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Boudreau LeBlanc A, Motulsky A, Moreault MP, Liang MQ, Ngueng Feze I, Des Côteaux L. Building a Logic Model to Foster Engagement and Learning Using the Case of a Province-Wide Multispecies Antimicrobial Use Monitoring System. EVALUATION REVIEW 2024; 48:736-765. [PMID: 37684036 PMCID: PMC11193913 DOI: 10.1177/0193841x231198706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Successfully designing and implementing a program is complex; it requires a reflexive balance between the available resources and the priorities of various stakeholders, both of which change over time. Logic models are theory-based evaluation approaches used to identify and address key challenges of a program. This article describes the process of building a logic model on advanced theories in complexity studies. The models aim to support a province-wide multispecies monitoring system of antimicrobial use (AMU), designed in collaboration with the animal health sector in Quebec (Canada). Based on a rigorous theoretical foundation, the logic model is built in three steps: (1) mapping, a narrative review of literature on similar programs in other jurisdictions; (2) framing, iterative consultations with project members to elaborate the logic model; (3) shaping, hypotheses based on the logic model. The model emerges from the reflexive balancing of current scientific knowledge and empirical insights to gather relevant information about stakeholders from interdisciplinary experts that led a 3-year consensus-building process within the community. Recognizing the challenge of unpacking theories for practical use, we illustrate how the process of an "open" logic model building could enable governance coordination in complex processes. Logic models are useful for evaluating public, private, and academic partnerships in One Health programs that characterize an adaptive governance process.
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Affiliation(s)
- Antoine Boudreau LeBlanc
- Département de Médecine sociale et préventive (Programmes de bioéthiques), École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Aude Motulsky
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Moreault
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, QC, Canada
- Le Centre de Recherche, Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Man Qing Liang
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, QC, Canada
| | - Ida Ngueng Feze
- Faculté de Médecine vétérinaire, Université de Montréal, Montréal, QC, Canada
| | - Luc Des Côteaux
- Faculté de Médecine vétérinaire, Université de Montréal, Montréal, QC, Canada
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Broom J, Broom A. Qualitative research methods: powerful tools for understanding practice and informing change. J Hosp Infect 2024; 149:182-183. [PMID: 38705473 DOI: 10.1016/j.jhin.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 05/07/2024]
Affiliation(s)
- J Broom
- School of Medicine and Dentistry (Sunshine Coast Campus), Griffith University, Sunshine Coast, Australia; Department of Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
| | - A Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, New South Wales, Australia
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Abel K, Agnew E, Amos J, Armstrong N, Armstrong-James D, Ashfield T, Aston S, Baillie JK, Baldwin S, Barlow G, Bartle V, Bielicki J, Brown C, Carrol E, Clements M, Cooke G, Dane A, Dark P, Day J, de-Soyza A, Dowsey A, Evans S, Eyre D, Felton T, Fowler T, Foy R, Gannon K, Gerada A, Goodman A, Harman T, Hayward G, Holmes A, Hopkins S, Howard P, Howard A, Hsia Y, Knight G, Lemoine N, Koh J, Macgowan A, Marwick C, Moore C, O’Brien S, Oppong R, Peacock S, Pett S, Pouwels K, Queree C, Rahman N, Sculpher M, Shallcross L, Sharland M, Singh J, Stoddart K, Thomas-Jones E, Townsend A, Ustianowski A, Van Staa T, Walker S, White P, Wilson P, Buchan I, Woods B, Bower P, Llewelyn M, Hope W. System-wide approaches to antimicrobial therapy and antimicrobial resistance in the UK: the AMR-X framework. THE LANCET. MICROBE 2024; 5:e500-e507. [PMID: 38461831 DOI: 10.1016/s2666-5247(24)00003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 03/12/2024]
Abstract
Antimicrobial resistance (AMR) threatens human, animal, and environmental health. Acknowledging the urgency of addressing AMR, an opportunity exists to extend AMR action-focused research beyond the confines of an isolated biomedical paradigm. An AMR learning system, AMR-X, envisions a national network of health systems creating and applying optimal use of antimicrobials on the basis of their data collected from the delivery of routine clinical care. AMR-X integrates traditional AMR discovery, experimental research, and applied research with continuous analysis of pathogens, antimicrobial uses, and clinical outcomes that are routinely disseminated to practitioners, policy makers, patients, and the public to drive changes in practice and outcomes. AMR-X uses connected data-to-action systems to underpin an evaluation framework embedded in routine care, continuously driving implementation of improvements in patient and population health, targeting investment, and incentivising innovation. All stakeholders co-create AMR-X, protecting the public from AMR by adapting to continuously evolving AMR threats and generating the information needed for precision patient and population care.
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Raad R, Dixon J, Gorsky M, Hoddinott G. Cycles of antibiotic use and emergent antimicrobial resistance in the South African tuberculosis programme (1950-2021): A scoping review and critical reflections on stewardship. Glob Public Health 2024; 19:2356623. [PMID: 38771831 DOI: 10.1080/17441692.2024.2356623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
The emergent threat of antimicrobial resistance (AMR) has resulted in debates around the use and preservation of effective antimicrobials. Concerns around AMR reflect a history of increasing dependence on antibiotics to address disease epidemics rooted in profound structural and systemic challenges. In the context of global health, this process, often referred to as pharmaceuticalisation, has commonly occurred within disease programmes, of which lessons are vital for adding nuance to conversations around antimicrobial stewardship. Tuberculosis (TB) is a notable example. A disease which accounts for one-third of AMR globally and remains the leading cause of death from a single infectious agent in many low - and middle-income countries, including South Africa. In this scoping review, we chart TB science in South Africa over 70 years of programming. We reviewed published manuscripts about the programme and critically reflected on the implications of our findings for stewardship. We identified cycles of programmatic responses to new drug availability and the emergence of drug resistance, which intersected with cycles of pharmaceuticalisation. These cycles reflect the political, economic, and social factors influencing programmatic decision-making. Our analysis offers a starting point for research exploring these cycles and drawing out implications for stewardship across the TB and AMR communities.
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Affiliation(s)
- Rene Raad
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin Dixon
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The Health Research Institute Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Martin Gorsky
- Centre for History in Public Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Mone NS, Syed S, Ravichandiran P, Kamble EE, Pardesi KR, Salunke-Gawali S, Rai M, Vikram Singh A, Prasad Dakua S, Park BH, Yoo DJ, Satpute SK. Synergistic and Additive Effects of Menadione in Combination with Antibiotics on Multidrug-Resistant Staphylococcus aureus: Insights from Structure-Function Analysis of Naphthoquinones. ChemMedChem 2023; 18:e202300328. [PMID: 37874976 DOI: 10.1002/cmdc.202300328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 10/26/2023]
Abstract
Antimicrobial resistance (AMR) interferes with the effective treatment of infections and increases the risk of microbial spread and infection-related illness and death. The synergistic activities of combinations of antimicrobial compounds offer satisfactory approaches to some extent. Structurally diverse naphthoquinones (NQs) including menadione (-CH3 group at C2) exhibit substantial antimicrobial activities against multidrug-resistant (MDR) pathogens. We explored the combinations of menadione with antibiotic ciprofloxacin or ampicillin against Staphylococcus aureus and its biofilms. We found an additive (0.590 %) were also observed. However, preformed biofilms were not affected. Dent formation was also evident in S. aureus treated with the test compounds. The structure-function relationship (SFR) of NQs was used to determine and predict their activity pattern against pathogens. Analysis of 10 structurally distinct NQs revealed that the compounds with -Cl, -Br, -CH3 , or -OH groups displayed the lowest MICs (32-256 μg/mL). Furthermore, 1,4-NQs possessing a halogen or -CH3 moiety showed elevated ROS activity, whereas molecules with an -OH group affected cell integrity. Improved activity of antimicrobial combinations and SFR approaches are significant in antimicrobial therapies.
