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Background This study describes the patterns of antibiotic prescribing in eight village clinics in rural China and evaluates factors associated with antibiotic prescribing using quantitative and qualitative methods. Methods From January 2015 to July 2017, 60 prescriptions were collected monthly from selected village clinics in Shandong, China. Village clinic doctors completed a questionnaire regarding their knowledge of antibiotic prescribing. Semi-structured interviews were conducted with 15 village doctors and 1 deputy director from the township hospital. Results Of the 14 526 prescriptions collected, 5851 (40.3%) contained at least one antibiotic, among which 18.4% had two or more antibiotics and 24.3% had parenteral antibiotics. The antibiotic prescribing rate (β=−0.007 [95% confidence interval −0.009 to −0.004]) showed a declining trend (1.7% per month). Higher antibiotic prescribing rates were observed for patients <45 y of age and those diagnosed with upper respiratory tract infections and among village doctors who had less working experience and a lower level of knowledge on antibiotic prescribing. Qualitative analyses suggested that antibiotic prescribing was influenced by the patients’ symptoms, patients’ requests, policies restraining the overuse of antibiotics, subsidies for referral and routine village doctor training. Conclusions Antibiotic prescribing has declined in the included village clinics, which may be due to the policy of reducing antibiotic overuse in primary health care centres in China.

It is becoming increasingly recognised that the environment plays an important role both in the emergence and dissemination of antibiotic-resistant bacteria. Mechanisms and factors facilitating this development are, however, not yet well understood. The high detection rate of CTX-M-genes in environmental sources provides an opportunity to explore this issue. In this study, 88 CTX-M-producing Escherichia coli were isolated from 30 pig faeces samples from 30 pig farms and 201 environmental samples. CTX-M-producing E. coli was detected with the following frequencies in the different types of samples; pig faeces, 73%, river water, 64%, river sediment, 52%, wastewater, 31%, drinking water, 23%, outlet sediment, 21%, soil, 17%, and vegetables, 4.4%. Zou et al 3 Dissemination of CTX-M-producing E. coli to different environmental matrices were evaluated by analysing the genetic relatedness of isolates from different environmental sources, and putative transmission routes via bird faeces, pig faeces, drinking water, river sediment, river water and wastewater were hypothesized. Dissemination via these routes is likely facilitated by anthropogenic activities and environmental factors. Wild birds as potential vectors for dissemination of CTX-M-producing E. coli have the capacity to spread antibiotic-resistant bacteria across long distances. Regional dissemination between different environmental matrices of CTX-M-producing E. coli increases the exposure risk of humans and animals in the area.

Background: Dysmenorrhea is a condition frequently affecting menstruating women worldwide. Unfortunately, only a few studies have estimated the relationship between alcohol consumption and dysmenorrhea among women. In particular, there are fewer studies to explore the association between alcohol consumption, dysmenorrhea, and age at menarche. Objective: This study aimed to evaluate whether and to what extent alcohol consumption is related to dysmenorrhea and age at menarche. Methods: This was a cross-sectional, observational study conducted among college students. A total of 3,837 participants (age ≥18 years) volunteered to participate in the study and completed the questionnaire. Moreover, 145 were excluded from the study owing to exclusion criteria. We divided female college students into two groups stratified by age at menarche (AAM) 13 years. Logistic regression models were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of alcohol consumption with dysmenorrhea, adjusting for confounding factors. Results: A total of 3692 female college students completed the survey, including 409 (11.08%) who reported alcohol use. We found that alcohol consumption was not related to dysmenorrhea. However, stratified by age at menarche, we found that a positive association between alcohol consumption and dysmenorrhea among participants with AAM ≥13 years (OR,1.41; 95% CI, 1.06, 1.88). Compared with participants who reported no alcohol consumption, participants who reported consuming alcohol at least once a month (OR,1.29; 95% CI, 0.94, 1.78) and alcohol consumption at least once a week (OR,1.92; 95% CI, 1.07, 3.45) were more likely to have dysmenorrhea adjusting for other confounding factors. Conclusion: Our findings showed overall no association of alcohol consumption with dysmenorrhea but a statistically significant positive association for those whose AAM was >13 years.

Background: Dysmenorrhea is common gynecological disease in the whole world. Unfortunately, only a few studies have estimated the relationship between alcohol consumption and dysmenorrhea among women. In particular, there are fewer studies to explore the association between alcohol consumption, dysmenorrhea, and age at menarche.Objective: This study aimed to evaluate whether and what extent alcohol consumption is related to dysmenorrhea and age at menarche.Methods: This is a cross-sectional, observational study conducted among college students. A total of 3,837 participants (age ≥18 years) volunteered to participate in the study and completed the questionnaire. Moreover, 145 were excluded from the study owing to exclusion criteria. Finally, a total of 3692 female college students were enrolled in this study using the following criteria. We divided female college students into two groups stratified by age at menarche 13 years. The logical regression model was performed to evaluate the association between alcohol use and primary dysmenorrhea. The model adjusted for confounding factors and estimated the odds ratio and 95% confidence interval.Results: A total of 3692 female college students completed the survey, including 409(11.08%) students with alcohol use and 3283 (88.92%) participants without alcohol use. We founded that alcohol use and alcohol consumption were not related to dysmenorrhea. However, stratified by age at menarche, we found that there was a negative association between alcohol consumption and dysmenorrhea among participants with AAM ≥13 years (OR,1.41; 95% CI, 1.06, 1.88). Compared with participants without alcohol consumption, participants with alcohol consumption at least once a month (OR,1.29; 95% CI, 0.94, 1.78) and alcohol consumption at least once a week (OR,1.92; 95% CI, 1.07, 3.45) were more likely to have dysmenorrhea adjusted for other confounding factors.Conclusion: Our findings showed there was a negative association between alcohol consumption and dysmenorrhea stratified by age at menarche (13 years).