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Box , Riyadh , Saudi Arabia. Antibiotics are responsible for most dramatic improvement in medical therapy in history. These medications contributed significantly to the decreasing mortality and morbidity when prescribed based on evidence of microbial infection.
The aim of this study was to determine the prevalence and predictors of self-prescription with antibiotics in Al Wazarat Health Center, Riyadh City, Kingdom of Saudi Arabia.
Material and Methods. Respondents were randomly selected using a multistage clustered random sampling technique. Data was entered into SPSS version 21 and analyzed. Descriptive statistics and multiple logistic regression models were applied. The prevalence of self-prescription with antibiotics in Al Wazarat Health Center was Amoxicillin was the most used self-prescribed antibiotic with prevalence of The level of self-prescribing antibiotics is relatively high among participants.
Health education on the appropriate use of antibiotics is highly recommended. The proper use of treatment guidelines for antibiotic therapy will significantly reduce self-prescription with antibiotics. In recent years, the use of nonprescribed antibiotics had become a major global public health problem [ 1 , 2 ]. This indiscriminate use of antibiotics contributes towards the spread of antimicrobial resistance globally [ 4 , 5 ].
Resistance of the microorganisms to treatment will definitely lead to treatment failure and endangering patients' life [ 6 , 7 ]. Microbial infections are most common types of infection which usually requires the use of antibiotics for treatment [ 8 , 9 ].
Nondoctor prescription of antibiotics has severe adverse health effects and economically billions of Saudi Riyals are spent yearly for shifting patients to the second line of antibiotics as results of the failure of the first line of treatment [ 10 ]. Saudi Arabia is one of the richest developing countries in the Middle East with a fast growing population. Saudi Arabia has been described as a country with worldwide significance in the context of global epidemiology of antimicrobial resistance [ 11 ].
The country has an excellent health system which takes care of the health of its citizens both civilian and military. Currently the health authorities are faced by several health challenges such as self-prescription of antibiotics which could lead to the development of microbial resistance, cross-resistance, and treatment failure. This issue affects all population including the military personnel.
As it is known military personnel are the backbone of any country, shouldering the defense of its nation from foreign invaders and enforcing low and order. In the developing world, the unsuccessfully treated bacterial infection is rising on daily basis and more human lives are lost [ 12 , 13 ].
Most studies have shown that self-prescription and nondoctor prescription may be due to the high cost of antibiotics, high cost of doctor consultation, and other economic factors [ 14 — 16 ]. On the other hand Saudi Arabia, a rich country with mostly free medications and free doctor consultations in most governmental hospitals, however still shows high self-prescription and nondoctor prescription.
There were no many published studies on self-prescribed antibiotics in Riyadh City. This study will not only determine the prevalence rate of self-prescription of antibiotics but also explore the reasons for self-prescription and identify the illnesses necessitated by self-prescription among military personnel.
The main justification for conducting this study was the fact that self-prescription with antibiotics is associated with development of resistance, cross-resistance, and treatment failure. This study is a hospital based cross-sectional study. It used structured questions to assess nonprescribed antibiotic usage among military and nonmilitary personnel who attended Al Wazarat Health Center in Prince Sultan Military Hospital in Riyadh, Saudi Arabia.
The center consists of 20 specialized clinics which provide services on daily basis. The MSD is one of the main healthcare providers in the country along with the Ministry of Health and the private sector. The study population was adults over 18 years old living in Riyadh City, with no disabilities that would prevent understanding the questionnaire.
Respondents were randomly selected using a two-stage cluster sampling method. The second stage of sampling was selecting patients from each of these six clinics using simple random sampling method among the participants who satisfied the inclusion criteria to achieve the required sample size; the questionnaire was then administered to each of the participants Table 1.
Distribution of calculated sample among the different clinics of Al Wazart Health Center using multistage cluster simple random sampling technique. The sample size required to study the self-medication with antibiotics in Riyadh City was calculated to be subjects based on the following formula:.
Therefore, the sample size required was calculated to be respondents. A questionnaire was developed based on literature in which self-medication with antibiotics was examined in Asian countries.