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Affiliation(s)
- Nishigandha S Mone
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, 411007, India
| | - Sahil Syed
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, 411007, India
| | - Palanisamy Ravichandiran
- Department of Energy Storage/Conversion Engineering (BK21 FOUR) of Graduate School, Hydrogen and Fuel Cell Research Center, Jeonbuk National University, Jeonju, Jeollabuk-do, 54896, Republic of Korea
- Department of Life Science, Jeonbuk National University, Jeonju, Jeollabuk-do, 54896, Republic of Korea
| | - Ekta E Kamble
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, 411007, India
| | - Karishma R Pardesi
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, 411007, India
| | - Sunita Salunke-Gawali
- Department of Chemistry, Savitribai Phule Pune University, Pune, Maharashtra m, 411007, India
| | - Mansi Rai
- Department of Microbiology, Central University of Rajasthan Ajmer, Rajasthan, 305817, India
| | - Ajay Vikram Singh
- Department of Chemical and Product Safety, German Federal Institute (BfR), Max-Dohrn-Str. 8-10, 10589, Berlin, Germany
| | | | - Byung-Hyun Park
- Department of Biochemistry, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54896, Republic of Korea
| | - Dong Jin Yoo
- Department of Energy Storage/Conversion Engineering (BK21 FOUR) of Graduate School, Hydrogen and Fuel Cell Research Center, Jeonbuk National University, Jeonju, Jeollabuk-do, 54896, Republic of Korea
- Department of Life Science, Jeonbuk National University, Jeonju, Jeollabuk-do, 54896, Republic of Korea
| | - Surekha K Satpute
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra, 411007, India
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Denyer Willis L, Kayendeke M, Chandler CIR. The politics of irrationality. Med Anthropol Q 2023; 37:382-395. [PMID: 37703403 PMCID: PMC10947286 DOI: 10.1111/maq.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/16/2023] [Indexed: 09/15/2023]
Abstract
In siloed discussions of antimicrobial resistance, antibiotic use on farms in the Global South has emerged as a key site for intervention. The antibiotic consumption targeted is not all consumption, but "irrational" consumption. This concept of irrationality is neither new, nor true, but rather is a long-standing form of maintenance work within global health systems. Via an attention to chickens and the antibiotics farmers use to raise them in the suburbs of Kampala, we suggest that claims of irrationality are a central part of constituting what Tania Li has called the 'deficient subject'. In other words, irrationality, like the chicken and the antibiotic, is itself a humanitarian device that maintains a certain condition of governance where 'Africans' are imagined as being in deficit of rationality and good behavior. Claims of irrationality justify (and mask the political nature of) intervention.
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Affiliation(s)
| | | | - Clare IR Chandler
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Zhang T, Lin H, Zhao X, Wang W, Yan F, Lambert H. Influences on treatment-seeking and antibiotic use for common illnesses in eastern China. BMC Public Health 2023; 23:1849. [PMID: 37740203 PMCID: PMC10517519 DOI: 10.1186/s12889-023-16700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people's decisions on treatment and antibiotic use for common illnesses in eastern China. METHODS Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project. RESULTS Participants' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use. CONCLUSIONS People's treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.
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Affiliation(s)
- Tingting Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hanyi Lin
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Xinping Zhao
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.
- Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, Shanghai, China.
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Degeling C, Yarwood T, Nettel-Aguirre A, Mullan J, Reynolds N, Chen G. Exploring the Preferences of the Australian Public for Antibiotic Treatments: A Discrete Choice Experiment. THE PATIENT 2023; 16:555-567. [PMID: 37462880 PMCID: PMC10409829 DOI: 10.1007/s40271-023-00640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES Identify Australian public preferences for antibiotic treatments in the context of antibiotic stewardship. METHODS A discrete choice experiment (DCE) was conducted in Australia to investigate the importance of seven attributes associated with antibiotic treatments and related stewardship practices: contribution to antimicrobial resistance (AMR), treatment duration, side effects, days needed to recover, days before taking antibiotics, treatment failure and out-of-pocket costs. The DCE data were analysed using conditional logit, mixed logit and latent class conditional logit models. The relative importance of each attribute was calculated. RESULTS A total of 1882 respondents completed the survey; the main study sample consist of 1658 respondents (mean age 48 years) who passed quality checks. All seven attributes significantly influenced respondents' preferences for antibiotic treatments. Based on the designed attribute levels in the DCE, on average, out-of-pocket costs (32.8%) and contribution to antibiotic resistance (30.3%) were the most important attributes, followed by side effects (12.9%). Days before starting medication was least important (3.9%). Three latent classes were identified. Class 1 (including respondents who were more likely to be older and more health literate; 24.5%) gave contribution to antibiotic resistance greater importance in treatment preferences. Class 2 (including respondents more likely to report poorer health; 25.2%) gave out-of-pocket costs greater importance. The remaining (50.4%), who were generally healthier, perceived side effects as the most important attribute. CONCLUSIONS Despite concerted public awareness raising campaigns, our results suggest that several factors may influence the preferences of Australians when considering antibiotic use. However, for those more likely to be aware of the need to preserve antibiotics, out-of-pocket costs and limiting the contribution to antibiotic resistance are the dominant influence. Delays in starting treatment were not important for any latent class, suggesting public tolerance for this measure. These results could help inform strategies to promote prudent antibiotic stewardship.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement Evidence and Values, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Trent Yarwood
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- Rural Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, University of Wollongong, NIASRA, Wollongong, NSW 2522 Australia
| | - Judy Mullan
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW Australia
| | - Nina Reynolds
- School of Business, Faculty of Business and Law, University of Wollongong, Wollongong, NSW Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Monash Business School, Melbourne, Australia
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Nair M, Engel N, Zeegers MP, Burza S. Perceptions of effective policy interventions and strategies to address antibiotic misuse within primary healthcare in India: A qualitative study. J Infect Prev 2023; 24:113-118. [PMID: 37065277 PMCID: PMC10090571 DOI: 10.1177/17571774231158778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Objectives Antimicrobial resistance poses a major public health threat. Despite Indian retail sector antibiotic consumption per capita increasing by approximately 22% between 2008 and 2016, empirical studies that examine policy or behavioural interventions addressing antibiotic misuse in primary healthcare are scarce. Our study aimed to assess perceptions of interventions and gaps in policy and practice with respect to outpatient antibiotic misuse in India. Methods We conducted 23 semi-structured, in-depth interviews with a variety of key informants with diverse backgrounds in academia, non-government organisations, policy, advocacy, pharmacy, medicine and others. Data were charted into a framework matrix and analysed using a hybrid, inductive and deductive thematic analysis. Themes were analysed and organised according to the socio-ecological model at various levels ranging from the individual to the enabling environment. Results Key informants largely focused on the importance of adopting a structural perspective to addressing socio-ecological drivers of antibiotic misuse. There was a recognition that educational interventions targeting individual or interpersonal interactions were largely ineffective, and policy interventions should incorporate behavioural nudge interventions, improve the healthcare infrastructure and embrace task shifting to rectify staffing disparities in rural areas. Conclusions Prescription behaviour is perceived to be governed by structural issues of access and limitations in public health infrastructure that create an enabling environment for antibiotic overuse. Interventions should move beyond a clinical and individual focus on behaviour change with respect to antimicrobial resistance and aim for structural alignment between existing disease specific programs and between the informal and formal sector of healthcare delivery in India.
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Affiliation(s)
- Mohit Nair
- Maastricht University, Maastricht, Netherlands
| | - Nora Engel
- Maastricht University, Maastricht, Netherlands
| | | | - Sakib Burza
- London School of Hygiene & Tropical Medicine, London, UK
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"If You Do Not Take the Medicine and Complete the Dose…It Could Cause You More Trouble": Bringing Awareness, Local Knowledge and Experience into Antimicrobial Stewardship in Tanzania. Antibiotics (Basel) 2023; 12:antibiotics12020243. [PMID: 36830154 PMCID: PMC9952761 DOI: 10.3390/antibiotics12020243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global health issue disproportionately affecting low- and middle-income countries. In Tanzania, multi-drug-resistant bacteria (MDR) are highly prevalent in clinical and community settings, inhibiting effective treatment and recovery from infection. The burden of AMR can be alleviated if antimicrobial stewardship (AMS) programs are coordinated and incorporate local knowledge and systemic factors. AMS includes the education of health providers to optimise antimicrobial use to improve patient outcomes while minimising AMR risks. For programmes to succeed, it is essential to understand not just the awareness of and receptiveness to AMR education, but also the opportunities and challenges facing health professionals. We conducted in-depth interviews (n = 44) with animal and human health providers in rural northern Tanzania in order to understand their experiences around AMR. In doing so, we aimed to assess the contextual factors surrounding their practices that might enable or impede the translation of knowledge into action. Specifically, we explored their motivations, training, understanding of infections and AMR, and constraints in daily practice. While providers were motivated in supporting their communities, clear issues emerged regarding training and understanding of AMR. Community health workers and retail drug dispensers exhibited the most variation in training. Inconsistencies in understandings of AMR and its drivers were apparent. Providers cited the actions of patients and other providers as contributing to AMR, perpetuating narratives of blame. Challenges related to AMR included infrastructural constraints, such as a lack of diagnostic testing. While health and AMR-specific training would be beneficial to address awareness, equally important, if not more critical, is tackling the challenges providers face in turning knowledge into action.
