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PubMed1986

Oral health patterns in a Swedish county population aged 65 and above.

The aims of the study were to survey oral health and related conditions in the population of non-institutionalized elderly people in Orebro County, Sweden, and to analyze the relative importance of certain factors within the oral health pattern. A random sample was taken of 500 non-institutionalized individuals, stratified according to age (65-74/75+) and residence (densely-populated areas/rest of county). Out of these subjects 305 were examined clinically; 158 interviewed by telephone. Totally 46% were edentulous; 35% in age group 65-74, 63% in age group 75+; 36% of the men were edentulous, 53% of the women. The lowest prevalence of edentulousness (9%) was found among married/cohabiting men in group 65-74 years, densely-populated areas. The mean number of remaining teeth in dentulous subjects was 17.1 in group 65-74 densely-populated areas; 10.1 in group 75+ rest of county. Regarding dental status the group 65-74 densely-populated areas consistently showed the best values, the group 75+ rest of county consistently showed the poorest values. Two subgroups diverged from the general pattern: the men in group 65-74 rest of county often showed poorer values than the others in aged 65-74; the men in group 75+ densely-populated areas often showed better values than the others aged 75+. The periodontal conditions were good or fairly good. Only 4% of the teeth had periodontal pockets 6 mm or deeper. Measured radiographically, about half of the teeth had 80% or more of the original bone level intact; 87% of the teeth had 60% or more of the original bone level remaining. Only 28% of the subjects had no periapical destruction. Ten percent of the teeth showed periapical destructions - 27% of root filled teeth; 6% in teeth without root fillings. Eighteen percent of the teeth were root filled - 27% of maxillary teeth, 11% of mandibular teeth. The root fillings were evaluated "not acceptable" in 69% of the teeth. Periapical destructions were more frequent in teeth with "not acceptable" root fillings as compared to those "acceptable" root filled. Socio-economic conditions were highly correlated with a number of dental parameters. In men those who were not married or cohabiting showed the poorest values; in women the differences were smaller but the highest prevalence of edentulousness was found in widows.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMedDate not supplied

Cancer mortality and the method of chlorination of public drinking water: St. Louis City and St. Louis County, Missouri.

St. Louis City and St. Louis County, Missouri share the same public drinking water source, namely the Missouri River. The 'all cancer' and most organ specific cancer mortality rates have been consistently and considerably higher for St. Louis City than for St. Louis County for the period 1960 through 1972. A change in the St. Louis County water treatment process, which included increasing the chlorine dosage and delaying the addition of ammonia to form chloramines until just prior to distribution, was instituted in 1955. St. Louis City has, by contrast, continued the lower chlorine level and early ammoniation. Trend analysis using the period 1960-67 and 1972-76 showed higher percentage as well as net cancer mortality rate per million increases for large bowel, liver and bladder cancers for St. Louis County. An apparent association between a probable increase in trihalomethane production in the St. Louis County water since 1955 and an increase in these specific cancer rates which exceed the increases in the St. Louis City rates appears to have been shown. This does not imply causality but is in general agreement with other studies which have examined water chlorination and cancer mortality.

Adult↗
PubMedDate not supplied

Trauma among American Indians in an urban county.

OBJECTIVE: To describe severe injury among American Indians in a large metropolitan county given that most previous studies of the high Indian injury morbidity and mortality rates have been conducted primarily in rural areas. METHODS: A retrospective analysis of a hospital trauma registry was conducted for the years 1986-92 at the Harborview Medical Center, the only Level I trauma center in King County, Washington, metropolitan county with the seventh largest number of urban American Indians in the United States. RESULTS: Of 14,851 King County residents included in the registry, 593 (4%) were classified as American Indian. With King County whites as the reference, the age-standardized incidence ratio for inclusion of American Indians in the registry was 4.4 (95% confidence interval 4.1, 4.8). The standardized incidence ratios and proportional incidence ratios showed significant differences in mechanism and whether it was intentional or unintentional among Indians compared with whites. Hospitalizations for stab wounds, bites, and other blunt trauma were all significantly more frequent among Indians. Trauma admissions among Indians were disproportionately associated with assaults. A high proportion (72.3%) of American Indians tested had blood alcohol levels exceeding 0.1%. CONCLUSION: Urban American Indians experience high rates of trauma, differing from those among whites. Efforts to reduce injury in urban areas should include collaboration with representative urban American Indian organizations.