A combination of open-ended and close-ended questions was used. The questionnaire consisted of three parts' sociodemographic characteristics such as age, gender, marital status, occupation and educational level, reasons for self-prescription of antibiotics, and symptoms or illness for which antibiotics are self-prescribed coughs, common cold, sore throat, fever, pneumonia, stomach ache, diarrhea, urinary tract infection, unintentional injury, skin disease, and no symptoms.
Two independent bilingual translators were selected to make a forward and backward translation from English language into Arabic language. The translators were asked to make a semantic translation and the study instrument was then checked for accuracy of translation. The questionnaire was assessed for face and content validity by a group of local experts, that is, three pharmacists, two medical doctors and a psychologist. This consultation process led to redrafting and reorganizing items in the questionnaire.
The questionnaire was pilot tested on 15 people, who were representative of the study population, to determine the clarity of the language and questionnaire structure.
Some words were changed based on responses. The instrument underwent test retest and then was validated before it was finally administered to study participants. Data collection was conducted over 3 months from May to July, , by two trained research assistants.
The questionnaires were self-administered to participants in a private room after participants willingly and voluntarily agreed to participate in the study. Data were entered, analyzed, and digitally stored with the assistance of statistical descriptive statistics that were used to describe sociodemographic characteristics of the respondents, the point prevalence, and the patterns of self-medication with antibiotics Statistical Package for the Social Sciences SPSS version 22 [ 17 ].
A cross-tabulation analyses with odds ratio test were performed to identify the association between the demographic characteristics of the respondents and the status of self-prescription of antibiotics.
Multiple logistic regression analysis was carried out to determine the predictors of self-prescription of antibiotics. Three different logistic regression techniques were used—the enter method, forward likelihood ratio, and backward likelihood ratio. Interaction was carefully examined and likely interaction terms were tested before the final model was produced. The predictor variables were the sociodemographic characteristics gender, marital status, education, work status, age, and job type , reasons for self-prescription of antibiotics advice from friend or relative, lack of time, high consultation fees, hospital or clinic being too far, ease of obtaining drugs, convenience, past experience, and mild illness , and symptoms or illness for which antibiotics are self-prescribed coughs, common cold, sore throat, fever, pneumonia, stomach ache, diarrhea, urinary tract infection, unintentional injury, skin disease, and no symptoms.
To predict factors affecting self-prescription with antibiotics we used a multiple logistic regression model. The following formula is to predict the probability of being self-prescribed with antibiotics given some selected variables.
Ethics approval was obtained from the ethical committee at Military Service Department at Ministry of Defense and research ethics committee at research center in Prince Sultan Military Medical Center under project number All of the participants verbally consented and agreed willingly and voluntarily to participate in the study.
Among the distributed questionnaires 59 patients refused to participate in the study and 17 questionnaires were incomplete and removed from the analysis. Table 2 shows the cross-tabulation results of sociodemographic variables and the status of self-prescription of antibiotics.
The relationship of six demographic factors gender, marital status, education, work status, age, and job type with status of self-prescription of antibiotics was examined. Demographics of study participants are summarized in Table 2. Study participants were more likely to be males who were Male participants have higher proportion of self-prescribed antibiotics compared to their female counterparts, according to the odds of being self-prescribed antibiotic user among men that was Older respondents were more likely to be self-prescribed antibiotic users than younger respondents.
The probability of self-prescription of antibiotics among the age group of 31—44 years was almost double [odds ratio: 1. Finally, with regard to the job type, majority of the respondents were civilian, Other sociodemographic characteristics such as gender, marital status, education, and work status were not statistically significant related to the status of self-prescription of antibiotics. Of the total observed encounters, Figure 1 lists 12 different antibiotics that are most commonly used by the study participants.
The vast majority of nonprescribed antibiotics are systemic antibiotics such as Amoxicillin, Ciprofloxacin, and Penicillin. It is reported that Amoxicillin is the most used self-prescribed antibiotic of the study respondents claiming The following topical local antibiotics trimethoprim, gentamicin, and tetracycline were small in number in the nonprescribed medication scoring 1.