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12
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da Silva-Brandao RR, de Oliveira SM, Correa JS, Zago LF, Fracolli LA, Padoveze MC, Currea GCC. Coping with in-locus factors and systemic contradictions affecting antibiotic prescription and dispensing practices in primary care-A qualitative One Health study in Brazil. PLoS One 2023; 18:e0280575. [PMID: 36662722 PMCID: PMC9857971 DOI: 10.1371/journal.pone.0280575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) is an increasing threat to global health. The risks and sanitary consequences of AMR are disproportionately experienced by those living in Low- and Middle-Income Countries (LMICs). While addressing antibiotic use has largely been documented in hospital settings, the understanding of social drivers affecting antibiotic prescribing and dispensing practices in the context of human and animal health in primary care (PC) in LMICs remains extremely limited. We seek to explore how in-locus and multi-level social factors influence antibiotic prescriptions and dispensing practices in the context of human and animal health in primary care in Brazil. This is a baseline qualitative One Health study; semi-structured interviews and field observations were undertaken in primary care sites located in a socioeconomically vulnerable area in the city of São Paulo, the most populated city of Brazil. Twenty-five human and animal healthcare professionals (HP) were purposely sampled. Interview data were subject to thematic analysis. Three overlapping social drivers were identified across HPs' discourses: individual and behavioral challenges; relational and contextual factors influencing the overprescription of antibiotics (AB); and structural barriers and systemic contradictions in the health system. As a result of the interaction between multilevel in-locus and structural and contextual factors, HPs experience contextual and territorial challenges that directly influence their risk perception, diagnosis, use of laboratorial and image exams, time and decision to undergo treatment, choice of AB and strategies in coping with AB prescriptions. Additionally, in-locus factors influencing antibiotic prescriptions and dispensing practices are intertwined with individual accounts of risk management, systemic contradictions and ambivalences in the national health system. Our findings suggest interventions tackling AB use and AMR in Brazil should consider the social context, the complex health system structure and current integrated programs and services in PC.
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Affiliation(s)
- Roberto Rubem da Silva-Brandao
- Nursing School, University of São Paulo, São Paulo, Brazil
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sandi Michele de Oliveira
- Section of General Practice, Institute of Public Health, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Gloria Cristina Cordoba Currea
- Section of General Practice, Institute of Public Health, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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13
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Garvey M, Meade E, Rowan NJ. Effectiveness of front line and emerging fungal disease prevention and control interventions and opportunities to address appropriate eco-sustainable solutions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158284. [PMID: 36029815 DOI: 10.1016/j.scitotenv.2022.158284] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Fungal pathogens contribute to significant disease burden globally; however, the fact that fungi are eukaryotes has greatly complicated their role in fungal-mediated infections and alleviation. Antifungal drugs are often toxic to host cells and there is increasing evidence of adaptive resistance in animals and humans. Existing fungal diagnostic and treatment regimens have limitations that has contributed to the alarming high mortality rates and prolonged morbidity seen in immunocompromised cohorts caused by opportunistic invasive infections as evidenced during HIV and COVID-19 pandemics. There is a need to develop real-time monitoring and diagnostic methods for fungal pathogens and to create a greater awareness as to the contribution of fungal pathogens in disease causation. Greater information is required on the appropriate selection and dose of antifungal drugs including factors governing resistance where there is commensurate need to discover more appropriate and effective solutions. Popular azole fungal drugs are widely detected in surface water and sediment due to incomplete removal in wastewater treatment plants where they are resistant to microbial degradation and may cause toxic effects on aquatic organisms such as algae and fish. UV has limited effectiveness in destruction of anti-fungal drugs where there is increased interest in the combination approaches such as novel use of pulsed-plasma gas-discharge technologies for environmental waste management. There is growing interest in developing alternative and complementary green eco-biocides and disinfection innovation. Fungi present challenges for cleaning, disinfection and sterilization of reusable medical devices such as endoscopes where they (example, Aspergillus and Candida species) can be protected when harboured in build-up biofilm from lethal processing. Information on the efficacy of established disinfection and sterilization technologies to address fungal pathogens including bottleneck areas that present high risk to patients is lacking. There is a need to address risk mitigation and modelling to inform efficacy of appropriate intervention technologies that must consider all contributing factors where there is potential to adopt digital technologies to enable real-time analysis of big data, such as use of artificial intelligence and machine learning. International consensus on standardised protocols for developing and reporting on appropriate alternative eco-solutions must be reached, particularly in order to address fungi with increasing drug resistance where research and innovation can be enabled using a One Health approach.
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Affiliation(s)
- Mary Garvey
- Department of Life Science, Atlantic Technological University, Sligo, Ireland; Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, Sligo, Ireland
| | - Elaine Meade
- Department of Life Science, Atlantic Technological University, Sligo, Ireland; Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, Sligo, Ireland
| | - Neil J Rowan
- Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone, Ireland; Centre for Decontamination, Sterilization and Biosecurity, Technological University of the Shannon Midlands Midwest, Athlone, Ireland; Empower Eco Sustainability Hub, Technological University of the Shannon Midlands Midwest, Athlone, Ireland.
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14
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Cañada JA, Sariola S, Butcher A. In critique of anthropocentrism: a more-than-human ethical framework for antimicrobial resistance. MEDICAL HUMANITIES 2022; 48:e16. [PMID: 35321873 PMCID: PMC9691817 DOI: 10.1136/medhum-2021-012309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 05/08/2023]
Abstract
Antimicrobial resistance (AMR) is often framed as a One Health issue, premised on the interdependence between human, animal and environmental health. Despite this framing, the focus across policymaking, implementation and the ethics of AMR remains anthropocentric in practice, with human health taking priority over the health of non-human animals and the environment, both of which mostly appear as secondary elements to be adjusted to minimise impact on human populations. This perpetuates cross-sectoral asymmetries whereby human health institutions have access to bigger budgets and technical support, limiting the ability of agricultural, animal health or environmental institutions to effectively implement policy initiatives. In this article, we review these asymmetries from an ethical perspective. Through a review and analysis of contemporary literature on the ethics of AMR, we demonstrate how the ethical challenges and tensions raised still emerge from an anthropocentric framing, and argue that such literature fails to address the problematic health hierarchies that underlie policies and ethics of AMR. As a consequence, they fail to provide the necessary tools to ethically evaluate the more-than-human challenges that the long list of actors involved in managing AMR face in their everyday practices. In response to such shortcomings, and to make sense of these challenges and tensions, this article develops an ethical framework based on relationality, care ethics and ambivalence that attends to the more-than-human character of AMR. We formulate this approach without overlooking everyday challenges of implementation by putting the framework in conversation with concrete situations from precarious settings in West Africa. This article concludes by arguing that a useful AMR ethics framework needs to consider and take seriously non-human others as an integral part of both health and disease in any given ecology.
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Affiliation(s)
- Jose A Cañada
- Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Salla Sariola
- Sociology, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Andrea Butcher
- Sociology, University of Helsinki, Helsinki, Uusimaa, Finland
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15
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Zago LF, Correa JS, da Silva‐Brandão RR, Fracolli LA, Padoveze MC, de Oliveira SM, Corboda Currea GC. Experiences of antibiotic use among Brazilian healthcare users: An exploratory study. Health Expect 2022; 26:343-354. [PMID: 36420763 PMCID: PMC9854310 DOI: 10.1111/hex.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This article analyzes experiences of antibiotic use and bacterial infections among Primary Health Care users of the Brazilian Unified Health System (SUS) and the possible implications for antimicrobial resistance (AMR). The aim is to map aspects that shape users' lay knowledge regarding antibiotics use and AMR. METHODS This is an exploratory study, which consists primarily of individual in-depth interviews with 19 respondents. Recurrent interview topics were coded and analysed according to thematic content analysis. RESULTS Our findings show users' lived experiences constitute three dimensions related to users' previous antibiotic use: (1) lay knowledge about medicines; (2) previous bacterial infections and (3) communication during the consultation. Lay knowledge encompasses the users' understanding of how antibiotics work in comparison to other drugs and experimentations they make with medication. Users' narratives about bacterial infections are divided into situations of urinary tract infections and antibiotic treatments for other conditions. Communication during the consultation is mainly characterized by a lack of shared knowledge and trust in the doctor-patient relationship. DISCUSSION Users bring together knowledge learned from their own experiences to create the rationale, which shapes how they understand antibiotic use, bacterial infections and medical advice. These experiences are interwoven with information received from healthcare professionals (HPs) on these topics, creating a scenario that goes beyond professional information about antibiotic use. Users have knowledge about medication, antibiotics use and bacterial infection but do not have room to share it with HP, allowing lived experiences to take precedence over professional information. CONCLUSION Users ascribe symbolic meanings to antibiotics creating a lay knowledge frame, even if this knowledge is not scientifically correct. The personal experiences of bacterial infections and their treatment are also an important source of knowledge about antibiotic use and AMR among users. Users demand from their HPs both trust and willingness to listen to their health narratives and experiences. By considering lay knowledge as part of the assessment of a user's health condition, rather than dismissing it as erroneous and therefore unworthy of attention, HPs may enhance the compliance of users. PATIENT OR PUBLIC CONTRIBUTION Patients or community members did not participate in the design stage of the study. Primary Care patients were invited to participate as respondents of in-depth interviews, which were carried out by the first author at a Primary Care Unit (PCU) in the suburb of Campo Limpo, Southern region of São Paulo, Brazil. Patients were interviewed after reading and signing a Free and Informed Consent Form, holding with them a copy of the Form. Among the final activities of the project, a feedback session at the same PCU is planned to report on the results of the study. All respondents will have the opportunity to contribute further information regarding their antibiotic use and exchange knowledge and experiences on antimicrobial resistance.
