Endocrine Disruption Is Reduced but Still Widespread in Wild Roach (Rutilus rutilus) Living in English Rivers

Do you think medicines can be prescribed in a more eco-directed, greener way? A qualitative study based on public and prescriber focus groups on the impact of pharmaceuticals in Scotland's water environment

OBJECTIVES

This qualitative study explored public and prescriber awareness of pharmaceutical pollution in the water environment and eco-directed sustainable prescribing (EDSP) as a mitigation strategy to reduce the environmental impact of prescribing in Scotland.

DESIGN

Focus groups explored prescriber and public perceptions of the topic. Common questions were asked through semistructured facilitation. Focus groups were digitally recorded and transcribed verbatim using an artificial intelligence system, then anonymised and thematically analysed using NVivo software. Data were iteratively analysed using the one sheet of paper technique.

SETTING

Public focus groups were held in-person (Inverness, Scotland, April 2023), and prescriber focus groups were held virtually (MS Teams, August 2023).

PARTICIPANTS

Nine public representatives and 17 NHS Scotland prescribers participated in one of four focus groups. Purposive and opportunistic sampling approaches were used to recruit participants through social media and other channels (ie, community groups, professional emails, general practitioner and hospital flyers). Prescriber representatives registered interest through an online survey to gather information about their professional background. Responses were reviewed to ensure representation of a mixture of medical backgrounds, experience, sectors and health boards.

RESULTS

There is growing awareness among the public and healthcare professionals of pharmaceutical pollution in the environment, but further education is required on the drivers, potential effects and possible interventions. Suggestions for more sustainable healthcare included public health awareness campaigns, better provision for pharmacy take-back schemes, clear medicine/packaging labelling, regular medicines reviews and more considered patient-centred care. From the prescriber perspective, EDSP resonated well with current sustainability initiatives (eg, Realistic Medicine, switching to dry-powder inhalers), but barriers to EDSP included lack of knowledge, confidence, time and resources to implement changes. Although the public representatives were generally open to the concept of EDSP, this decision required weighing pros/cons considering personal health choices, information accessibility and transparency, and trust in and time with prescribers.

CONCLUSIONS

This study identified new insights from prescribers and the public related to the concept of, and barriers to, EDSP in Scotland, as well as perspectives regarding knowledge support tools and information communication. Cross-sector and transdisciplinary collaborative approaches are needed to address the challenges identified here. Nonetheless, EDSP merits further exploration in developing more sustainable, appropriate and effective healthcare which contributes to improved public and planetary health.

Fe(III)-Aided Novosphingobium sp. ES2-1 Regulates Molecular Mechanisms of 17β-Estradiol Biodegradation

17β-estradiol (E2) is one of the strongest environmental estrogens threatening wildlife and human health globally. Microbial degradation is an alternative strategy to remediate E2-contaminated sites and may be regulated by ubiquitous Fe(III) in eco-environments. We have previously obtained a high-efficiency E2 degrader, Novosphingobium sp. ES2-1, and investigated its metabolic pathway in connection with monooxygenase EstO1-induced ring-B opening; however, the molecular mechanisms of ring-A cleavage in E2 are sorely lacking, especially under Fe(III)-aided regulation. Here, an extradiol dioxygenase EstN1 from strain ES2-1 involved in the ring-A cleavage of E2 was reported. It catalyzed the 4,5-seco reaction of 4-hydroxyestrone (4-OH-E1, a key E2-oxidized intermediate) with the support of the electron transport chain consisting of ferredoxin EstN2 and ferredoxin reductase EstN3, resulting in a ring-A meta-cleaved product. Interestingly, Fe(III)-assisted strain ES2-1 consolidated the opening of rings A and B in E2 by reinforcing the expression of estO1 and estN1 genes, consequently enhancing E2 metabolism. Compared to Fe(III) starvation, the biodegradation half-life of E2 was sharply reduced from 1.35 to 0.59 d after Fe(III) supplementation. Simultaneously, the transcription of estO1 and estN1 genes increased clearly from 4.3 to 47.5 times and 6.6 to 246.8 times after Fe(III) induction, respectively, accompanied by remarkable improvement in the abundance of ring-A/B cleavage products and their pyridine derivatives. These findings highlight the significance of Fe(III) in regulating the microbial remediation of environmental estrogens at the molecular level.

Co-developing frameworks towards environmentally directed pharmaceutical prescribing in Scotland - A mixed methods study

The presence of human pharmaceuticals in the aquatic environment is recognised internationally as an important public health and environmental issue. In Scotland, healthcare sustainability targets call for improvements to medicine prescribing and use to reduce healthcare's impact on the environment. This proof-of-concept study aimed to develop a framework on the environmental impact of pharmaceuticals to use as a knowledge support tool for healthcare professionals, focussing on pharmaceutical pollution. Nominal Group Technique was applied to achieve consensus on pharmaceuticals and modelling factors for the framework, working with a panel of cross-sector stakeholders. Bayesian Belief Network modelling was applied to predict the environmental impact (calculated from hazard and exposure factors) of selected pharmaceuticals, with Scotland-wide mapping for visualisation in freshwater catchments. The model calculated the pollution risk score of the individual pharmaceuticals, using the ratio of prescribed mass vs. mass that would not exceed the predicted no-effect concentration in the freshwater environment. The pharmaceuticals exhibited different risk patterns, and spatial variation of risk was evident (generally related to population density), with the most catchments predicted to exceed the pollution risk score for clarithromycin (probability >80 % in 35 of 40 modelled catchments). Simulated risk scores were compared against observed risk calculated as the ratio of measured environmental concentrations from national regulatory and research monitoring and predicted no-effect concentrations. The model generally overpredicted risk, likely due to missing factors (e.g. solid-phase sorption, temporal variation), low spatial resolution, and low temporal resolution of the monitoring data. This work demonstrates a novel, trans-disciplinary approach to develop tools aiding collation and integration of environmental information into healthcare decision-making, through application of public health, environmental science, and health services research methods. Future work will refine the framework with additional clinical and environmental factors to improve model performance, and develop electronic interfaces to communicate environmental information to healthcare professionals.

Assessing Environmental Risks during the Drug Development Process for Parasitic Vector-Borne Diseases: A Critical Reflection

Parasitic vector-borne diseases (VBDs) represent nearly 20% of the global burden of infectious diseases. Moreover, the spread of VBDs is enhanced by global travel, urbanization, and climate change. Treatment of VBDs faces challenges due to limitations of existing drugs, as the potential for side effects in nontarget species raises significant environmental concerns. Consequently, considering environmental risks early in drug development processes is critically important. Here, we examine the environmental risk assessment process for veterinary medicinal products in the European Union and identify major gaps in the ecotoxicity data of these drugs. By highlighting the scarcity of ecotoxicological data for commonly used antiparasitic drugs, we stress the urgent need for considering the One Health concept. We advocate for employing predictive tools and nonanimal methodologies such as New Approach Methodologies at early stages of antiparasitic drug research and development. Furthermore, adopting progressive approaches to mitigate ecological risks requires the integration of nonstandard tests that account for real-world complexities and use environmentally relevant exposure scenarios. Such a strategy is vital for a sustainable drug development process as it adheres to the principles of One Health, ultimately contributing to a healthier and more sustainable world.