Participants have reported 10 different diseases for which antibiotics were self-prescribed. Respiratory diseases such as cough, sore throat, and common colds were reported as the most frequent illnesses for self-medication with antibiotics while other diseases such as diarrhea, urinary tract infections, and skin disease were among the least common illnesses for intended self-medication of antibiotics Figure 2.
Table 4 shows logistic regression for determinants of self-prescription of antibiotics using the backward stepwise method.
We used three different methods enter, forward stepwise, and backward stepwise to determine which of the three would be the most suitable and parsimonious.
After evaluation of these three methods, the best and the most parsimonious model would appear to be backward stepwise model as this model offers all significant factors which are common to all three models while retaining sufficiently high overall percentage which is correct.
We entered 17 variables into the model and evaluated the results. We found that nine factors were statistically significant in both univariate analysis and multiple logistic regression analysis indicating that they are not confounded by other factors; check Table 4.
To our knowledge this study is the first of its kind examining predictors of self-medication with antibiotics in military hospitals in Riyadh City.
Our results show that the prevalence of self-medication with antibiotics in Al Wazarat Health Center in Riyadh was This result is certainly not unique to Saudi Arabia as it is comparable to several studies from the region and beyond which reported similar and even higher prevalence rates. In Eastern Province of Saudi Arabia, the prevalence of self-prescribed antibiotic was In UAE study shows that the prevalence of self-prescribed antibiotics was This high prevalence may not be surprising as most of antibiotics in Saudi Arabia and other countries in the region can be bought from private pharmacies without doctor's prescription.
This study found significant discrepancies in self-prescribed antibiotic among users. Among the respondents 70 or The odds of being self-prescribed antibiotic user were higher among older respondents, as well as those with civil job type; this may indicate that military people are better well informed about the risks associated with self-medication or may be prudent to abide by the law and rules that prohibit the use and sale of medicines without prescription.
In addition, respondents who are self-employed or retired had lower chances of being self-prescribed antibiotic user; this may be due to the fact that at older age people are more keen about their health and therefore they are supposed to visit doctors, so they are more likely to use prescribed antibiotics [ 13 , 18 , 23 ].
According to the study results, the most prevalent antibiotics used by study respondents were Amoxicillin, Ciprofloxacin, and Penicillin. These drugs are the common self-prescribed drugs and sometimes are used wrongly to treat common cold and other repertory infections and are also used wrongly as pain killer. Amoxicillin and Penicillin were reported to be the most common self-prescribed antibiotics in different countries [ 2 , 24 , 25 ]. The use of self-prescription may lead to the wrong use of antibiotics and inappropriate dosage which cause more harm than benefits [ 26 — 28 ].
Finally the inappropriate use of antibiotics should not only be blamed on the patients alone as the healthcare providers and physicians in particular have a significant role to play by providing health education on self-prescription.
A View Across the Life Span of Counseling Psychology
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Mikal N. Publications Citations Highly Influential Citations Follow Author
It has been said of psychology, as a discipline, that it has a long past and a short history. This contrast refers to the roots of psychology in philosophy, medicine, and education that date back over several hundred years—and in the case of philosophy and medicine, several thousand. Counseling psychology has deep roots, as well, although its technical birth was in These three domains are a focus on building strengths; a holistic, or systems, perspective; and a collaborative, patient-centered model. We trace the development of these domains, noting where, in other parts of this volume, more complete discussion can be found, and we highlight their current explications. Keywords: values , history , development.
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Family Therapy_Models and Techniques_Chapter1 - The History of Family Therapy
Du kanske gillar. Ladda ned. Spara som favorit. Skickas inom vardagar. This text offers a straightforward, comprehensive overview of both traditional and evolving theoretical models of family therapy and intervention techniques as well as a discussion of clinical issues unique to family therapy practice.
F amily therapy as a distinct method of psychotherapy practice did not actually emerge until the early s. However, the conceptual and clinical influences that informed the development of family therapy can be traced to a much earlier period. The task in this chapter is to identify some of the major social factors as well as those conceptual, research, and clinical efforts that nourished the soil for the growth of family therapy as a treatment modality.