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Affiliation(s)
- Luiz F. Zago
- Department of Nursing in Collective Health, School of NursingUniversity of São PauloSão PauloBrazil
| | - Juliana S. Correa
- Department of Nursing in Collective Health, School of NursingUniversity of São PauloSão PauloBrazil
| | | | - Lislaine A. Fracolli
- Department of Nursing in Collective Health, School of NursingUniversity of São PauloSão PauloBrazil
| | - Maria Clara Padoveze
- Department of Nursing in Collective Health, School of NursingUniversity of São PauloSão PauloBrazil
| | - Sandi Michele de Oliveira
- Section of General Practice, Institute of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Gloria C. Corboda Currea
- Section of General Practice, Institute of Public Health, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Antimicrobial Research Unit, School of Health SciencesUniversity of Kwazulu‐NatalDurbanSouth Africa
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16
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Thornber K, Bashar A, Ahmed MS, Bell A, Trew J, Hasan M, Hasan NA, Alam MM, Chaput DL, Haque MM, Tyler CR. Antimicrobial Resistance in Aquaculture Environments: Unravelling the Complexity and Connectivity of the Underlying Societal Drivers. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:14891-14903. [PMID: 36102785 PMCID: PMC9631993 DOI: 10.1021/acs.est.2c00799] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 05/26/2023]
Abstract
Food production environments in low- and middle-income countries (LMICs) are recognized as posing significant and increasing risks to antimicrobial resistance (AMR), one of the greatest threats to global public health and food security systems. In order to maximize and expedite action in mitigating AMR, the World Bank and AMR Global Leaders Group have recommended that AMR is integrated into wider sustainable development strategies. Thus, there is an urgent need for tools to support decision makers in unravelling the complex social and environmental factors driving AMR in LMIC food-producing environments and in demonstrating meaningful connectivity with other sustainable development issues. Here, we applied the Driver-Pressure-State-Impact-Response (DPSIR) conceptual framework to an aquaculture case study site in rural Bangladesh, through the analysis of distinct social, microbiological, and metagenomic data sets. We show how the DPSIR framework supports the integration of these diverse data sets, first to systematically characterize the complex network of societal drivers of AMR in these environments and second to delineate the connectivity between AMR and wider sustainable development issues. Our study illustrates the complexity and challenges of addressing AMR in rural aquaculture environments and supports efforts to implement global policy aimed at mitigating AMR in aquaculture and other rural LMIC food-producing environments.
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Affiliation(s)
- Kelly Thornber
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
- Centre
for Sustainable Aquaculture Futures, University
of Exeter, Stocker Road, Exeter EX4
4QD, United Kingdom
| | - Abul Bashar
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | | | - Ashley Bell
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | - Jahcub Trew
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | - Mahmudul Hasan
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Neaz A. Hasan
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Md. Mehedi Alam
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Dominique L. Chaput
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | | | - Charles R. Tyler
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
- Centre
for Sustainable Aquaculture Futures, University
of Exeter, Stocker Road, Exeter EX4
4QD, United Kingdom
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17
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Lazure P, Augustyniak M, Goff DA, Villegas MV, Apisarnthanarak A, Péloquin S. Gaps and barriers in the implementation and functioning of antimicrobial stewardship programmes: results from an educational and behavioural mixed methods needs assessment in France, the United States, Mexico and India. JAC Antimicrob Resist 2022; 4:dlac094. [PMID: 36196443 PMCID: PMC9524477 DOI: 10.1093/jacamr/dlac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/19/2022] [Indexed: 01/26/2023] Open
Abstract
Background Evidence shows limited adherence to antimicrobial stewardship (AMS) principles. Objectives To identify educational gaps and systemic barriers obstructing adherence to AMS principles. Methods A mixed-methods study combining a thematic analysis of qualitative interviews (January-February 2021) and inferential analysis of quantitative surveys (May-June 2021) was conducted. Participants from France, the USA, Mexico and India were purposively sampled from online panels of healthcare professionals to include infectious disease physicians, infection control specialists, clinical microbiologists, pharmacologists or pharmacists expected to apply AMS principles in their practice setting (e.g. clinic, academic-affiliated or community-based hospital). A gap analysis framework guided this study. Results The final sample included 383 participants (n = 33 interviews; n = 350 surveys). Mixed-methods findings indicated suboptimal knowledge and skills amongst participants to facilitate personal and collective application of AMS principles. Survey data indicated a gap in ideal versus current knowledge of AMS protocols, especially amongst pharmacologists (Δ0.95/4.00, P < 0.001). Gaps in ideal versus current skill levels were also measured and were highest amongst infectious control specialists (Δ1.15/4.00, P < 0.001), for convincing hospital executives to allocate resources to AMS programmes. Already existing systemic barriers (e.g. insufficient dedicated time/funding/training) were perceived as being aggravated during the COVID-19 pandemic (72% of survey participants agreed). Reported gaps were highest in India and France. Conclusions The educational needs of professionals and countries included in this study can inform future continuous professional development activities in AMS. Additional funding should be considered to address perceived systemic barriers. Local assessments are warranted to validate results and suitability of interventions.
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Affiliation(s)
| | | | - Debra A Goff
- The Ohio State University, College of Pharmacy, Columbus, OH, USA
| | - Maria Virginia Villegas
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
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18
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Irwin R. Imagining the postantibiotic future: the visual culture of a global health threat. MEDICAL HUMANITIES 2022; 48:371-380. [PMID: 33127615 PMCID: PMC9411892 DOI: 10.1136/medhum-2020-011884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
This article is concerned with the visual culture of global health data using antimicrobial resistance (AMR) as an example. I explore how public health data and knowledge are repackaged into visualisations and presented in four contemporary genres: the animation, the TED Talk, the documentary and the satire programme. I focus on how different actors describe a world in which there are no or few antibiotics that are effective against bacterial infections. I examine the form, content and style of the visual cultural of AMR, examining how these genres tell a story of impending apocalypse while also trying to advert it. This is a form of story-telling based around the if/then structure: we are told that if we do not take certain actions today, then we will face a postantibiotic future with certain, often catastrophic, consequences. Within this if/then structure, there are various aims and objectives: the goal may be preventing further spread of AMR, building awareness or pushing for certain policy or funding decisions. These stories also serve to place or deflect blame, on animals, occupations, patients, industries and others and to highlight risks and consequences. These examples share similarities in the forms of story-telling and narrative, and in the use of specific data sources and other images. By using several Swedish examples, I demonstrate how global data are reinterpreted for a national audience. Overall, I argue that while the convergence of a dominant narrative indicates scientific consensus, this consensus also stifles our collective imagination in finding new solutions to the problem. Finally, I also use the example of AMR to discuss the need for a broader social science and humanities engagement with the visual culture of global health data.
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Affiliation(s)
- Rachel Irwin
- Department of Arts and Cultural Sciences, Lund University, Lund, Sweden
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19
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Meagher KM, Watson S, Suh GA, Virk A. The New Precision Stewards? J Pers Med 2022; 12:jpm12081308. [PMID: 36013256 PMCID: PMC9409858 DOI: 10.3390/jpm12081308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.
