Understanding media publics and the antimicrobial resistance crisis

Media coverage of antimicrobial resistance in Germany and Switzerland: An interpretation through the multiple streams framework

This article analyzes the newspaper coverage of antimicrobial resistance (AMR) between 1999 and 2021 in Germany and Switzerland through the lens of the Multiple Streams Framework (MSF). The MSF serves as an organizing framework to trace the development of AMR media coverage by focusing on key elements of the policy process: problems, solutions, problem brokers and policy entrepreneurs. The analysis produces three main findings: First, the overall newspaper coverage of AMR is increasing from 1999 to 2021, albeit non-linearly but related to specific events. Second, the general growth in AMR and the use of antibiotics with animals are the most frequently mentioned problems. Different types of solutions are prominent in the media, but only some actors manage to connect their preferred solution to a given problem, while other solutions appear independently of specific problems. Third, scientific and state actors from the national level are most prominent in AMR media coverage, and potentially act as entrepreneurs. Overall, the analysis highlights the diversity of problems, solutions, and actors, and thus of multiple perspectives and dynamics, on AMR as an issue of emerging attention.

One health: a structured review and commentary on trends and themes

BACKGROUND

One Health (OH) is defined as a unifying approach aiming to sustainably balance and optimise the health of people, animals and the ecosystem. It recognises that the health of humans, animals (both domestic and wild), plants and the wider ecosystem are both interdependent and linked. As a concept, it aims to address complex problems requiring input from multiple disciplines. Suitable issues for OH approaches typically include global issues which can widely impact not only the health of humans and animals, but also have a significant environmental impact. Examples include emerging zoonotic diseases and antimicrobial resistance (AMR). Interpretations and use of the term OH differ in the literature and have the potential to dilute its impact. The meaning of OH among the research community has evolved over time. Here, we collate the OH relevant literature from the last two decades, identifying major themes and trends and considering how OH has been embraced differently across various geographical regions.

METHODS AND RESULTS

Bibliographic databases were searched using the term "One Health" AND ("Veterinary" OR "Animal") AND ("Medicine" OR "Human") AND ("Environment" OR "Ecosystem") during the period between 1980 and 2022. Data analysis and narrative synthesis identified themes, similarities, and differences within literature. Web of Science and PubMed returned 948 and 1250 results for the period mentioned above. The predominant literature focused on human health, with veterinary health second, although often to benefit human health. It was found that OH is often utilised as a public health approach, generally towards the end of disease surveillance and control. Interestingly, while authors from low- and middle-income countries were well-represented within studies using the term OH, they were less well-represented as corresponding authors.

CONCLUSIONS

The predominant focus of the literature was on human and veterinary health, implying OH approach is human-orientated, despite its suggestion that all domains share a common 'health'. Potential improvement to OH could be achieved through greater incorporation of the environmental and social sciences for a more encompassing approach.

Patient and public understanding of antimicrobial resistance: a systematic review and meta-ethnography

Objectives

To further develop an understanding of laypeople's (adult patients and public) beliefs and attitudes toward antimicrobial resistance (AMR) by developing a conceptual model derived from identifying and synthesizing primary qualitative research.

Methods

A systematic search of 12 electronic databases, including CINAHL, MEDLINE, PsycINFO, PubMed and Web of Science to identify qualitative primary studies exploring patient and public understanding of AMR published between 2012 and 2022. Included studies were quality appraised and synthesized using Noblit and Hare's meta-ethnographic approach and reported using eMERGe guidance.

Results

Thirteen papers reporting 12 qualitative studies were synthesized. Studies reported data from 466 participants aged 18-90 years. Five themes were identified from these original studies: the responsible patient; when words become meaningless; patient-prescriber relationship; past experience drives antibiotic use; and reframing public perception. These themes supported the development of a conceptual model that illustrates the tension between two different assumptions, that is, how can antibiotics be used for the collective good whilst balancing the immediate needs of individual patients.

Conclusions

Findings suggest that AMR is a distinct ethical issue and should not be viewed purely as a prescribing problem. The meta-ethnography-generated conceptual model illustrates many factors affecting the public's perception of AMR. These include laypeople's own knowledge, beliefs and attitudes around antibiotic use, the relationship with the healthcare provider and the wider context, including the overwhelming influence of the media and public health campaigns. Future research is needed to explore effective health messaging strategies to increase laypeople's baseline awareness of AMR as a public threat.

The portrayal of antimicrobial resistance in Bangladeshi newspapers during 2010-2021: Toward understanding the narrative

BACKGROUND

Antimicrobial resistance (AMR) is a major global public health crisis and around the last decade, newspapers were one of the main sources of public dissemination of information for so. This study highlights how Bangladeshi mainstream newspapers represented AMR-related news and how they created the narrative of AMR in Bangladesh.

METHODS

We conducted both quantitative and qualitative content analysis on 275 AMR-related news articles published in the twelve highest circulated dailies (January 2010 to September 2021). We divided the articles into report, opinion, and editorials and analyzed how their contents built the narrative of AMR in Bangladesh.

