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Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon

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      Abstract

      Objectives:to assess the knowledge of both parents and community pharmacists regarding antibiotics use and resistance in pediatrics in Lebanon.Methods:A cross-sectional study was conducted between June and August 2017 in community pharmacies. A pre-established questionnaire targeting knowledge of parents and pharmacists regarding antibiotics use/misuse was carried out. An index of knowledge was computed to assess factors associated with good knowledge on antibiotics use/misuse.Results:The study showed that 28.7% of pharmacists did not know which factors may contribute to antimicrobial resistance. Concerning the misuse of antibiotics, pharmacists blamed at first parents (90.1%), at second level physicians (72.8%), and third themselves (59.4%). Furthermore, pharmacists believed that the socioeconomic problems of the country (86.1%), the level of resistance to the molecule of choice (80.8%), the lack of consultation time (71.2%) and the lack of national guidelines/recommendations (66.3%) might be additional factors contributing to antimicrobial resistance. In case of acute otitis media, the majority of pharmacists chose the correct treatment, dose and duration according to international guidelines; this was in contrast to the results obtained in case of pharyngitis. Female pharmacists had a significantly higher knowledge score compared to their male counterparts (ORa=2.51). Half of parents (42.6%) declared that antibiotics act against both viruses and bacteria, 55.9% still believe that the presence of fever requires the administration of antibiotics, 50% didn’t know the consequences of antibiotics misuse, 58.4% said that it is okay to give their child antibiotics without a physician’s advice or based on a pharmacist’s recommendation, and 66.7% trusted the pharmacist in the antibiotic prescription. Parents with a university level of education or a master’s degree had significantly better knowledge compared to illiterate ones (ORa=9.04 and ORa=16.46, respectively).Conclusions:Based on the results obtained, it would be necessary to implement educational campaigns in order to increase awareness on antibiotics misuse and resistance in pediatrics.

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      Simulation study of confounder-selection strategies.

      In the absence of prior knowledge about population relations, investigators frequently employ a strategy that uses the data to help them decide whether to adjust for a variable. The authors compared the performance of several such strategies for fitting multiplicative Poisson regression models to cohort data: 1) the "change-in-estimate" strategy, in which a variable is controlled if the adjusted and unadjusted estimates differ by some important amount; 2) the "significance-test-of-the-covariate" strategy, in which a variable is controlled if its coefficient is significantly different from zero at some predetermined significance level; 3) the "significance-test-of-the-difference" strategy, which tests the difference between the adjusted and unadjusted exposure coefficients; 4) the "equivalence-test-of-the-difference" strategy, which significance-tests the equivalence of the adjusted and unadjusted exposure coefficients; and 5) a hybrid strategy that takes a weighted average of adjusted and unadjusted estimates. Data were generated from 8,100 population structures at each of several sample sizes. The performance of the different strategies was evaluated by computing bias, mean squared error, and coverage rates of confidence intervals. At least one variation of each strategy that was examined performed acceptably. The change-in-estimate and equivalence-test-of-the-difference strategies performed best when the cut-point for deciding whether crude and adjusted estimates differed by an important amount was set to a low value (10%). The significance test strategies performed best when the alpha level was set to much higher than conventional levels (0.20).
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        Purposeful selection of variables in logistic regression

        Background The main problem in many model-building situations is to choose from a large set of covariates those that should be included in the "best" model. A decision to keep a variable in the model might be based on the clinical or statistical significance. There are several variable selection algorithms in existence. Those methods are mechanical and as such carry some limitations. Hosmer and Lemeshow describe a purposeful selection of covariates within which an analyst makes a variable selection decision at each step of the modeling process. Methods In this paper we introduce an algorithm which automates that process. We conduct a simulation study to compare the performance of this algorithm with three well documented variable selection procedures in SAS PROC LOGISTIC: FORWARD, BACKWARD, and STEPWISE. Results We show that the advantage of this approach is when the analyst is interested in risk factor modeling and not just prediction. In addition to significant covariates, this variable selection procedure has the capability of retaining important confounding variables, resulting potentially in a slightly richer model. Application of the macro is further illustrated with the Hosmer and Lemeshow Worchester Heart Attack Study (WHAS) data. Conclusion If an analyst is in need of an algorithm that will help guide the retention of significant covariates as well as confounding ones they should consider this macro as an alternative tool.
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          The impact of confounder selection criteria on effect estimation.

           R Mickey,  S Greenland (1988)
          Much controversy exists regarding proper methods for the selection of variables in confounder control. Many authors condemn any use of significance testing, some encourage such testing, and other propose a mixed approach. This paper presents the results of a Monte Carlo simulation of several confounder selection criteria, including change-in-estimate and collapsibility test criteria. The methods are compared with respect to their impact on inferences regarding the study factor's effect, as measured by test size and power, bias, mean-squared error, and confidence interval coverage rates. In situations in which the best decision (of whether or not to adjust) is not always obvious, the change-in-estimate criterion tends to be superior, though significance testing methods can perform acceptably if their significance levels are set much higher than conventional levels (to values of 0.20 or more).
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            Author and article information

            Affiliations
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). lama.zhd@ 123456hotmail.com
            Faculty of Pharmacy, Lebanese University, Hadat; & Faculty of Medicine and Medical Sciences, Holy Spirit University , Kaslik (Lebanon). souheilhallit@ 123456hotmail.com
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). shadiashakaroun@ 123456hotmail.com
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). alhajje.amal@ 123456outlook.com
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). sanaa3a@ 123456hotmail.com
            Faculty of Pharmacy & Faculty of Public Health, Lebanese University , Hadat (Lebanon). nathalie.lahoud@ 123456hotmail.com
            Contributors
            ORCID: http://orcid.org/0000-0002-2640-0083,
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). lama.zhd@ 123456hotmail.com
            ORCID: http://orcid.org/0000-0001-6918-5689,
            Faculty of Pharmacy, Lebanese University, Hadat; & Faculty of Medicine and Medical Sciences, Holy Spirit University , Kaslik (Lebanon). souheilhallit@ 123456hotmail.com
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). shadiashakaroun@ 123456hotmail.com
            ORCID: http://orcid.org/0000-0001-7810-3390,
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). alhajje.amal@ 123456outlook.com
            ORCID: http://orcid.org/0000-0001-9482-2483,
            Faculty of Pharmacy, Lebanese University , Hadat (Lebanon). sanaa3a@ 123456hotmail.com
            ORCID: http://orcid.org/0000-0001-5571-2783,
            Faculty of Pharmacy & Faculty of Public Health, Lebanese University , Hadat (Lebanon). nathalie.lahoud@ 123456hotmail.com
            Journal
            Pharm Pract (Granada)
            Pharm Pract (Granada)
            Pharmacy Practice
            Centro de Investigaciones y Publicaciones Farmaceuticas
            1885-642X
            1886-3655
            Jul-Sep 2018
            12 August 2018
            : 16
            : 3
            6207355
            pharmpract-16-1194
            10.18549/PharmPract.2018.03.1194
            Copyright: © Pharmacy Practice

            This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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