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Affiliation(s)
- Karen M. Meagher
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9528
| | - Sara Watson
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Gina A. Suh
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Abinash Virk
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
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20
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Review of position statements on antimicrobial resistance and stewardship from professional pharmacy organisations. Res Social Adm Pharm 2022; 18:3974-3979. [PMID: 35842397 DOI: 10.1016/j.sapharm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Pharmacists play a key role in tackling the global public health threat of antimicrobial resistance (AMR) through contributing to antimicrobial stewardship (AMS) practices. Professional pharmacy organisations describe this AMS role in position statements. Understanding how this role is described, including the why and potential impact is a first step to understanding how this issue is described to the profession, and framed in advocacy. OBJECTIVE To examine how pharmacy's role in optimising antimicrobial use is articulated in pharmacy professional organisations' position statements. METHODS Publicly available AMR position statements were sourced between February 2021 and May 2021 from the available websites of all International Pharmaceutical Federation (FIP) member organisations, supplemented by a general engine search. Descriptive analysis was conducted with a focus on four key themes of interest: 1) rationale for pharmacists' involvement in AMS) 2) characterisation of pharmacists' AMS role; 3) perceived impact of pharmacists' involvement in AMS; and 4) perceived enablers and/or barriers to AMS involvement. RESULTS 17 position statements were sourced and analysed. Professional pharmacy organisations appear to focus on characterising pharmacists as advisors and educators as their primary role in AMS, with this function supported by their medication knowledge and accessibility as a health service. Specific settings, such as hospital or community pharmacy, were often highlighted in the documents, and were associated with the framing of the capacity and nature of pharmacists' involvement in AMS. However, the limitations of pharmacists and their positions were not discussed. CONCLUSIONS There is an opportunity for future research to explore the concordance between the expectation of pharmacists' involvement in AMS as outlined in these position statements, with the reality of their involvement. This is of importance in the primary care setting, as a key access point to antimicrobials globally.
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21
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Jones N, Mitchell J, Cooke P, Baral S, Arjyal A, Shrestha A, King R. Gender and Antimicrobial Resistance: What Can We Learn From Applying a Gendered Lens to Data Analysis Using a Participatory Arts Case Study? Front Glob Womens Health 2022; 3:745862. [PMID: 35720810 PMCID: PMC9199426 DOI: 10.3389/fgwh.2022.745862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance (AMR), the natural process by which bacteria become resistant to the medicines used to kill them, is becoming one of the greatest threats to health globally. AMR is accelerating at alarming rates due to behaviors across human, animal, and environmental health sectors as well as governance and policy shortfalls across each sector. Antimicrobial resistant infections occur through the same channels as other infectious diseases and are most common in countries/areas where there is limited access to improved sanitation facilities, reliable healthcare and health education. At the community level, much remains to be understood about the drivers of antimicrobial resistance and how to generate community-led, acceptable solutions. Gender can influence every part of an individual's health experiences; access to knowledge, healthcare facilities, financial resources and paid employment are all heavily gendered and influence behaviors relating to the procurement of antimicrobial and antibiotic agents. This analysis uses data gathered during a participatory video study designed to work with two communities in Nepal to understand drivers of antibiotic mis and over use from the perspective of the communities themselves. Findings reveal that gender impacts upon many aspects of AMR-driving behaviors within this community and stimulate essential discussion as to the importance of gender in future AMR research. This paper places a spotlight on gender in the wider AMR conversation, an area that is currently neglected, and improve our collective knowledge on the drivers of AMR from a gendered perspective.
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Affiliation(s)
- Nichola Jones
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Paul Cooke
- Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | | | | | | | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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22
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Cobo-Angel C, Gohar B, LeBlanc SJ. Values and Risk Perception Shape Canadian Dairy Farmers’ Attitudes toward Prudent Use of Antimicrobials. Antibiotics (Basel) 2022; 11:antibiotics11050550. [PMID: 35625194 PMCID: PMC9137716 DOI: 10.3390/antibiotics11050550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is an important challenge in public health. Ensuring rational antimicrobial use (AMU) on farms is one of the key components of antimicrobial stewardship. We aimed to describe a sample of Canadian dairy farmers’ personal factors for AMUand their AMR risk perception, and to associate these factors with their attitude toward promotion of prudent AMU. We distributed an online survey among dairy farmers in Ontario and Atlantic Canada (New Brunswick, Nova Scotia, and Prince Edward Island). The questionnaire was designed to solicit information on dairy farmers’ AMU decision-making process, attitudes toward AMU reduction, awareness of AMR, and individual values. We performed a factor analysis on 15 statements related to AMR awareness and AMU reduction and used a logistic regression model to identify variables associated with the probability of disagreeing with the need to increase promotion of responsible AMU in the dairy industry. Respondents’ (n = 193) previous experience was the main reason to select an antimicrobial treatment for their cattle. We identified four groups of factors related to knowledge, risk perception, and emotional states among respondents. To the question “Should there be more initiatives to promote responsible use of antibiotics in the dairy industry?” 23% of respondents answered no, which was associated in a logistic regression model with being a farm owner, having a tie-stall barn, and considering their own experience as the most important factor in selecting antimicrobial treatments. The score for the conservation value dimension and score for a factor described as sense of responsibility when using antimicrobials were also retained in the final model. Our results indicate that tailored strategies to promote prudent AMU on dairy farms may be preferable to a generic strategy because there are individual differences in attitudes, values, and AMR awareness that shape AMR risk perception and willingness to modify current AMU practices.
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Affiliation(s)
- Claudia Cobo-Angel
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (B.G.); (S.J.L.)
- CLEV Research Group, Universidad de Caldas, Manizales 170004, Colombia
- Correspondence:
| | - Basem Gohar
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (B.G.); (S.J.L.)
| | - Stephen J. LeBlanc
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (B.G.); (S.J.L.)
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Skjølstrup NK, Vaarst M, Jensen CS, Lastein DB. Danish cattle veterinarians' perspectives on antimicrobial use: Contextual and individual influencing factors. J Dairy Sci 2022; 105:3377-3393. [PMID: 35094860 DOI: 10.3168/jds.2021-20981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
The global risk for antimicrobial resistance (AMR) can be reduced by reducing antimicrobial use (AMU). Veterinarians are one of the key actors in relation to AMU in livestock, and understanding the dynamics of veterinary treatment and prescription is central to achieving AMU reduction. Veterinary AMU decisions are influenced by a complex pattern of both individual and contextual factors. In this study, we conducted semi-structured interviews with 16 Danish cattle veterinarians to investigate their perspectives on AMU and current practices in a national context with low use and extensive legal control. We found that personal experiences and emotions, rather than scientific evidence, guided some veterinarians when making AMU choices. Furthermore, less-experienced veterinarians felt pressure to prescribe according to colleagues' and farmers' preferences for certain antimicrobials. We found that changes in Danish legislation seemed to have introduced hesitancy and a lack of motivation within the veterinary profession, and that AMR was perceived as an abstract threat not applicable to the veterinarians' daily professional decision making. We concluded that the lack of field-generated research of local relevance nourished a culture in which AMU choices are built on personal experience rather than scientific evidence, which also diminished newly educated veterinarians' self-confidence in relation to their AMU choices. Future research should focus on developing locally relevant research on optimal AMU choices and AMR, and the implications of extensive legal control of AMU in livestock farming should be further investigated to find a balance on the path to reducing AMU.
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Affiliation(s)
- Nanna K Skjølstrup
- Section for Production, Nutrition and Health, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark.
| | - Mette Vaarst
- Department of Animal Sciences, Aarhus University, 8830 Tjele, Denmark
| | - Carsten S Jensen
- Department of Sociology, Faculty of Social Sciences, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Dorte B Lastein
- Section for Production, Nutrition and Health, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark
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24
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Christensen I, Haug JB, Berild D, Bjørnholt JV, Skodvin B, Jelsness-Jørgensen LP. Factors Affecting Antibiotic Prescription among Hospital Physicians in a Low-Antimicrobial-Resistance Country: A Qualitative Study. Antibiotics (Basel) 2022; 11:antibiotics11010098. [PMID: 35052975 PMCID: PMC8773165 DOI: 10.3390/antibiotics11010098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
Antimicrobial resistance (AMR) is a threat to hospital patients. Antimicrobial stewardship programs (ASPs) can counteract AMR. To optimize ASPs, we need to understand what affects physicians’ antibiotic prescription from several contexts. In this study, we aimed to explore the factors affecting hospital physicians’ antibiotic choices in a low-resistance country to identify potential targets for future ASPs. We interviewed 14 physicians involved in antibiotic prescription in a Norwegian hospital. The interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. The main factors affecting antibiotic prescription were a high work pressure, insufficient staff resources, and uncertainties regarding clinical decisions. Treatment expectations from patients and next of kin, benevolence towards the patients, suboptimal microbiological testing, and limited time for infectious disease specialists to offer advisory services also affected the antibiotic choices. Future ASP efforts should evaluate the system organization and prioritizations to address and manage potential time-pressure issues. To limit the use of broad-spectrum antibiotics, improving microbiology testing and the routines for consultations with infectious disease specialists seems beneficial. We also identified a need among the prescribing physicians for a debate on ethical antibiotic questions.
