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Why people overuse antibiotics

The overuse of antibiotics occurs due to the mistaken widespread belief that they are beneficial for a broad array of conditions and because many physicians are willing to prescribe antibiotics if patients ask for the medication, according to a Rutgers study.

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The overuse of antibiotics occurs due to the mistaken widespread belief that they are beneficial for a broad array of conditions and because many physicians are willing to prescribe antibiotics if patients ask for the medication, according to a Rutgers study.

The study, published in the journal BioEssays, reviewed more than 200 peer-reviewed studies to examine the causes behind antibiotic overuse, which can lead harmful bacteria to become drug-resistant and cause harmful effects on the microbiome, the collection of beneficial germs that live in and on our bodies.

Martin Blaser, director of the Center for Advanced Biotechnology and Medicine at Rutgers and lead author, said the global use of antibiotics between 2000 and 2015 increased 39 percent, with a 77 percent increase in low- and middle-income countries. He discusses the study’s findings.

What health concerns result from the disruption of the microbiome by antibiotics?

In children, improper antibiotic use can alter the microbiome while their immunological, metabolic and neural systems are developing. Epidemiological studies associate antibiotic exposure with an increased risk of disease of allergic, metabolic and cognitive disorders that have grown more common in children during the antibiotic era.

In adults, there is increasing evidence that antibiotics may enhance risk for metabolic and neoplastic diseases, including diabetes, kidney stones and growths in the colon and rectum that can lead to cancer.

What are the trends you found in antibiotic use?

Studies in the United States, United Kingdom and China found numerous online pharmacies selling antibiotics without a prescription. This problem also is large in Iow- to middle-income countries, where 60 percent of antibiotics are sold without prescriptions, often by untrained medical practitioners.

Perhaps of special concern during the COVID-19 pandemic is the finding that telemedicine services are another potential source of questionable antibiotic sales in the United States. A recent analysis found that patients with acute respiratory infections were more often prescribed broad-spectrum antibiotics if they had a tele-health doctor visit, compared to an in-person visit.

Worldwide, antibiotic use is highest in young children, especially in low-income areas. This is often in response to the fact that young children are prone to have four to six upper respiratory tract infections each year. Although most of these infections are treated by antibiotics, 80 percent are not caused by bacteria and would therefore derive no benefit from antibiotics.

Are some practitioners more likely to prescribe antibiotics?

Our findings are consistent with the hypothesis that older physicians are more likely than their younger colleagues to prescribe antibiotics. For example, one study found that physicians over 30 were several times more likely to prescribe antibiotics for common respiratory conditions that do not necessarily require them. Another study found that physicians with over 25 years in practice were disproportionately likely to issue prescriptions of more than eight days.

What misinformation did you find among the public?

Many people believe that antibiotics are effective against bacterial and viral illnesses, lumping all types of pathogens together and adopting a “germs are germs” attitude. Others believe that taking antibiotics can’t hurt. Across Europe, for example, 57 percent of people surveyed were unaware that antibiotics were ineffective against viruses, and 44 percent did not know that antibiotics have no effect against colds or influenza.

What other reasons did you find for inappropriate prescription of antibiotics?

Antibiotics are commonly used across the world to self-treat health problems for which they were never intended, such as in Nigeria, where women are increasingly using antibiotics to reduce menstrual cramps. In low- to middle-income countries, antibiotics are often seen as strong, magical medicines, capable of both curing and preventing a range of illness. In many countries people also take them to return to work or school when ill. One of the studies found that 63 percent of Chinese university students kept a personal antibiotic stock at home.

Parents may appeal for an antibiotic for their children so that they can go to work or for the children to return to school or daycare. A U.S. study found that 43 percent of parents of a child with cold symptoms believed that antibiotics were necessary.

In addition, some doctors are inclined to prescribe an antibiotic to maintain a good relationship with patients who expect to receive medication. Patients may not demand antibiotics outright, but rather infer their need for them by how they describe the severity of their illness or note that they worked in the past for a similar issue. People have become less willing to wait and let an illness run its course. The perception that there is a pill for ills of all kinds leads the public to demand immediate relief for symptoms from practitioners and to self-medicate.

Every time an antibiotic is given, money changes hands. This is especially a problem in low- and middle-income countries, where pharmacists are happy to dispense without a prescription to their customers. The rural health practitioners in China are paid every time they dispense an antibiotic as well. Such monetary incentives favor the wide use of antibiotics.

