South Korea reports post-COVID increase in outpatient antibiotic prescribing

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South Korea has seen a significant uptick in outpatient antibiotic prescribing for respiratory infections since the end of COVID-19 restrictions, according to a report today in Korea Biomedical Review.

The results of a drug appropriateness assessment by South Korea's Health Insurance Review and Assessment Service (HIRA), which evaluates outpatient treatment at the country's 54,017 medical institutions, shows that the prescription rate of antibiotics for acute upper respiratory tract infections rose from 32.4% in 2022 to 41.4% in 2023. The rate of antibiotic prescribing for acute lower respiratory tract infections rose from 54.1% in 2022 to 59.8% in 2023.

The antibiotic prescribing rate for all outpatient general and respiratory diseases also saw year-on-year increases, according to the report.

By age, infants were prescribed the highest percentage antibiotics for acute upper respiratory tract infections, at 48.7%, followed by children and adolescents (42.9%), adults (40.4%), and older adults (27.2%). The highest rate of prescribing by institution was at health clinics (60.1%).

End of pandemic-era restrictions

The increase in antibiotic prescribing occurred as South Korea relaxed many of its pandemic-era restrictions, including a mask mandate. Those restriction may have played a role in a sharp drop in diagnosed non-COVID respiratory illnesses from 2020 to 2023. In 2021, the number of diagnostic statements for acute upper respiratory tract infections fell to less than half the pre-pandemic level.

"Although the prescription rate of antibiotics has been halved over the past 20 years, the rate has risen again since the coronavirus endemic, so we will make efforts in various ways, such as strengthening support for medical institutions, including quality improvement support and improving the value-added payment project," Kim Ki-won, head of HIRA's Evaluation and Management Office, told the journal.

HIRA said it will send notices to healthcare facilities with high antibiotic prescribing rates.

Study: COVID-19 pandemic exacerbated depression in adults with diabetes

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Stephanie Soucheray, MA

A new study in the Archives of Gerontology and Geriatrics Plus shows that older Canadians with diabetes experienced spikes in depression during the COVID-19 pandemic.

The study was based on results of the Canadian Longitudinal Study on Aging surveys, which polled Canadian residents aged 45 to 85 who were recruited in 2012 to 2015 and subsequently completed three follow-up surveys beginning in the fall of 2020. A total of 2,730 people with diabetes were included in this study, the authors said.

Participants with diabetes and a history of depression were the most at risk for experiencing a new episode of depression when the pandemic started, with almost half reporting depression during COVID-19 (48.5%; 95% confidence interval [CI], 45.4% to 51.7%).

Among participants with diabetes and no history of depression, the incidence of new depression was 12.9% (95% CI, 11.3% to 14.4%) during the pandemic.

Women at greater risk

Being female was associated with depression. Men had 38% lower odds of developing depression than women did (odds ratio 0.62; 95% CI, 0.44 to 0.87).

"Those with a history of depression also had lower household income, less total savings, and were less able to satisfy their needs with their income prior to the pandemic," the authors wrote.

"The pandemic has taken a significant toll on the mental health of everyone, particularly older adults with chronic conditions such as diabetes," said study co-author Grace Li, a research assistant and PhD candidate at the University of Toronto's Institute for Life Course and Aging, in a press release. "It's important for primary health providers to be vigilant for signs of depression among their older patients, even those who were doing well in the past."

In conclusion, the authors of the study said the findings should prompt clinicians to ask diabetes patients about depression symptoms, especially during periods of increased stress.

HPV vaccination 4-fold higher when hesitant parents got clinician reminder, study suggests

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Mary Van Beusekom, MS

Teen girl receiving vaccination — *Alex Raths / iStock*

Only a third of vaccine-hesitant US parents reported that their children received at least one dose of the human papillomavirus (HPV) vaccine, but immunization rates were more than fourfold higher when the parents received a healthcare provider recommendation to do so, University of Arkansas researchers reported yesterday in Vaccine.

The team analyzed data from phone surveys conducted in October 2022 via the random-digit dialing of 2,201 Arkansan adults, focusing on a subsample of 201 who said they were unsure about vaccinating their children aged 9 to 17 years.

HPV is the most common sexually transmitted infection in the United States, the researchers wrote. "HPV-associated diseases are preventable with vaccination, but HPV vaccine coverage remains below other vaccines recommended during childhood and adolescence."

Kids twice as likely to get vaccine when moms decide

A third (33.0%) of hesitant parents reported that their children had received at least one dose of the HPV vaccine. Slightly over half (51.0%) said they received a clinician recommendation to vaccinate their children against HPV.

Conflating vaccine hesitancy with refusal is inaccurate and may contribute to inconsistency in healthcare provider recommendations for HPV vaccination.

The likelihood of HPV vaccination was more than four times higher when the parents received a recommendation (adjusted odds ratio [aOR], 4.67) than when they did not, but the odds weren't significantly different from those with no provider (7.9%) when recommendations weren't given. The chances of pediatric HPV vaccination were twice as high for mothers than for fathers (OR, 2.03).

Of skeptical parents whose provider recommended HPV vaccination, 48.5% were vaccinated. In total, 19.0% of parents who didn't receive a recommendation reported that their children were vaccinated—compared with 30.0% for those whose children did not have a provider.

"Additional research is needed to understand why pediatric HPV vaccine recommendations are not made more often or consistently, particularly among vaccine-hesitant populations," the study authors wrote.

"Continued investigation of hesitant adopters is important for increasing vaccine coverage for HPV and other vaccines and countering misleading characterizations of vaccine hesitancy," they added. "Conflating vaccine hesitancy with refusal is inaccurate and may contribute to inconsistency in healthcare provider recommendations for HPV vaccination."