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Affiliation(s)
- Ingrid Christensen
- Department of Infection Control, Østfold Hospital Trust, Kalnes, 1714 Graalum, Norway; (J.B.H.); (L.-P.J.-J.)
- Faculty of Medicine, Ph.D. Program Medicine and Health Sciences, University of Oslo, 0315 Oslo, Norway
- Correspondence: ; Tel.: +47-9073-3113; Fax: +47-6986-4885
| | - Jon Birger Haug
- Department of Infection Control, Østfold Hospital Trust, Kalnes, 1714 Graalum, Norway; (J.B.H.); (L.-P.J.-J.)
| | - Dag Berild
- Department of Infectious Diseases, Oslo University Hospital, 0424 Oslo, Norway;
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway;
| | - Jørgen Vildershøj Bjørnholt
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway;
- Department of Microbiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Brita Skodvin
- Norwegian Advisory Unit on Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, 5021 Bergen, Norway;
| | - Lars-Petter Jelsness-Jørgensen
- Department of Infection Control, Østfold Hospital Trust, Kalnes, 1714 Graalum, Norway; (J.B.H.); (L.-P.J.-J.)
- Faculty of Health and Social Studies, Østfold University College, 1671 Fredrikstad, Norway
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Tompson AC, Manderson L, Chandler CIR. Understanding antibiotic use: practices, structures and networks. JAC Antimicrob Resist 2021; 3:dlab150. [PMID: 34617017 PMCID: PMC8488471 DOI: 10.1093/jacamr/dlab150] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In this article, we consider how social sciences can help us to understand the rising use of antibiotics globally. Drawing on ethnography as a way to research how we are in the world, we explore scholarship that situates antibiotic use in relation to interactions of pathogens, humans, animals and the environment in the context of globalization, changes in agriculture and urbanization. We group this research into three areas: practices, structures and networks. Much of the public health and related social research concerning antimicrobial resistance has focused on antibiotic use as a practice, with research characterizing how antibiotics are used by patients, farmers, fishermen, drug sellers, clinicians and others. Researchers have also positioned antibiotic use as emergent of political-economic structures, shedding light on how working and living conditions, quality of care, hygiene and sanitation foster reliance on antibiotics. A growing body of research sees antibiotics as embedded in networks that, in addition to social and institutional networks, comprise physical, technical and historical connections such as guidelines, supply chains and reporting systems. Taken together, this research emphasizes the multiple ways that antibiotics have become built into daily life. Wider issues, which may be invisible without explication through ethnographic approaches, need to be considered when addressing antibiotic use. Adopting the complementary vantage points of practices, networks and structures can support the diversification of our responses to AMR.
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Affiliation(s)
- A C Tompson
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
| | - L Manderson
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - C I R Chandler
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
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26
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Degeling C, Brookes V, Hill T, Hall J, Rowles A, Tull C, Mullan J, Byrne M, Reynolds N, Hawkins O. Changes in the Framing of Antimicrobial Resistance in Print Media in Australia and the United Kingdom (2011-2020): A Comparative Qualitative Content and Trends Analysis. Antibiotics (Basel) 2021; 10:1432. [PMID: 34943644 PMCID: PMC8698020 DOI: 10.3390/antibiotics10121432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/21/2023] Open
Abstract
Educating the public about antimicrobial resistance (AMR) is considered a key part of an optimal public health response. In both media depictions and policy discourses around health risks, how a problem is framed underpins public awareness and understanding, while also guiding opinions on what actions can and should be taken. Using a mixed methods approach we analyse newspaper content in Australia and the United Kingdom (UK) from 2011 to 2020 to track how causes, consequences and solutions to AMR are represented in countries with different policy approaches. Analyses demonstrate greater variability in the frames used in UK newspapers reflecting large hospital and community outbreaks and a sustained period of policy reform mid-decade. Newspapers in Australia focus more on AMR causes and consequences, highlighting the importance of scientific discovery, whereas UK coverage has greater discussion of the social and economic drivers of AMR and their associated solutions. Variations in the trends of different frames around AMR in UK newspapers indicate greater levels of public deliberation and debate around immediate and actionable solutions; whereas AMR has not had the same health and political impacts in Australia resulting in a media framing that potentially encourages greater public complacency about the issue.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
| | - Victoria Brookes
- Sydney School of Veterinary Science Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Tarant Hill
- Illawarra-Shoalhaven Local Health District, NSW Health, Warrawong, NSW 2502, Australia;
| | - Julie Hall
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
| | - Anastacia Rowles
- School of Health & Society, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (A.R.); (C.T.)
| | - Cassandra Tull
- School of Health & Society, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (A.R.); (C.T.)
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Mitchell Byrne
- College of Human and Health Sciences, Charles Darwin University, Darwin, NT 0909, Australia;
| | - Nina Reynolds
- School of Business, Faculty of Business and Law, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Olivia Hawkins
- Australian Centre for Health Engagement, Evidence and Values, The Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (J.H.); (O.H.)
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Nabirye C, Denyer Willis L, Nayiga S, Kayendeke M, Staedke SG, Chandler CIR. Antibiotic ‘entanglements’: health, labour and everyday life in an urban informal settlement in Kampala, Uganda. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1994526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sarah G. Staedke
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare IR. Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Tompson AC, Mateus ALP, Brodbelt DC, Chandler CIR. Understanding Antibiotic Use in Companion Animals: A Literature Review Identifying Avenues for Future Efforts. Front Vet Sci 2021; 8:719547. [PMID: 34692805 PMCID: PMC8531418 DOI: 10.3389/fvets.2021.719547] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022] Open
Abstract
Addressing antibiotic use is essential to tackle antimicrobial resistance, a major human and animal health challenge. This review seeks to inform stewardship efforts in companion animals by collating research insights regarding antibiotic use in this group and identifying overlooked avenues for future research and stewardship efforts. The development of population-based methods has established that antibiotics are frequently used in companion animal care. Research insights are also contributing toward an in-depth comprehension of the contexts to antibiotic use. Qualitative approaches, for example, have enabled a nuanced understanding in four key areas: interactions with owners, clinical and financial risk management, time pressures, and clinic dynamics. This review identifies that much of the existing research frames antibiotic use as the result of choices made by the individuals at the interface of their use. Future research and policy endeavours could look beyond the moment of prescribing to consider the societal structures and networks in which companion animal antibiotic use is entangled. A diversification in research approaches and frameworks through which antibiotic use is understood will facilitate the identification of additional targets for stewardship initiatives beyond providing information and awareness campaigns.
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Affiliation(s)
- Alice C Tompson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana L P Mateus
- VEEPH Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
| | - Dave C Brodbelt
- VEEPH Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
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29
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Thornber K, Pitchforth E. Communicating antimicrobial resistance: the need to go beyond human health. JAC Antimicrob Resist 2021; 3:dlab096. [PMID: 34322670 PMCID: PMC8313517 DOI: 10.1093/jacamr/dlab096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kelly Thornber
- Department of Biosciences, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | - Emma Pitchforth
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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30
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Khine Zaw Y, Bawk JS, De Lima Hutchison C. Negotiating authoritarian law and (dis)order: medicines, drug shops, and regulators in a poor Yangon suburb. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1943314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yuzana Khine Zaw
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Ja Seng Bawk
- Independent Research Consultant, Yangon, Myanmar
| | - Coll De Lima Hutchison
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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31
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McKinn S, Trinh DH, Drabarek D, Trieu TT, Nguyen PTL, Cao TH, Dang AD, Nguyen TA, Fox GJ, Bernays S. Drivers of antibiotic use in Vietnam: implications for designing community interventions. BMJ Glob Health 2021; 6:e005875. [PMID: 34257138 PMCID: PMC8278923 DOI: 10.1136/bmjgh-2021-005875] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance is a global challenge that threatens our ability to prevent and treat common infectious diseases. Vietnam is affected by high rates of antimicrobial resistant infections, driven by the overuse of antibiotics and the Vietnamese government has recognised antimicrobial resistance as a health security priority. This study aimed to understand how people in Vietnam use antibiotics in community settings, and the factors that impact their practices and decision-making regarding antibiotics. METHODS We conducted 43 qualitative in-depth interviews with 50 community members in two urban and two rural sites in Vietnam. We conducted iterative, inductive thematic analysis alongside data collection through a process of systematic debriefings based on detailed interview summaries. Through this process, we developed a coding framework that was then applied to transcribed interview data. RESULTS Frequent and indiscriminate use of antibiotics was driven by the powerful appeal that antibiotics held for many Vietnamese consumers. Consumers were discerning in making decisions in their purchase and use of antibiotics. Consumers' decisions were affected by perceptions of what constitutes high-quality medicine (effective, strong, accessible and affordable); privileging symptom control over diagnosis; social constructions of antibiotics as a trusted remedy with embodied evidence of prior efficacy, which is reinforced by advice from trusted sources in their community; and varied, generally incomplete, understanding of the concept of antibiotic resistance and its implications for individuals and for public health. CONCLUSION Antibiotic use at the community and primary care level in Vietnam is driven by community members' social and economic response to what constitutes effective healthcare, rather than biomedical logic. Community-based interventions to reduce unnecessary antibiotic use need to engage with the entangled socio-structural factors that 'resist' current public health efforts to ration antibiotic use, alongside biomedical drivers. This study has informed the design of a community-based trial to reduce unnecessary antibiotic use.
