Non-prescription acquisition of antibiotics: Prevalence, motives, pathways and explanatory factors in the Swedish population.

Prior studies indicate prevalence of unregulated non-prescription use of antibiotics also in the northern European countries. The aim of this study is to investigate the extent to which antibiotics are acquired without prescription in Sweden, and people's attitudes and motives linked to this practice. We use data from an online survey of a representative sample of the Swedish general population which included questions about respondents' antibiotic use, attitudes towards antibiotics, health care contacts, self-rated health and trust in health care. We also asked about their reason for obtaining/not obtaining antibiotics without a prescription. The results show that, in the last five years, 2,3% of the respondents had acquired antibiotics in other ways than from a Swedish physician having issued a prescription, and 4,3% reported that they are likely to do so in the future. We also show that the two most important reasons for non-prescription acquisition were physicians' refusal to prescribe antibiotics followed by travel abroad. The most important reason for not obtaining antibiotics without a prescription was to not contribute to antibiotic resistance. Using logistic regression, we show that non-prescription acquisition of antibiotics, and the intention to engage in this practice in the future, are strongly associated with low trust in health care.

Who is willing to stay sick for the collective? - Individual characteristics, experience, and trust.

•We study attitudes towards antibiotics and antibiotic resistance.•We analyze results from a novel web-survey of Swedish citizens (n = 1906).•Acceptability of doctor's decision not to prescribe antibiotics was found to be large.•Trust in the healthcare sector is linked to acceptability of doctor's decision.•Concern about antibiotic resistance is linked to willingness to limit antibiotic use.

Corruption and use of antibiotics in regions of Europe.

The aim of this article is to investigate the association between corruption and antibiotic use at sub-national level. We explore the correlation between, on the one hand, two measures of corruption (prevalence of corruption in the health sector and prevalence of bribes in the society) at regional level from the European Quality of Government Index; and, on the other, the consumption of antibiotics in those European regions from a 2009 Special Euro Barometer. In a multivariate regression model, we control for potential confounders: purchasing power of standardized regional gross domestic product, inhabitants per medical doctor and age-standardized all-cause mortality rates. We find that there is a strong positive association between both measures of corruption (i.e. in the health sector, and in the society at large) and antibiotics use; and that this association is robust to the introduction of the control variables. These results support previous findings in the literature linking corruption to higher antibiotic use at cross-national level. We show that corruption does seem to account for some of the remarkable between-region variation in antibiotic consumption in Europe.

"Beauty contest" indicator of cognitive ability and free riding strategies. Results from a scenario experiment about pandemic flu immunization.

High immunization coverage rates are desirable in order to reduce total morbidity and mortality rates, but it may also provide an incentive for herd immunity free riding strategies. The aim of this paper was to investigate the link between cognitive ability and vaccination intention in a hypothetical scenario experiment about Avian Flu immunization. A between-subject scenario experiment was utilized to examine the willingness to undergo vaccination when the vaccination coverage was proclaimed to be 36, 62 and 88%. Respondents were later assigned to a "Beauty contest" experiment, an experimental game commonly used to investigate individual's cognitive ability. Results show that there was a significant negative effect of the proclaimed vaccination uptake among others on the vaccination intention. However, there were no significant association between the "Beauty contest" indicator of cognitive ability and the use of herd immunity free riding strategies.

Contextual generalized trust and immunization against the 2009 A(H1N1) pandemic in the American states: A multilevel approach.

The aim of the study was to investigate the association between contextual generalized trust and individual-level 2009 A(H1N1) pandemic immunization acceptance. A second aim was to investigate whether knowledge about the A(H1N1) pandemic mediated the association between contextual generalized trust and A(H1N1) immunization acceptance. Data from the National 2009 H1N1 Flu Survey was used. To capture contextual generalized trust, data comes from an aggregation of surveys measuring generalized trust in the American states. To investigate the association between contextual generalized trust and immunization acceptance, while taking potential individual-level confounders into account, multilevel logistic regression was used. The investigation showed contextual generalized trust to be significantly associated with immunization acceptance. However, controlling for knowledge about the A(H1N1) pandemic did not substantially affect the association between contextual generalized trust and immunization acceptance. In conclusion, contextual state-level generalized trust was associated with A(H1N1) immunization, but knowledge about A(H1N1) was not mediating this association.

Trust, reciprocity and collective action to fight antibiotic resistance. An experimental approach.

Antibiotic resistance is a collective action dilemma. Individuals may request antibiotics, but an overall reduction in use is necessary to limit resistance. A reoccurring theoretical claim is that social capital increase cooperation in social dilemmas. The aim of this paper is to investigate the link between generalized trust and reciprocity and the willingness to postpone antibiotic treatment in order to limit overuse in a scenario-based study. A between-subject scenario experimental approach with hypothetical scenarios was utilized. Participants were asked to imagine that they were seeing a doctor for a respiratory infection. The doctor prescribes antibiotics, but advise postponing therapy to see if the disease resolves by itself, for the sake of limiting overuse. Respondents were asked to answer how long they could accept postponing antibiotic treatment, from 0 to 7 days. The number of days that most people would be able to accept postponing treatment was considered the between-subject factor. In total, the study sample included 981 respondents with a mean age of 51 years. A majority of respondents were men (65.7%). The mean number of days that the respondents stated they were willing to postpone antibiotic treatment was positively associated with the number of days the respondents were told that most people were willing to postpone antibiotic treatment, p < 0.001. There was a positive association between number of days they were willing to postpone antibiotic treatment and generalized trust, p = 0.001. In conclusion, the results showed that the proclaimed public willingness to postpone therapy influenced a respondent's willingness to postpone antibiotic therapy in different scenarios. Also, generalized trust was positively associated with the willingness to postpone therapy.

Social capital and immunisation against the 2009 A(H1N1) pandemic in Sweden.

AIM: To investigate the connection between social capital indicators and immunisation. METHOD: The national Society Opinion & Media (SOM) survey is an annual cross-sectional postal survey. In 2009, a random sample of persons aged 16-85 was drawn from the Swedish national register and yielded a 59% participation rate. The number of respondents analysed was 2130. A multiple logistic regression model was used to investigate the connection between the explanatory variables institutional trust and generalised trust and the outcome variable immunisation intent. The analyses included sex, age, education, self-rated health, and personal and societal concern about the 2009 A(H1N1) pandemic. RESULTS: For institutional trust in health care, the odds ratios for intention to vaccinate against the A(H1N1) pandemic were significantly higher in the Medium trust and High trust categories as compared to the Low trust reference category. For generalised trust, the odds ratio for vaccination intention was significantly higher in the High trust category as compared to the Low trust reference category. CONCLUSIONS: Two important social capital indicators - institutional trust in health care and generalised trust - seem to be independently associated with intention to accept vaccination against the 2009 A(H1N1) pandemic. The effect holds also when controlling for plausible confounders, such as education, self-rated health, and personal and societal concern about the 2009 A(H1N1) pandemic.