How can antibiotic overuse be addressed?

Clinicians need to be better educated about the long-term effects on the microbiome and learn about better ways to speak with their patients about antibiotic risks and benefits. They also need to improve their communication about the consequences of antibiotic treatments and identify antibiotic alternatives.

NewsMakers

Happiness really does come for free

Majority of people reported remarkably high levels of happiness. This was especially true in the communities with the lowest levels of monetization, where citizens reported a degree of happiness comparable to that found in Scandinavian countries which typically rate highest in the world.

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Economic growth is often prescribed as a sure way of increasing the well-being of people in low-income countries, but a study led by McGill and the Institute of Environmental Sciences and Technologies at the Universitat Autònoma de Barcelona (ICTA-UAB) suggests that there may be good reason to question this assumption.

The researchers set out to find out how people rate their subjective well-being in societies where money plays a minimal role, and which are not usually included in global happiness surveys. They found that the majority of people reported remarkably high levels of happiness. This was especially true in the communities with the lowest levels of monetization, where citizens reported a degree of happiness comparable to that found in Scandinavian countries which typically rate highest in the world.

The results suggest that high levels of subjective well-being can be achieved with minimal monetization, challenging the perception that economic growth will automatically raise life satisfaction among low-income populations.

Measuring happiness

To explore how monetization affects people’s sense of well-being, the researchers spent time in several small fishing communities, with varying degrees of monetization, in the Solomon Islands and Bangladesh, two very low-income countries. Over a period of a few months, with the help of local translators, they interviewed citizens in both rural and urban areas a number of times. The interviews, which took place both in person and through phone calls at unexpected moments, were designed to elicit information about what constituted happiness for the study subjects, as well as to get a sense of their passing moods, their lifestyle, fishing activities, household income, and level of market integration.

In all, the researchers interviewed 678 people, ranging in age between their mid-twenties and early fifties, with an average age of about 37. Almost 85 % of the study participants were male. The disproportionate number of men in the study was due to the fact that cultural norms in Bangladesh made it difficult to interview women. In the Solomon Islands, responses to the study questions from men and women were not significantly different. However, this is not necessarily applicable to the situation in Bangladesh, as men and women’s social realities and lifestyles differ so much. Further research will need to address whether gender-related societal norms impact the association found in this study.

Early stages of monetization may be detrimental to happiness

The researchers found that in the communities where money was in greater use, such as in urban Bangladesh, residents reported lower levels of happiness.

“Our study hints at possible ways of achieving happiness that are unrelated to high incomes and material wealth,” says Eric Galbraith, a professor in McGill’s Department of Earth and Planetary Sciences and the senior author on the study, which was recently published in PLOS One. “This is important, because if we replicate these results elsewhere and can pinpoint the factors that contribute to subjective well-being, it may help us circumvent some of the environmental costs associated with achieving social well-being in the least developed nations.”

“In less monetized sites, we found that people reported a greater proportion of time spent with family and contact with nature as being responsible for making them happy,” explains Sara Miñarro, the lead author on the study who is a Postdoctoral Research Fellow at (ICTA-UAB). “But with increasing monetization, we found that the social and economic factors commonly recognized in industrialized countries played a bigger role. Overall, our findings suggest that monetization, especially in its early stages, may actually be detrimental to happiness.”

Interestingly, while other research has found that technology and access to information from faraway cultures with different lifestyles may affect people’s sense of their own well-being by offering standards to which people compare their own lives, this did not appear to be the case in these communities.

“Happy without money: Minimally monetized societies can exhibit high subjective well-being” by Sara Miñarro, et al was published in PLOS One.

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Picture books can boost physical activity for youth with autism

There are numerous health benefits of exercise, such as pumping blood in your body, better sleep and reduced risk of obesity. Also, if we can get kids with autism more physically engaged, they are more likely to run around and play with their peers, so there are other aspects of their life we can improve as well.

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While physical activity is important for everyone, research has shown people with developmental disabilities do not exercise as often as their typically developed peers. In an effort to close this disparity, a researcher at the University of Missouri recently created fitness picture books that help youth with autism exercise more frequently while offering low-income families a simple resource for workout motivation when outdoor fitness equipment might not be accessible.