This is a ground breaking and long overdue book that proposes a variety if innovative and practical strategies to address relevant issues for Africa American men in micro-practice approaches individual, couple, family and group treatment as wel She received her Masters degree in social work from the University of Michigan Ann Arbor and a Doctorate degree in social welfare from Columbia University. She was the co-principal investigator for a multiyear research grant funded by the John D. MacArthur Foundation for the study of poor, non-custodial African American fathers. She is also the author of several chapters in books on the subjects of African American men and families.
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Один из них, к ее удивлению, был адресом анонимного провайдера. Сьюзан открыла одно из старых входящих сообщений, и у нее тотчас же перехватило дыхание. ТО: NDAKOTAARA. ANON. ORG FROM: ETDOSH1SHA. EDU И далее текст сообщения: ГРОМАДНЫЙ ПРОГРЕСС. ЦИФРОВАЯ КРЕПОСТЬ ПОЧТИ ГОТОВА.
Ключ, Чед. Бринкерхофф покраснел до корней волос и повернулся к мониторам. Ему хотелось чем-то прикрыть эти картинки под потолком, но. Он был повсюду, постанывающий от удовольствия и жадно слизывающий мед с маленьких грудей Кармен Хуэрты. ГЛАВА 66 Беккер пересек зал аэропорта и подошел к туалету, с грустью обнаружив, что дверь с надписью CABALLEROS перегорожена оранжевым мусорным баком и тележкой уборщицы, уставленной моющими средствами и щетками. Он перевел взгляд на соседнюю дверь, с табличкой DAMAS, подошел и громко постучал.
Говорили, что от него уходит жена, с которой он прожил лет тридцать. А в довершение всего - Цифровая крепость, величайшая опасность, нависшая над разведывательной службой. И со всем этим ему приходится справляться в одиночку. Стоит ли удивляться, что он находится на грани срыва?. - С учетом обстоятельств, я полагаю, - сказала Сьюзан, - вам все же нужно позвонить директору. Стратмор покачал головой, и капля пота с его лба упала на стол.
Велел ему сегодня не приходить. Он ничего не сказал о том, что поменялся с тобой дежурством.
Господь явно поторопился с утешением, подумал Беккер. Сьюзан также сообщила, что интерес к криптографии появился у нее еще в школе, в старших классах. Президент компьютерного клуба, верзила из восьмого класса Фрэнк Гут-манн, написал ей любовные стихи и зашифровал их, подставив вместо букв цифры.
Это явно не было составной частью плана. - У них там прямо-таки дискотека! - пролопотал Бринкерхофф. Фонтейн смотрел в окно, пытаясь понять, что происходит. За несколько лет работы ТРАНСТЕКСТА ничего подобного не случалось. Перегрелся, подумал .
Танкадо неоднократно публично заявлял, что у него есть партнер. Наверное, этим он надеялся помешать производителям программного обеспечения организовать нападение на него и выкрасть пароль. Он пригрозил, что в случае нечестной игры его партнер обнародует пароль, и тогда все эти фирмы сойдутся в схватке за то, что перестало быть секретом. - Умно, - сказала Сьюзан. Стратмор продолжал: - Несколько раз Танкадо публично называл имя своего партнера.
Панк брезгливо ее пожал. - Проваливал бы ты, пидор. Беккер убрал руку.
Программы компьютерного кодирования раскупались как горячие пирожки. Никто не сомневался, что АНБ проиграло сражение. Цель была достигнута.
Ведь пилот может радировать Стратмору. Усмехнувшись, Беккер еще раз посмотрелся в зеркало и поправил узел галстука. Он уже собрался идти, как что-то в зеркале бросилось ему в .
Теперь начнутся судебные процессы, последуют обвинения, общественное негодование. Он много лет служил своей стране верой и правдой и не может допустить такого конца. Я просто добивался своей цели, - мысленно повторил. Ты лжешь, - ответил ему внутренний голос.
Клаус Шмидт, - выпалил Беккер имя из старого учебника немецкого. Долгая пауза. - Сэр… я не нахожу Клауса Шмидта в книге заказов, но, быть может, ваш брат хотел сохранить инкогнито, - наверное, дома его ждет жена? - Он непристойно захохотал.
Да этот парень - живая реклама противозачаточных средств. - Убирайся к дьяволу! - завопил панк, видя, что над ним все смеются. - Подтирка для задницы.