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Affiliation(s)
- Shannon McKinn
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Duy Hoang Trinh
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Dorothy Drabarek
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thao Thu Trieu
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | | | - Thai Hung Cao
- Medical Service Administration, Ministry of Health, Hanoi, Vietnam
| | - Anh Duc Dang
- National Insitute of Hygiene and Epidemiology, Ministry of Health, Hanoi, Vietnam
| | - Thu Anh Nguyen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Greg J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Sarah Bernays
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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32
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Golding SE, Ogden J, Higgins HM. Examining the Effect of Context, Beliefs, and Values on UK Farm Veterinarians' Antimicrobial Prescribing: A Randomized Experimental Vignette and Cross-Sectional Survey. Antibiotics (Basel) 2021; 10:445. [PMID: 33921073 PMCID: PMC8071438 DOI: 10.3390/antibiotics10040445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial resistance (AMR) is a pressing threat to public and animal health. There is evidence that antimicrobial prescribing and stewardship behaviors by veterinarians (vets) are influenced by non-clinical factors, such as psychological, social, and environmental factors. This study explored the role of context, beliefs, and values on vets' antimicrobial prescribing decisions. UK-based practicing farm vets (n = 97) were recruited to an online study. Using an experimental vignette methodology, vets were randomly assigned across four conditions, to examine the effects of different contexts (pressure on farm economics, the farmer, or the vet-farmer relationship, compared to a control condition) on vets' likelihood of prescribing antibiotics. Vets' beliefs about different groups' responsibility for causing and preventing AMR and vets' values were also measured. Key findings were that context alone, values, and beliefs about groups' responsibilities for causing AMR were not predictive of vets' likelihood of prescribing antibiotics. However, vets' beliefs about groups' responsibilities for preventing AMR were predictive of an increased likelihood of prescribing antibiotics, when vets were exposed to the experimental condition of the vignette in which the vet-farmer relationship was under pressure. Farm vets also believed that different groups have different levels of responsibility for causing and preventing AMR. Results should be interpreted cautiously, given the smaller than planned for sample size, and the possibility for both false negatives and false positives. Further research is needed to explore how these findings could inform antimicrobial stewardship interventions in veterinary medicine.
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Affiliation(s)
- Sarah E. Golding
- School of Psychology, Faculty of Health and Medical Sciences, Stag Hill Campus, University of Surrey, Guildford GU2 7XH, UK;
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, Stag Hill Campus, University of Surrey, Guildford GU2 7XH, UK;
| | - Helen M. Higgins
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire CH64 7TE, UK;
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Dixon J, Manyau S, Kandiye F, Kranzer K, Chandler CIR. Antibiotics, rational drug use and the architecture of global health in Zimbabwe. Soc Sci Med 2021; 272:113594. [PMID: 33529937 DOI: 10.1016/j.socscimed.2020.113594] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
Rising concerns around antimicrobial resistance (AMR) have led to a renewed push to rationalise antibiotic prescribing in low- and middle-income countries (LMICs). There is increasing unease in conceptualising antibiotic use as individuals behaving '(ir)rationally' and recognition that rising use is emergent of and contributing to wider economic and political challenges. But in between these individual and societal 'drivers' of antibiotic use is an everyday articulation of care through these substances, written-in to the scripts, delivery chains and pedagogics of global healthcare. This article focuses on this everyday 'architecture' that over time and across spaces has knitted-in antibiotics and rhetorics of control that inform current responses to AMR. Based on historically informed ethnographic research in Zimbabwe, we examine points of continuity and change between 20th Century rational drug use (RDU) discourses and contemporary socio-political formations around AMR and antimicrobial stewardship (AMS), paying particular attention to their co-evolution with the process of pharmaceuticalisation. We illustrate how the framework and techniques of RDU were embedded within programmes to increase access to essential medicines and as such complemented the building of one of Africa's strongest postcolonial health systems in Zimbabwe. Whilst 20th Century RDU was focused on securing the health and safety of patients and affordability for systems, AMS programmes aim to secure medicines. Continuous through both RDU and AMS programmes is the persistent rhetoric of 'irrational use'. Health workers in Harare, attuned to the values and language of these programmes, enact in their everyday practice an architecture in which antibiotics have been designed-in. This research illustrates the struggle to optimise antibiotic use within current framings for action. We propose a reconfiguring of the architecture of global health such that frontline prescribers are able to provide 'good' care without necessarily turning to antibiotics. To design-out antibiotic reliance would require attention beyond '(ir)rationality', to the redrafting of blueprints that inscribe practice.
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Affiliation(s)
- Justin Dixon
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Salome Manyau
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Faith Kandiye
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK; Biomedical Research and Training Institute, Harare, Zimbabwe; Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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34
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Skjølstrup NK, Nielsen LR, Jensen CS, Lastein DB. Veterinary Herd Health Consultancy and Antimicrobial Use in Dairy Herds. Front Vet Sci 2021; 7:547975. [PMID: 33604361 PMCID: PMC7884328 DOI: 10.3389/fvets.2020.547975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023] Open
Abstract
The globally increasing level of antimicrobial resistance affects both human and animal health, why it is necessary to identify ways to change our current use of antimicrobials. The veterinary herd health collaboration between veterinarians and dairy farmers provides a useful setting for changing antimicrobial use in livestock. However, farmers and veterinarians work in a complex agricultural setting influenced by socio-economic factors, which complicates their choices regarding antimicrobial usage. It is therefore necessary to be aware of the range of potential influencing factors and to integrate this knowledge in the relevant local settings. This manuscript presents a literature review of relevant factors relating to antimicrobial use within the veterinary herd health consultancy setting, including knowledge gaps of relevance for changing the use of antimicrobials. An enriched version of the framework of the Theory of Planned Behaviour was used to organise the literature review. We identified diverging attitudes on correct treatment practices and perceptions of antimicrobial resistance among veterinarians and farmers, influenced by individual risk perception as well as social norms. Furthermore, disagreements in terms of goal setting and in the frequency of herd visits in relation to herd health consultancy can negatively influence the collaboration and the intention to change antimicrobial use. Farmers and veterinarians emphasise the importance of legislation and the role of the dairy industry in changing antimicrobial use, but the relevance of specific factors depends on the country-specific context. Overall, farmers and veterinarians must communicate better to understand each other's perspectives and establish common goals within the collaboration if they are to work efficiently to reduce antimicrobial use. Farmers and veterinarians both requested changes in individual behaviour; however, they also called for national and structural solutions in terms of balanced legislation and the availability of better diagnostics to facilitate a change in antimicrobial use practices. These various paths to achieving the desired changes in antimicrobial use illustrate the need to bridge methodological research approaches of veterinary science and social sciences for a better understanding of our potential to change antimicrobial use within the dairy farm animal sector.
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Affiliation(s)
- Nanna K. Skjølstrup
- Section for Production, Nutrition and Health, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Liza R. Nielsen
- Section for Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Carsten S. Jensen
- Department of Sociology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte B. Lastein
- Section for Production, Nutrition and Health, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Kamenshchikova A, Fedotova MM, Fedorova OS, Fedosenko SV, Wolffs PFG, Hoebe CJPA, Horstman K. Obligatory medical prescription of antibiotics in Russia: Navigating formal and informal health-care infrastructures. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:353-368. [PMID: 33636030 PMCID: PMC8247943 DOI: 10.1111/1467-9566.13224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
Antimicrobial resistance control programmes often aim to "fix" the behaviour of antibiotic users and prescribers. Such behavioural interventions have been widely criticised in social science literature for being inefficient and too narrow in scope. Drawing on these criticisms, this article analyses how political programmes for fixing antibiotic behaviours were adapted into the practices of health-care professionals and patients in Russia. In 2018, we conducted interviews with medical doctors, pharmacists and patients in a Russian city; focusing on their practices around the policy requirement introduced in 2017 which obligated medical prescriptions of antibiotics. We conceptualised the obligatory medical prescription as a political technique which sought to change practices of self-treatment and over-the-counter sales of medications by establishing doctors as an obligatory passage point to access antibiotics. Our analysis shows that the requirement for medical prescriptions does not fulfil the infrastructural gaps that influence antibiotic practices. By navigating the antibiotic prescriptions, doctors, pharmacists and patients informally compensate for the gaps in the existing infrastructure creating informal networks of antibiotic care parallel to the requirement of obligatory prescriptions. Following these informal practices, we could map the inconsistencies in the current policy approaches to tackle AMR as a behavioural rather than infrastructural problem.