Adolescent↗
PubMed1997

[Synchronous variations in the incidence of temporal arteritis and polymyalgia rheumatica in Danish counties. Association with epidemics of Mycoplasma pneumonia infection].

The incidences of temporal arteritis and polymyalgia rheumatica during a twelve year period were studied in different regions of Denmark. Data concerning the incidences of these diagnoses were obtained from two general hospitals from 1982 to 1994 and from the National Patient Register of all diagnoses from all hospitals in 13 of 16 Danish counties from 1982 til 1993. Data from all temporal artery biopsies in two counties were also obtained. Serological epidemiological surveillance data concerning infections causing epidemics in Denmark were obtained from Statens Serum Institut. Data concerning 10,818 patients from 13 counties and 2651 temporal artery biopsies from two counties were analysed. The incidence rate of temporal arteritis in the population aged 50 years and over was 20.4 per 100,000 (95% CI 19-23), and that of polymyalgia rheumatica 41.3 per 100,000 (95% CI 30-67). Significantly higher incidence rates were found in locations with a high population density. The incidence rate of histologically proven temporal arteritis in two counties was 15.1 per 100,000 > 50 years (95% CI 11-20). Pronounced quarterly and annual variations of the incidence were found, with a clustering in five peaks. These cyclic fluctuations were seen simultaneously in several regions. Two periods with an increased incidence of temporal arteritis and polymyalgia rheumatica occurred in close relation to epidemics of Mycoplasma pneumoniae infection. Two peak incidence rates were partly related to epidemics of Parvovirus B19 and one peak to an epidemic of Chlamydia pneumoniae. The synchronous variations in the incidences of temporal arteritis and polymyalgia rheumatica recorded in several regions of Denmark strongly indicate that an environmental infectious factor influences the frequencies. The close concurrence with the above-mentioned epidemics suggests that temporal arteritis and polymyalgia rheumatica may be triggered by certain viral and/or bacterial agents.

Aged↗
PubMed1998

Epidemiology of human blastomycosis in Vilas County, Wisconsin. II: 1991-1996.

PURPOSE: A previous report identified Vilas County, Wisconsin, as an area highly endemic for blastomycosis based on a case series 1979-90. This study was done to compare the epidemiologic features of persons with this disease over the following six years. METHODS: Compilation of data from the 47 mandatory physician/laboratory case reports of blastomycosis, disease onset 1991-96, received at the Vilas County Health Department; case mapping by site visit; and statistical comparison to the previous series. RESULTS: The estimated mean annual incidence rate for Vilas County during 1991-96, 40/100,000, remains unchanged from 1984-90. Cases were again disproportionately represented in the southeast corner of the county, and 36/46 lived within 1/4 mile of water. There was a trend toward a higher proportion of female cases in this study (27/47) compared to the prior report (28/73; P = 0.06); the mean age, 47 years, did not differ. Among 32 patients whose activities were recorded, a minority engaged in hunting (4), fishing (4) and gardening (12) prior to disease onset; but 19/32 recalled excavation prior to exposure compared to 17/60 in 1979-90 (P < 0.01). Among cases with a pulmonary presentation, winter onset cases (3/40) were significantly fewer than in 1979-90 (19/55). However, over the entire 18 years there was no disproportionately represented season. CONCLUSIONS: In highly endemic Vilas County, the mean annual incidence of human blastomycosis appears stable over the past 13 years. A combined case series of 18 years reveals no predilection by gender or season of onset.

Adolescent↗
PubMed1994

Development of the city-county (public) hospital.

Prior to 1966, the United States had a two-tiered system of health care. Those patients who could afford the cost of medical care were treated by private physicians in their offices and in private hospitals. For patients who could not afford care, ie, the indigent and retirees over 65 years of age who developed catastrophic illnesses, the city and county (public) hospitals provided the only health care available. All counties assumed responsibility for their indigent patients, and all but the smallest counties had their local hospital. In the larger cities, these hospitals developed teaching programs and affiliations with medical schools that provided a volunteer teaching faculty (Table) (John G. Raffensperger, unpublished data, 1991; John E. Salvaggio, unpublished data, 1989). The smaller county hospitals relied on a few full-time generalists, but primarily they depended on volunteer physicians from the community to provide patient care.