“There is so much research geared toward helping individuals with autism improve their academic performance, social skills and communication skills, but we also need to remember how important physical activity is for living a healthy lifestyle,” said Lorraine Becerra, an assistant teaching professor at the MU College of Education. “There are numerous health benefits of exercise, such as pumping blood in your body, better sleep and reduced risk of obesity. Also, if we can get kids with autism more physically engaged, they are more likely to run around and play with their peers, so there are other aspects of their life we can improve as well.”

Becerra is also a behavior analyst at the Thompson Center for Autism and Neurodevelopmental Disorders. Since some of her former clients with autism had body mass indexes that had risen to unhealthy levels due to excessive sedentary behavior, their caregivers asked Becerra to develop creative ways to encourage their children to exercise more.

So, in a recent research study, Becerra created fitness picture books that contained step-by-step images of various exercises, such as jumping jacks, bear crawls and lunges. The picture books were successfully utilized to increase the amount of time the individuals with autism engaged in physical activity.

Having previously worked in low-income school districts with limited financial resources, Becerra understands the need to find cost-efficient methods to help kids with autism exercise more frequently.

“It’s important to remember that some schools might not have a jungle gym or many age-appropriate resources for kids to play with,” Becerra said. “The great thing about the picture books is they provide simple, engaging exercises that can be done in a wide variety of settings, like a school playground, backyard or even an empty field at a park. It is also a quick and easy way for caregivers or teachers to provide organized structure during flexible free time, such as during recess.”

With recent advancements in technology and entertainment, youth are increasingly spending more of their time sitting in front of televisions, tablets and personal electronic devices. Becerra is passionate about reminding youth — particularly individuals on the autism spectrum — about the importance of scheduling time for physical activity.

“These lifelong habits start when you are young,” Becerra said. “Making time to run around and establish those exercise routines early in life will help youth maintain those habits in their adolescent and adult years.”

“The effect of photographic activity schedules on moderate-to-vigorous physical activity in children with autism spectrum disorder” was recently published in the Journal of Applied Behavior Analysis.

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Taking the fear out of driver education

Educational programs often use fear-based messaging and films of crash scenes to reduce risky driving behavior among young people. But does this “scary” approach work?

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New drivers between the ages of 15 and 25 account for nearly half of the more than one million road deaths that occur worldwide each year, according to the World Health Organization. Educational programs often use fear-based messaging and films of crash scenes to reduce risky driving behavior among young people. But does this “scary” approach work?

A new study published in the journal Risk Analysis suggests that fear-based messaging fails to reduce risky driving behavior, while fear-based Virtual Reality (VR) films depicting a violent collision may actually lead young drivers to take more chances behind the wheel.

A team of psychologists led by University of Antwerp researcher Clara Alida Cutello, PhD, conducted a study of 146 students who had been legally driving for less than five years. The researchers examined the impact of both content (fear vs. positive) and delivery mode (2D vs. VR) of driver safety intervention programs.

Fear-based driver ed films often show terrible crash scenes in graphic detail. The assumption behind this approach is that arousing a sense of fear by depicting a serious consequence such as death will persuade young people to drive more carefully. Positively framed films take the opposite approach, using humor and empathy and modeling safe driving behaviors that result in positive consequences.

Three tests were used to gauge the risk-taking behavior of the young drivers before and after participating in the intervention program. One was a Driver Behavior Questionnaire. The other was the Vienna Risk-Taking Test on traffic, which asks participants to watch video clips of driving situations from the point of view of the driver and choose whether they view a situation as too risky. For example, choosing whether to pass another car in icy conditions. A third test was a 21-item Emotional Arousal Scale that measured the level of emotional arousal (such as feeling afraid) after watching a film.

The results showed that participants who viewed the fear-based VR film reported riskier driving behaviors afterward, while those who viewed a positively framed VR film exhibited the greatest reduction in risky driving behavior. This finding supports other research that has shown that exposing participants to an extreme and graphic collision tends to activate defensive mechanisms, such as paying attention for a shorter time, disengaging, rejecting a message, and an increase in risky behaviors.

“Fear appeals have been used in many health and environmental campaigns, such as smoking, anti-drug, safe sex, and HIV prevention campaigns,” says Dr. Cutello. “Further experimental research is needed to determine whether the use of fear is effective.”

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