.13
Other Central American country 3 (12.5) 21 (87.5)
South American country 8 (33.3) 16 (66.7)
United States 1 (14.3) 6 (85.7)
* N = 219.
Table 3. Relationship between home country behavior, health beliefs,
and access to care variables to acquisition of nonprescribed
antimicrobial drugs in United States *
Obtained in US without
prescription, n (%)
Variable Yes No p
Bought outside the United States
without prescription
Yes 31 (31.3) 68 (68.7) <0.01
No 11 (9.2) 109 (90.8)
Should antimicrobial drugs be
available without
prescription?
Yes 25 (37.3) 42 (62.7) <0.01
No 17 (11.2) 135 (88.8)
Age (y)
<30 29 (24.2) 91 (75.8) 0.04
[greater than or equal to] 30 13 (13.1) 86 (86.9)
Health status
Excellent-good 39 (20.5) 151 (79.5) 0.19
Fair-poor 3 (10.3) 26 (89.7)
Sex
Male 16 (21.0) 60 (79.0) 0.61
Female 26 (18.2) 117 (81.8)
Years in United States
<4 11 (12.4) 78 (87.6) 0.03
[greater than or equal to] 4 31 (23.8) 99 (76.2)
Insurance
None 40 (20.0) 160 (80.0) 0.32
Insured 2 (10.5) 17 (89.5)
Education
Did not graduate from 15 (14.0) 92 (86.0) 0.06
high school
High school graduate or more 27 (24.1) 85 (75.9)
County of birth
Mexico 35 (21.3) 129 (78.7) 0.26
Other Central American country 2 (8.3) 22 (91.7)
South American country 5 (20.5) 19 (79.2)
United States 0 7 (100)
* N = 219.
Table 4. Significant predictors from stepwise logistic regression
regarding whether person had obtained nonprescribed antimicrobial
drugs in United States
Variable Odds ratio 95% CI *
Should antimicrobial drugs be available
without a prescription?
Yes 5.70 2.52-12.92
No 1.00 --
Bought outside the United States
without prescription
Yes 5.41 2.33-12.58
No 1.00 --
Years in United States --
<4 1.00
[greater than or equal to] 4 4.28 1.72-10.68
Age (y)
<30 3.00 1.28-7.01
[greater than or equal to] 30 1.00 --
* CI, confidence interval.
Acknowledgments We would like to thank Vanessa Diaz and Elaine Larson for their help with the questionnaire and Claire Campbell, Brian Giddens, and Eileen Yamada for their help with the initial conceptualization con·cep·tu·al·ize v. con·cep·tu·al·ized, con·cep·tu·al·iz·ing, con·cep·tu·al·iz·es v.tr. To form a concept or concepts of, and especially to interpret in a conceptual way: . This project was supported by grants 5 P01 HS010871 from the Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality, n.pr formerly known as the Agency for Health Care Policy and Research, this agency researches the quality of medical care and health services. , 5 P30 AG021677 from the National Institute on Aging The National Institute on Aging is a division of the U.S. National Institutes of Health, located in Bethesda, Maryland. Formed in 1974, NIA's mission is to improve the health and well-being of older Americans through research. It is the primary U.S. , and 1D12HP00023-01 from the Health Resources and Services Administration The Health Resources and Services Administration (HRSA) is an agency within the United States Department of Health and Human Services whose goal is to improve access to health care for those without insurance. . References (1.) Austin DJ, Kristinsson KG, Anderson RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proc Natl Acad Sci USA. 1999;96: 1152-6. (2.) Albrich WC, Monnet DL, Harbarth S. Antibiotic selection pressure and resistance in Streptococcus pneumoniae Streptococcus pneu·mo·ni·ae n. Pneumococcus. Streptococcus pneumoniae Microbiology A pathogenic streptococcus with 90 serotypes associated with pneumonia, bacteremia, meningitis Transmission Person to person Incidence and Streptococcus pyogenes Streptococcus py·og·e·nes n. A bacterium that causes the formation of pus or of fatal septicemias. Streptococcus pyogenes A common bacterium that causes strep throat and can also cause tonsillitis. . Emerg Infect infect /in·fect/ (in-fekt´) 1. to invade and produce infection in. 2. to transmit a pathogen or disease to. in·fect v. 1. Dis. 2004;10:514-7. (3.) Mainous AG III, Hueston, WJ, Pearson WS, Davis MP. Trends in antimicrobial prescribing for bronchitis bronchitis (brŏnkī`tĭs), inflammation of the mucous membrane of the bronchial tubes. It can be caused by viral or bacterial infections or by allergic reactions to irritants such as tobacco smoke. and upper respiratory infections Noun 1. upper respiratory infection - infection of the upper respiratory tract respiratory infection, respiratory tract infection - any infection of the respiratory tract among adults and children. Am J Public Health. 2003;93:1910-4. (4.) Finkelstein JA, Stille C. Nordin J, Davis R, Rae el MA. Roblin D, et al. Reduction in antibiotic use among US children, 1996-2000. Pediatrics. 