Emergency Service, Hospital↗
PubMed1978

Relative frequency and survival results of cancer seen at a county hospital.

The relative frequency of cancer cases (percentage of total malignancies) admitted to Los Angeles County-University of Southern California (LAC-USC) Medical Center from 1942 to 1974 was studied (basal cell and epidermoid carcinoma of the skin were excluded). Among cancers of the digestive system, the relative frequency of cancer of the stomach has definitely declined from a high of 9.5% before 1946 to a low of 2% in 1972. Carcinoma of the colorectum has shown a downward trend in the last decade. Among cancers of the respiratory system, cancer of the lung continues its steady increase from a relative frequency of 7% before 1946 to a high of 20% in 1974. The percentages of malignant lesions of the female organs (breast, uterine body, ovaries) have stayed relatively constant. Cancers of the central nervous system and malignancy of unknown primary site showed an increasing trend over the last 15 years. The 8 most common cancers according to their relative frequency at Los Angeles County Hospital in 1974 are: colon (10%), rectum (5%), breast (15%), lung (13%), prostate (7%), cervix uteri (6%), stomach (3%), and pancreas (3%). In general, survival results of patients in the California Tumor Registry are comparable with those reported in the national study, and survival rates of patients seen at the Los Angeles County Hospital are lower. But 5 year survival rates have improved by more than 3 percentage points for patients with all stages of cancer of the colon, breast, prostate, and cervix uteri diagnosed at the Los Angeles County Hospital in recent years.

Brain Neoplasms↗
PubMedDate not supplied

Height and mortality in the counties of England and Wales.

Average heights of adults and children in the counties of England and Wales were examined using national samples of people born between 1920 and 1970. Although height increased over this 50-year period the differences between counties persisted. Average height in a county is closely related to its pattern of death rates, which were derived from all deaths during 1968-78. Counties with taller populations have lower mortality from chronic bronchitis, rheumatic heart disease, ischaemic heart disease and stroke, and higher mortality from three hormone-related cancers, of the breast, prostate and ovary. The inverse relation of height with bronchitis and cardiovascular disease is further evidence of risk factors acting in early childhood. The positive relation between height and cancers of the breast, ovary and prostate could suggest that promotion of child growth has disadvantages as well as benefits.

Adolescent↗
PubMed1992

Giant cell arteritis and visual loss. A 3-year retrospective hospital investigation in a Danish county.

An ophthalmic status is given for 95 consecutive patients referred from other departments of the Central County Hospital 1986-88 due to suspected giant cell arteritis. Eventually, the diagnosis was confirmed in 51/95 (18 had positive biopsy of the temporal artery; in 33 it was on clinical grounds). Nine of the 51 had significant visual loss, in one even as bilateral blindness. Generalized malignancies were found in 2 of the 44 with diagnosis other than giant cell arteritis. Retrospectively, in the same 3-year period a total of 263 cases of giant cell arteritis were registered in the somatic hospitals of the county (population 340,000). One further case with visual loss became known from requests to the primary health sector ophthalmologists. Between 3-4% were thus known to have significant visual loss, a result mainly in keeping with other Nordic clinical studies. Probably, the low figures of visual impairment are related to high diagnostic rates of giant cell arteritis, and to early treatment. Our hospital-based data of giant cell arteritis gave a calculated annual incidence of 1 per 1000 of those older than 50 years in the county, or 27/100,000 including all ages. The true county incidence would be even higher had it been possible to find and include the additional cases of giant cell arteritis who were diagnosed and treated in the primary health sector only.

Adult↗
PubMed1998

Urban health care in transition: challenges facing Los Angeles County.

The authors examine the Medicaid Section 1115 Demonstration Project currently underway in Los Angeles County. The waiver was designed as part of a response to a financial crisis the Los Angeles County Department of Health Services (LACDHS) faced in 1995. It provides financial relief to give the county time to restructure its system for serving the medically indigent population. Los Angeles County's goal is to reduce its traditional emphasis on emergency room and hospital care by building an integrated system of community-based primary, specialty, and public health care. This case study describes activities completed through the spring of 1997, approximately 1 year after the waiver was approved.