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Affiliation(s)
- Alena Kamenshchikova
- Department of Health, Ethics and SocietySchool of Public Health and Primary Care (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
| | - Marina M. Fedotova
- Department of Faculty PaediatricsSiberian State Medical UniversityTomskRussian Federation
| | - Olga S. Fedorova
- Department of Faculty PaediatricsSiberian State Medical UniversityTomskRussian Federation
| | - Sergey V. Fedosenko
- Department of General Medical Practice and Outpatient TherapySiberian State Medical UniversityTomskRussian Federation
| | - Petra F. G. Wolffs
- Department of Medical MicrobiologySchool of Public Health and Primary Care (CAPHRI)Maastricht University Medical Center (MUMC+)MaastrichtThe Netherlands
| | - Christian J. P. A. Hoebe
- Department of Social Medicine and Medical MicrobiologySchool of Public Health and Primary Care (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
- Department of Sexual HealthInfectious Diseases and Environmental HealthSouth Limburg Public Health Service (GGD South LimburgHeerlenThe Netherlands
| | - Klasien Horstman
- Department of Health, Ethics and SocietySchool of Public Health and Primary Care (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands
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Holloway B, Mathur A, Pathak A, Bergström A. Utilisation of diagnostics in India: a rapid ethnographic study exploring context and behaviour. BMJ Open 2020; 10:e041087. [PMID: 33243808 PMCID: PMC7692986 DOI: 10.1136/bmjopen-2020-041087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/21/2020] [Accepted: 11/08/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To explore factors that influence behaviour in the utilisation of diagnostics by caregivers of sick children. Utilisation is defined as a caregiver assisting a child to get diagnostic tests done and return for follow-up of results. Understanding these experiences may help inform the development of interventions and implementation strategies to improve the use of diagnostics, thereby target treatment and optimise antibiotic use. DESIGN A rapid ethnographic qualitative study using 3 months of unstructured observations, 1 month of structured observations of diagnostic utilisation and 43 semi-structured interviews. Transcripts were coded and analysed using inductive thematic analysis. Findings were explored from a behavioural perspective through the lens of the 'Capability, Opportunity, Motivation and Behaviour' (COM-B) model for understanding behaviour. The multiple methods of investigation applied allowed for triangulation and cross-validation of the findings. SETTING The paediatric outpatient department of a teaching hospital in rural, central India. PARTICIPANTS Caregivers of sick children attending the paediatric outpatient department who were sent for one or more diagnostic test. RESULTS Three key themes were identified that influenced caregivers' behaviour. Caregivers trusted and understood the importance of diagnostics but their acceptance wavered depending on the severity of illness and preference to treat their child directly with medicines. Caregivers struggled to access diagnostics, describing delays in testing, receiving results and follow-up, further complicated by travel time, distance and competing priorities such as work. Diagnostics were relatively cheap compared with other healthcare facilities however, the cost of the test, travel expenses and wages lost for missing work, were barriers to getting the tests done and returning for follow-up. CONCLUSIONS Diagnostics are generally accepted and their purpose understood, however, the organisation of diagnostic services, direct and indirect costs hinder caregivers from using diagnostics. Improvements in accessibility and affordability may increase caregiver motivation to use diagnostics and return for follow-up.
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Affiliation(s)
- Bronwen Holloway
- Department of Womens and Childrens Health, Uppsala Global Health Research on Implementation and Sustainability, Uppsala University, Uppsala, Sweden
| | - Aditya Mathur
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
| | - Ashish Pathak
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- Department of Global Public Health, Health Systems and Policy: Medicines, Focusing Antibiotics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bergström
- Department of Womens and Childrens Health, Uppsala Global Health Research on Implementation and Sustainability, Uppsala University, Uppsala, Sweden
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Chen M, Kadetz P, Cabral C, Lambert H. Prescribing Antibiotics in Rural China: The Influence of Capital on Clinical Realities. FRONTIERS IN SOCIOLOGY 2020; 5:66. [PMID: 33869472 PMCID: PMC8022764 DOI: 10.3389/fsoc.2020.00066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/27/2020] [Indexed: 05/29/2023]
Abstract
Primary care clinicians in rural China are required to balance their immediate duty of care to their patients with patient expectations for antibiotics, financial pressures, and their wider responsibilities to public health. The clinicians in our sample appear to make greater efforts in managing immediate clinical risks and personal reputation than in considering the long-term consequences of their actions as potentially contributing to antimicrobial resistance. This paper employs Bourdieu's theory of capital to examine the perspectives and practices of Chinese primary care clinicians prescribing antibiotics at low-level health facilities in rural Anhui province, China. We examine the institutional context and clinical realities of these rural health facilities and identify how these influence the way clinicians utilize antibiotics in the management of common upper respiratory tract infections. Confronted with various official regulations and institutional pressures to generate revenues, informants' desire to maintain good relations with patients coupled with their concerns for patient safety result in tensions between their professional knowledge of "rational" antibiotic use and their actual prescribing practices. Informants often deferred responsibility for antimicrobial stewardship to the government or upper echelons of the healthcare system and drew on the powerful public discourse of "suzhi" (human quality) to legitimize their liberal prescribing of antibiotics in an imagined socioeconomic hierarchy. The demands of both practitioners' and patients' social, cultural, and economic forms of capital help to explain patterns of antibiotic prescribing in rural Chinese health facilities.
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Affiliation(s)
- Meixuan Chen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Paul Kadetz
- Center for Global Health, School of Public Health, Zhejiang University, Hangzhou, China
| | - Christie Cabral
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Redding LE, Brooks C, Georgakakos CB, Habing G, Rosenkrantz L, Dahlstrom M, Plummer PJ. Addressing Individual Values to Impact Prudent Antimicrobial Prescribing in Animal Agriculture. Front Vet Sci 2020; 7:297. [PMID: 32548132 PMCID: PMC7270172 DOI: 10.3389/fvets.2020.00297] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/01/2020] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance is a growing public health threat driven by antimicrobial use—both judicious and injudicious—in people and animals. In animal agriculture, antimicrobials are used to treat, control, and prevent disease in herds of animals. While such use generally occurs under the broad supervision of a veterinarian, individual animals are often treated by farm owners or managers. The decision to administer antimicrobials is therefore influenced not only by the clinical situation but also by the motivations and priorities of different individual actors. Many studies have examined the drivers of external forces such as costs, workload and time constraints, or social pressures on antimicrobial use by veterinarians and producers, but none have explored the role of individually held values in influencing decision-making related to antimicrobial use. Values are deeply held normative orientations that guide the formation of attitudes and behaviors across multiple contexts. Values have been shown to be strongly tied to perceptions of and attitudes toward polarizing topics such as climate change, and preliminary evidence suggests that values are also associated with attitudes to antimicrobial resistance and stewardship. In this article, we draw on lessons learned in other fields (human health care, climate change science) to explore how values could be tied to the extrinsic and intrinsic factors that drive antimicrobial use and prescribing in animal agriculture. We also provide suggestions for ways to build a bridge between the veterinary and social sciences and incorporate values into future research aimed at promoting antimicrobial stewardship in animal agriculture.
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Affiliation(s)
- Laurel E Redding
- School of Veterinary Medicine, University of Pennsylvania Kennett Square, PA, United States
| | - Cecilia Brooks
- Department of Psychology and Family Studies, Mississippi University for Women, Columbus, MS, United States
| | | | - Greg Habing
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, United States
| | - Leah Rosenkrantz
- Department of Geography, Simon Fraser University, Burnaby, BC, Canada
| | - Michael Dahlstrom
- Greenlee School of Journalism and Communication, Iowa State University, Ames, IA, United States
| | - Paul J Plummer
- Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, United States.,National Institute of Antimicrobial Resistance Research and Education, Ames, IA, United States
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