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Thi Hoan Le1,2, Ellinor Ottosson3, Thi Kim Chuc Nguyen4, Bao Giang Kim5, Peter Allebeck11Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; 2Department of Environmental Health, Hanoi Medical University, Hanoi, Vietnam; 3Department of Medicine, Gothenburg University, Gothenburg, Sweden; 4Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam; 5Department of Health Education, Hanoi Medical University, Hanoi, VietnamAims: To explore the knowledge, attitudes, and behaviors of parents in their use of drugs for respiratory illness or diarrhea among children under 5 years of age, and to understand factors influencing self-medication.Methods: A qualitative study was conducted, using in-depth interviews with two drug sellers and three health care providers, and four focus-group discussions with mothers of children under 5 years of age. Verbatim transcriptions were analyzed, and emerging themes and categories identified, using content analysis.Results: Use of a number of different drugs was reported, including broad-spectrum antibiotics and corticosteroids. There was poor awareness of side-effects, antibiotic resistance, and drug efficacy. Factors influencing self-medication were perceptions of the illness in the child, waiting time, and convenience, the attitudes of public health medical staff, insufficient drug supply in public health facilities, and poor control of prescribed drugs on the market.Conclusion: Misuse and misconceptions regarding drug use gave rise to considerable problems. Mothers' knowledge and attitudes to illness and health care services played an important role in determining the nature of self-medication. Financial barriers were not the only obstacle to adequate treatment. Health services should be more accessible and responsive to the needs of the population.Keywords: health services, parental attitudes, education

Understanding the distribution and dynamics of species is central to ecology and important for managing biodiversity. The distributions of species in metacommunities are determined by many factors, including environmental conditions and interactions between species. Yet, it is difficult to quantify the effect of species interactions on metacommunity dynamics from observational data. We present an approach to estimate the importance of species interactions that combines data from two observational presence-absence inventories (providing colonization-extinction data) with data from species interaction experiments (providing informative prior distributions in the Bayesian framework). We further illustrate the approach on wood-decay fungi that interact within a downed log through competition for resources and space, and facilitate the succession of other species by decomposing the wood. Specifically, we estimated the relative importance of species interactions by examining how the presence of a species influenced the colonization and extinction probability of other species. Temporal data on fruit body occurrence of 12 species inventoried twice were jointly analyzed with experimental data from two laboratory experiments that aimed to estimate competitive interactions. Both environmental variables and species interactions affected colonization and extinction dynamics. Late-successional fungi had more colonization interactions with predecessor species than early-successional species. We identified several species interactions, and the presence of certain species changed the probability that later-successional species colonized by -81% to 512%. The presence of certain species increased the probability that other species went extinct from a log by 14%-61%. Including the informative priors from experimental data added two colonization interactions and one extinction interaction for which the observational field data was inconclusive. However, most species had no detectable interactions, either because they did not interact or because of low species occupancy, meaning data limitation. We show how temporal presence-absence data can be combined with experimental data to identify which species influence the colonization-extinction dynamics of others. Accounting for species interactions in metacommunity models, in addition to environmental drivers, is important because interactions can have cascading effects on other species., (© 2025 The Author(s). Ecology published by Wiley Periodicals LLC on behalf of The Ecological Society of America.)

Changes in biodiversity might alter decomposition processes and, consequently, carbon and nutrient cycling. We examined fungal diversity and density loss in experimental Norway spruce logs after 12 years of decay in a hemiboreal forest. Between 28 and 50% of the original wood biomass remained, depending on the fungal community composition in the log, operational taxonomic unit (OTU) richness had only a minor effect on the log biomass. Although the communities were OTU rich (190-340 OTUs per log), the majority of OTUs were infrequent or rare; wood degradation therefore depended mostly on the most abundant OTUs and their decomposing abilities. The least decayed logs were characterized by continuous dominance of an earlier colonizer and by high within-log community diversity, which was significantly related to sample variables (position in log, density and moisture). In the most decayed logs, the earlier colonizers were generally replaced by white-rot species able to exploit the highly decomposed wood. The communities were relatively spatially uniform within whole logs, independent of the sample variables, whereas among-log diversity was high. Importance of fungal community composition in decomposition processes should be taken into account when studying and modeling carbon dynamics in forest ecosystems., (© FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Fungal communities in Norway spruce (Picea abies) logs in two forests in Sweden were investigated by 454-sequence analyses and by examining the ecological roles of the detected taxa. We also investigated the relationship between fruit bodies and mycelia in wood and whether community assembly was affected by how the dead wood was formed. Fungal communities were highly variable in terms of phylogenetic composition and ecological roles: 1910 fungal operational taxonomic units (OTUs) were detected; 21% were identified to species level. In total, 58% of the OTUs were ascomycetes and 31% basidiomycetes. Of the 231 337 reads, 38% were ascomycetes and 60% basidiomycetes. Ecological roles were assigned to 35% of the OTUs, accounting for 62% of the reads. Wood-decaying fungi were the most common group; however, other saprotrophic, mycorrhizal, lichenized, parasitic and endophytic fungi were also common. Fungal communities in logs formed by stem breakage were different to those in logs originating from butt breakage or uprooting. DNA of specific species was detected in logs many years after the last recorded fungal fruiting. Combining taxonomic identification with knowledge of ecological roles may provide valuable insights into properties of fungal communities; however, precise ecological information about many fungal species is still lacking., (© FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To describe the pattern of drug use among the children with respiratory illnesses and/or diarrhoea; and to analyze the association between various socio-economic factors and pattern of drug use., Methods: A population-based survey of 4087 children under five was conducted within the framework of an epidemiological surveillance site in a rural district of Vietnam. Through interviewing mothers or caretakers, data on self-reported illness, use of drugs, and use of health services during 2 weeks prior to the survey and other background information were collected., Results: Out of 4087 children, 1836 children had respiratory illness and/or diarrhoea during 2 weeks before the interview and drugs were used in the majority of cases. Antibiotics (72.2%) and analgesics/antipyretics (53.5%) were the drugs most commonly reported. Corticosteroids were used in 11.6% of all cases. Among children with diarrhoea, Oral Rehydration Solution (ORS) was used in 9.7%, while anti-diarrhoea drugs were used in 36.1% of all cases. There was a significant association between the family's socio-economic condition and use of corticosteroids, but to a lesser degree regarding other drugs. There was no significant association between pattern of drug use and type of health service consulted., Conclusions: There are major problems about irrational drug use among children. The treatment guidelines for respiratory illness and diarrhoea are not followed. Urgent actions are needed and should target all actors in the field, mothers, doctors, pharmacy staff, and authorities in order to improve this situation.