Community Health Services↗
PubMed2004

Prevalence of the chronic sinusitis diagnosis in Olmsted County, Minnesota.

BACKGROUND: Commonly cited estimates from the National Health Interview Survey rank chronic sinusitis as one of the most prevalent chronic diseases in the United States. These data rely on patient self-reporting of the disease. However, chronic sinusitis is difficult to diagnose because its symptoms overlap those of many other disease processes. As such, these prevalence data may be unreliable. OBJECTIVE: To provide an estimate of the prevalence of chronic sinusitis based on assigned International Classification of Diseases, Ninth Revision (ICD-9) codes for the year 2000 in a population-based sample. This study establishes the individual patient as the unit of measure vs previous ICD-9-based estimates that measured physician encounters. DESIGN: Using existing databases, we identified all residents of Olmsted County, Minnesota, who were assigned an ICD-9 diagnosis code for chronic sinusitis (473.x) in the year 2000. SETTING: Primary care and referral center serving the general community. PARTICIPANTS: All residents of Olmsted County who provided research authorization were eligible. MAIN OUTCOME MEASURE: Age- and sex-specific prevalence of chronic sinusitis based on assigned ICD-9 diagnosis codes. RESULTS: In the year 2000, 2405 residents of Olmsted County were given an ICD-9 diagnosis code for chronic sinusitis. Among these, 1627 (67.7%) were female and 778 (32.3%) were male. The overall age- and sex-adjusted prevalence per 100,000 was 1955 (1.96%). The mean (SD) age at the time of diagnosis was 39.4 (17.6) years (age range, 4.2 months to 94 years). Eighty-seven percent were diagnosed at Mayo Clinic, and the balance were from the Olmsted Medical Center. At Mayo, family practitioners and internists diagnosed most of the cases (70%); only 8% were diagnosed by the Department of Otolaryngology. The diagnosis code 473.9 for unspecified chronic sinusitis made up 95% of cases. CONCLUSIONS: Current prevalence estimates of chronic sinusitis may be exaggerated. Chronic sinusitis has been reported to affect 14% to 16% of the US population according to a National Health Interview Survey. In Olmsted County, we found a much lower prevalence (1.96%) of chronic sinusitis using ICD-9 codes as an identifier.

Adult↗
PubMed2005

The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study.

OBJECTIVE: To determine the incidence of autism among children in Olmsted County, Minnesota. DESIGN: Through the Rochester Epidemiology Project, all inpatient and outpatient diagnoses are indexed for computerized retrieval. This computerized diagnostic index was used to identify children with any developmental disorder. A glossary of symptoms of autism was used to review medical and school records of these children for symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for autistic disorder. SETTING: Olmsted County, Minnesota. Subjects All residents of Olmsted County 21 years or younger between 1976 and 1997. Main Outcome Measure The incidence of research-identified autism based on DSM-IV criteria for autistic disorder. RESULTS: The age-adjusted incidence of research-identified autism was 5.5 (95% confidence interval, 1.4-9.5) per 100 000 children from 1980 to 1983 and 44.9 (95% confidence interval, 32.9-56.9) from 1995 to 1997 (8.2-fold increase). This increase was confined to children younger than 10 years who were born after 1987. CONCLUSIONS: The incidence of research-identified autism increased in Olmsted County from 1976 to 1997, with the increase occurring among young children after the introduction of broader, more precise diagnostic criteria, increased availability of services, and increased awareness of autism. Although it is possible that unidentified environmental factors have contributed to an increase in autism, the timing of the increase suggests that it may be due to improved awareness, changes in diagnostic criteria, and availability of services, leading to identification of previously unrecognized young children with autism.

Adolescent↗
PubMed1988

Kawasaki syndrome clusters in Harris County, Texas, and eastern North Carolina. A high endemic rate and a new environmental risk factor.

Sixty-one cases of Kawasaki syndrome (KS) occurred in Harris County, Texas, during the three-year period from January 1982 through December 1984. Fifty-five (90%) of these 61 patients were under 5 years old, for an annual endemic rate in children under 5 years old of 9.1 cases per 100,000 per year. To our knowledge this is the highest endemic rate reported to date in the continental United States. Between Aug 26 and Sept 19, 1984, seven children with KS were hospitalized in Harris County. The seven children were between 5 months and 5 years old. The number of cases in this cluster was unusual for late summer, which is generally a low-incidence season for KS in Harris County. More important, a case-control study of these children revealed that they resided significantly closer to a bayou or drainage ditch than did randomly selected matched control subjects. A similar association with drainage ditches or creeks was observed in a subsequent cluster of 13 cases of KS in seven eastern North Carolina counties. To our knowledge, this is the first report of a possible association between KS and residing near water.