2003;112:620-7. (5.) Interagency in·ter·a·gen·cy adj. Involving or representing two or more agencies, especially government agencies. Task Force on Antimicrobial Resistance. A public health action plan to combat antimicrobial resistance. Part 1: domestic issues. Washington: US Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS ; 2004. (6.) Becker J, Drucker E, Enyong P, Marx P. Availability of injectable in·ject·a·ble adj. Capable of being injected. Used of a drug. n. A drug or medicine that can be injected. antimicrobial drugs in a town market in southwest Cameroon. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife. lan·cet n. Infect Dis. 2002;2:325-6. (7.) Hsueh P-R, Luh K-T K-T Cretaceous-Tertiary . Antimicrobial resistance in Streptococcus pneumoniae, Taiwan. Emerg Infect Dis. 2002;8:1487-91. (8.) Dua V, Kunin CM, White LV. The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country. Soc Sci Med. 1994;38:717-24. (9.) Drug Utilization Research Group, Latin America. Multicenter study on self medication and self-prescription in six Latin American countries. Clin Pharmacol Ther. 1997;61:488-93. (10.) Calva J. Antibiotic use in a periurban community in Mexico: a household and drugstore survey. Soc Sci Med. 1996;42:1121-8. (11.) Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Juban N, et al. Purchase of antibiotics Antibiotics Definition Antibiotics may be informally defined as the subgroup of anti-infectives that are derived from bacterial sources and are used to treat bacterial infections. without a prescription in Manila Manila (mənĭl`ə), city (1990 pop. 1,601,234), capital of the Philippines, SW Luzon, on Manila Bay. Manila is the center of the country's largest metropolitan area, its chief port, and the focus of all governmental, commercial, industrial, , The Philippines. Inappropriate choices and doses. J Clin Epidemiol. 1990;43:61-7. (12.) Weinberg M, Waterman S. Lucas CA, Falcon VC, Morales PK, Lopez LA, et al. The U.S.-Mexico border infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. surveillance project: establishing bi-national border surveillance. Emerg Infect Dis. 2003;9:97-102. (13.) Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic an·thro·pol·o·gy n. 1. The scientific study of the origin, the behavior, and the physical, social, and cultural development of humans. 2. and cross-cultural research. Ann Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med. 1978;88:251-8. (14.) Pachter LM. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA JAMA abbr. Journal of the American Medical Association . 1994;271:690-4. (15.) Fishman BM, Bobo L, Kosub K, Womeodu RJ. Cultural issues in serving minority populations: emphasis on Mexican Americans This is a list of notable Mexican-Americans. Athletes Baseball players
(16.) McKee MD, Mills L, Mainous AG III. Antibiotics for the treatment of upper respiratory, infections in a diverse community. J Fam Pract. 1999;48:993-6. (17.) Larson E, Lin SX, Gomez-Duarte C. Antibiotic use in Hispanic households, New York City. Emerg infect Dis. 2003;9:1096-1102. Arch G. Mainous III, * Andrew Y. Cheng, * Rebecca C. Garr, * Barbara C. Tilley, * Charles J. Everett, * and M. Diane McKee ([dagger]) * Medical University of South Carolina, Charleston, South Carolina, USA; and ([dagger]) Albert Einstein College of Medicine
The Albert Einstein College of Medicine (AECOM) is a graduate school of Yeshiva University. It is a private medical school located in the Jack and Pearl Resnick Campus of Yeshiva University in the Morris Park , Bronx, New York, USA Dr. Mainous is a professor in the Department of Family Medicine at the Medical University of South Carolina. He has conducted a variety of studies on the overuse overuse Health care The common use of a particular intervention even when the benefits of the intervention don't justify the potential harm or cost–eg, prescribing antibiotics for a probable viral URI. Cf Misuse, Underuse. of antimicrobial drugs for respiratory infections focusing on such aspects as physician prescribing, how knowledge affects prescribing decisions, and colonization colonization, extension of political and economic control over an area by a state whose nationals have occupied the area and usually possess organizational or technological superiority over the native population. with resistant organisms. Address for correspondence: Arch G. Mainous III, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun St, Charleston, SC 29425, USA; fax: 843-792-3598; email: mainouag@ musc.edu |
|
||||||||||||||||||||
Bahamas 
Printer friendly
Cite/link
Email
Feedback
Reader Opinion