Objective: To analyze equivocal duplex findings in patients with clinically suspected deep venous thrombosis and thus to increase the diagnostic utility of color duplex sonography in this category of patients., Methods: Phlebography was requested in a series of 102 consecutive patients with inconclusive duplex findings. These patients were, according to the duplex findings only, subdivided into having low, intermediate, and high probability of deep venous thrombosis., Results: Phlebographywas attempted in 71 cases and successfully performed in 49. The remaining 53 patients were prospectively followed clinically for 6 months. Phlebography showed deep venous thrombosis in 1 of 63 patients in the group with low probability, 3 of 31 in the intermediate group, and all of the 8 patients with high probability. Twenty-two (31%) of the 71 attempted phlebographic examinations were nondiagnostic. None of the patients in the follow-up group had any thromboembolic complications., Conclusions: Even if a duplex examination is equivocal, it is still possible to extract clinically useful information by categorizing the duplex results into subgroups with low, intermediate, and high probability of deep venous thrombosis. This can have implications for the diagnostic or therapeutic handling of these patients and thus can increase the utility of sonography in patients with inconclusive duplex findings.

The aim of this study was to evaluate prospectively the clinical short-term outcome of patients with suspected deep venous thrombosis (DVT) and negative duplex investigation and to assess whether it is clinically safe to withhold anticoagulant therapy on the basis of a single negative color duplex examination including the calf veins. The study included a consecutive series of patients with suspected DVT referred for color duplex examination over 1 year. Patients with negative duplex findings (n = 341) were followed up for 3 months clinically and/or by reviewing hospital charts and the official registry of health care and causes of death. In only 1 of the patients was DVT diagnosed following a negative duplex examination. This patient had accentuated symptoms and a thrombus in the peroneal vein was detected at subsequent phlebography. None of the other patients with a negative duplex finding developed signs of, or had treatment initiated for, DVT or pulmonary embolism during the 3-month period after the duplex investigation. Five patients died, but none of the deaths was related to thromboembolism. The results indicate that it is clinically safe to rely on a single negative color duplex examination in patients without any progressing symptoms from the affected limb.

A previously published clinical trial was used for analysis of costs for antibiotic treatment in patients with serious bacterial infections requiring the use of injectable broad spectrum antibiotics. The patients were randomized to receive imipenem/cilastatin 500/500 mg q6h (77 patients of which 56 were evaluable for efficacy) or clindamycin 600 mg q6h plus gentamicin 1.5 mg/kg with dose intervals determined by serum concentration monitoring (86 patients of which 62 were evaluable for efficacy). An analysis of the costs for antibiotics, including drugs, equipment and staff for administration and gentamicin serum concentration assays, showed that imipenem/cilastatin was not more expensive than gentamicin plus clindamycin per treatment day although the drug cost was considerably higher for imipenem/cilastatin. Since imipenem/cilastatin was significantly more effective and caused less frequent adverse reactions than gentamicin plus clindamycin it was more cost-effective in the patients studied.

In 63 teenagers the proximal surfaces of premolars to be extracted for orthodontic reasons and the adjacent surfaces of neighboring teeth, 598 surfaces in all, were examined radiographically and by probing. Direct inspection after extraction revealed that 51% of the surfaces had incipient carious lesions and 5% lesions with cavities. Of the surfaces with cavities 82.1% were correctly diagnosed radiographically if any radiolucency, regardless of its extent, was used as a diagnostic criterion. However, this yielded a false positive rate of 19.6%. If only radiolucencies extending at least into the inner third of the enamel were called positive the true positive rate was 36.7% and the associated false positive rate 1.6%. At a 5% cavity frequency the predictive positive values were 17% and 53%, respectively. Probing yielded a true positive rate of about 29% and a false positive rate of 1.1% with a predictive positive value of 50-57%. All radiolucencies extending into the dentin were associated with cavities. When the most liberal radiographic criterion was used 37.5% of all carious lesions, whether associated with a cavity or not, were detected and 3.8% of sound surfaces were falsely called carious. The corresponding predictive positive value at the actual rate of incipient lesions and lesions with cavities was 92.6%.