Child↗
PubMed1994

The Larimer County Children's Clinic. A public-private partnership to provide medical care to indigent children.

OBJECTIVE: To describe a unique collaboration between private and public entities to provide comprehensive health care to medically indigent children in rural Larimer County, Colo. SETTING: The Children's Clinic, Fort Collins, Colo. STUDY PARTICIPANTS: Uninsured children and those eligible for Medicaid, living in families with incomes below 150% of the federal poverty level. SELECTION PROCEDURES: Eligible patients have been enrolled in the Children's Clinic on a first-come, first-served basis. INTERVENTIONS: A community collaboration involving an interactive system with the Children's Clinic staff, the Larimer County Department of Health and Environment, private primary care and subspecialty physicians, ancillary health providers, and the family practice residency program at Poudre Valley Hospital, Fort Collins. Funding for this endeavor has been composed of city and county funds, public and private grants, community business support, and local fund-raising efforts, as well as Medicaid reimbursements. MEASUREMENTS/MAIN RESULTS: Since 1989, comprehensive pediatric care has been provided to a growing number of eligible children. At present, 3619 children, aged birth to 18 years, from 2230 families are being served. From this population, there were 8945 office visits to the Children's Clinic, 1392 patient contacts by the clinic social workers, 1287 visits to the Larimer County Department of Health and Environment for well-child care, 543 referrals to subspecialists and other community health care providers, and 615 after-hours visits to the Poudre Valley Hospital emergency department between July 1, 1992, and June 30, 1993. The clinic's professional staff consists of 2 1/4 full-time pediatric care providers, one nurse, one medical social worker, one receptionist, and one administrator, with an expenditure of $356,471. CONCLUSIONS: The Children's Clinic collaboration has provided comprehensive pediatric health care to a population that previously received only fragmented care. The next step is to assess the impact of this program on the frequency of emergency department visits for these patients.

Adolescent↗
PubMed2004

Incidence of multiple myeloma in Olmsted County, Minnesota: Trend over 6 decades.

BACKGROUND: Previous studies have indicated that the incidence and mortality rates for multiple myeloma have increased in the United States. The authors reported on the incidence of multiple myeloma in Olmsted County, Minnesota, between 1991 and 2001 and on trends in multiple myeloma incidence over the last 56 years. METHODS: Using the files of the Mayo Clinic and the Olmsted Medical Center (Rochester, MN), the authors identified all residents of Olmsted County who had multiple myeloma, suspected myeloma, or a related disorder. Reports of all laboratory determinations, in addition to autopsy findings and death certificates, were obtained. The criteria for the diagnosis of multiple myeloma have not changed during the last 6 decades. RESULTS: All but 1 of the 47 residents with multiple myeloma first diagnosed between 1991 and 2001 were recognized antemortem. Fifty-five percent had a previous monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, or solitary plasmacytoma before multiple myeloma was diagnosed. From 1991 to 2001, the overall annual incidence rate, age-adjusted to the 2000 U.S. population, was 4.3 per 100,000 (95% confidence interval, 3.0-5.5 per 100,000). Poisson regression analysis showed no statistically significant trend in Olmsted County incidence rates over 56 years. In similar fashion, the authors adjusted multiple myeloma incidence rates from nine other studies worldwide for which adequate data were available and documented similar findings in each case, except for one study that included patients with smoldering multiple myeloma. CONCLUSIONS: The overall incidence of multiple myeloma in Olmsted County, Minnesota, has not changed in almost 6 decades. The apparent increase in incidence elsewhere is unexplained but probably is attributable to improvements in diagnostic techniques, particularly in older patients.

Adolescent↗
PubMed2007

Update on the incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota, 1940-2000.

BACKGROUND: We previously reported that the prevalence of Crohn's disease (CD) and ulcerative colitis (UC) in Olmsted County, Minnesota, had risen significantly between 1940 and 1993. We sought to update the incidence and prevalence of these conditions in our region through 2000. METHODS: The Rochester Epidemiology Project allows population-based studies of disease in county residents. CD and UC were defined by previously used criteria. County residents newly diagnosed between 1990 and 2000 were identified as incidence cases, and persons with these conditions alive and residing in the county on January 1, 2001, were identified as prevalence cases. All rates were adjusted to 2000 US Census figures for whites. RESULTS: In 1990-2000 the adjusted annual incidence rates for UC and CD were 8.8 cases per 100,000 (95% confidence interval [CI], 7.2-10.5) and 7.9 per 100,000 (95% CI, 6.3-9.5), respectively, not significantly different from rates observed in 1970-1979. On January 1, 2001, there were 220 residents with CD, for an adjusted prevalence of 174 per 100,000 (95% CI, 151-197), and 269 residents with UC, for an adjusted prevalence of 214 per 100,000 (95% CI, 188-240). CONCLUSION: Although incidence rates of CD and UC increased after 1940, they have remained stable over the past 30 years. Since 1991 the prevalence of UC decreased by 7%, and the prevalence of CD increased about 31%. Extrapolating these figures to US Census data, there were approximately 1.1 million people with inflammatory bowel disease in the US in 2000.

Adolescent↗
PubMed2002

Economic-environmental modeling of point source pollution in Jefferson County, Alabama, USA.

This paper uses an integrated economic-environmental model to assess the point source pollution from major industries in Jefferson County, Northern Alabama. Industrial expansion generates employment, income, and tax revenue for the public sector; however, it is also often associated with the discharge of chemical pollutants. Jefferson County is one of the largest industrial counties in Alabama that experienced smog warnings and ambient ozone concentration, 1996-1999. Past studies of chemical discharge from industries have used models to assess the pollution impact of individual plants. This study, however, uses an extended Input-Output (I-O) economic model with pollution emission coefficients to assess direct and indirect pollutant emission for several major industries in Jefferson County. The major findings of the study are: (a) the principal emission by the selected industries are volatile organic compounds (VOC) and these contribute to the ambient ozone concentration; (b) the direct and indirect emissions are significantly higher than the direct emission by some industries, indicating that an isolated analysis will underestimate the emission by an industry; (c) while low emission coefficient industries may suggest industry choice they may also emit the most hazardous chemicals. This study is limited by the assumptions made, and the data availability, however it provides a useful analytical tool for direct and cumulative emission estimation and generates insights on the complexity in choice of industries.

Alabama↗
PubMed2003

Utilisation of antibiotics in young children: opposite relationships to adult educational levels in Danish and Swedish counties.

BACKGROUND: Antibiotic utilisation varies profoundly among and within countries, and the extent of antibiotic utilisation correlates with the frequency of bacterial resistance, particularly among children. Hence, it is important to assess which factors may influence prescribing. In addition to variations in morbidity, health-care organisation, drug regulatory and supply systems, prescriber's attitudes, parents' behaviour, attitudes and socio-economic positions seem important. We compared socio-economic position (educational level of adults) and antibiotic utilisation in children in the municipalities within a Danish and a Swedish county which are geographically close, have similar social and economic development, and similar drug regulatory and supply systems. METHODS: Data on antibiotic utilisation (1998), expressed in defined daily doses per 1000 inhabitants per day (DDD/TID), were obtained from the Copenhagen County Health Insurance register and from the National Corporation of Swedish Pharmacies. Data on municipal educational levels were obtained from Statistics Denmark and Statistics Sweden. RESULTS: The utilisation of antibiotics in 0- to 6-year-old children was higher in the Swedish than in the Danish county but varied between the municipalities within both the Swedish (9.6-17.7 DDD/TID) and the Danish (8.0-12.9 DDD/TID) counties. Most notably, utilisation rates correlated negatively with the education levels in the Danish (r=-0.539, P=0.021) but positively in the Swedish (r=+0.390, P=0.025) municipalities. CONCLUSION: The observed variations in antibiotic prescribing may reflect different parental and/or prescriber attitudes towards use of antibiotics and they emphasise that antibiotic prescribing is influenced by factors other than the prevalence of bacterial infections. Relationships between socio-economic position (educational level) and drug utilisation should not be generalised from one area to another.

Anti-Bacterial Agents↗