RESULTS

Bangladeshi newspapers reported misuse of antibiotics by the consumers the most (32.2%), followed by selling without prescriptions (29%), and over-prescription by the health providers (26.1%). There were hardly any news reports describing the impact of pharmaceutical companies in prescribing and selling antibiotics. Around 45% of the news articles were event-oriented. Moreover, they suggested inadequate recommendations to battle AMR.

CONCLUSION

Valid, consistent, and reliable AMR news coverage can play a crucial role in creating mass awareness, making providers accountable, and supporting national action plan in mitigating AMR threat. The Bangladeshi journalists interested in reporting AMR-issues should focus on disseminating more Bangla articles with scientific information, and reporting causes and recommendations responsibly.

High-Throughput Screening Method Using Escherichia coli Keio Mutants for Assessing Primary Damage Mechanism of Antimicrobials

The Escherichia coli Keio mutant collection has been a tool for assessing the role of specific genes and determining their role in E. coli physiology and uncovering novel functions. In this work, specific mutants in the DNA repair pathways and oxidative stress response were evaluated to identify the primary targets of silver nanoparticles (NPs) and their mechanism of action. The results presented in this work suggest that NPs mainly target DNA via double-strand breaks and base modifications since the recA, uvrC, mutL, and nfo mutants rendered the most susceptible phenotype, rather than involving the oxidative stress response. Concomitantly, during the establishment of the control conditions for each mutant, the katG and sodA mutants showed a hypersensitive phenotype to mitomycin C, an alkylating agent. Thus, we propose that KatG catalase plays a key role as a cellular chaperone, as reported previously for the filamentous fungus Neurospora crassa, a large subunit catalase. The Keio collection mutants may also be a key tool for assessing the resistance mechanism to metallic NPs by using their potential to identify novel pathways involved in the resistance to NPs.

Assignment of the antibacterial potential of Ag2O/ZnO nanocomposite against MDR bacteria Proteus mirabilis and Salmonella typhi isolated from bone marrow transplant patients

The rate of infectious diseases started to be one of the major mortality agents in the healthcare sector. Exposed to increased bacterial infection by antibiotic-resistant bacteria became one of the complications that occurred for bone marrow transplant patients. Nanotechnology may provide clinicians and patients with the key to overcoming multidrug-resistant bacteria. Therefore, this study was conducted to clarify the prevalence of MDR bacteria in bone marrow transplant recipients and the use of Ag2O/ZnO nanocomposites to treat participants of diarrhea brought on by MDR bacteria following bone marrow transplantation (BMT). Present results show that pathogenic bacteria were present in 100 of 195 stool samples from individuals who had diarrhea. Phenotypic, biochemical, and molecular analysis clarify that Proteus mirabilis and Salmonella typhi were detected in 21 and 25 samples, respectively. Successful synthesis of Ag2O/ZnO nanocomposites with a particle enables to inhibition of both pathogens. The maximum inhibitory impact was seen on Salmonella typhi. At low doses (10-5 g/l), it prevented the growth by 53.4%, while at higher concentrations (10-1 g/l), Salmonella typhi was inhibited by 95.5%. Regarding Proteus mirabilis, at (10-5 g/l) Ag2O/ZnO, it was inhabited by 78.7%, but at higher concentrations (10-1 g/l), it was inhibited the growth by 94.6%. Ag2O/ZnO nanocomposite was therefore found to be the most effective therapy for MDR-isolated bacteria and offered promise for the treatment of MDR bacterial infections that cause diarrhea.

Antimicrobial resistance as a super wicked problem: how do we engage the public to be part of the solution

Antimicrobial resistance (AMR) is now regarded as one of the greatest global challenges of the 21st century. The complexity, urgent timeframe, and lack of clear solution to AMR have contributed to its classification as a 'super wicked problem'. Yet knowledge surveys of the general public have found that they still harbour numerous misconceptions linked to both the sources and impact of AMR. This confusion is compounded by AMR being a One Health issue, and therefore a factor in not just human health but in other industries, such as farming. This can further inhibit understanding and knowledge transfer around AMR for those without a prior knowledge base. In order to address the escalating risk that AMR presents, however, it is essential to address this knowledge gap and engage with the public to support wide scale changes in behaviour and consumer choice. The WHO now requires national action plans tackling AMR to include patient and public involvement/engagement (PPI/E) to support changing the trajectory of AMR. Despite this, little detail is available as part of strategic plans on how PPI/E should be undertaken in order to aid implementation. This paper discusses a number of approaches to support the design and delivery of PPI/E in relation to AMR, including the different social behaviour models underlying successful PPI/E strategies, and key considerations linked to specific activity types. The framework produced includes features for steps from initial planning and design through to evaluation. The aim is to help improve the ability of scientists and healthcare professionals to produce high quality AMR PPI/E.

Unveiling global public interest and seasonal patterns of antibiotics and antibiotic resistance: An infodemiology study with implications for public health awareness and intervention strategies

INTRODUCTION

The health-related information-seeking through internet sources has drastically increased throughout the world. This study aimed to analyze the Global public interest on "antibiotics" and "antibiotic resistance".

METHODS

The worldwide internet trend for the search terms "antibiotics" and "antibiotic resistance" from February 2017 to February 2022 was obtained using Google trends. The seasonal variation of interest was analyzed using the Seasonal Decomposition of Time Series by Loess.

RESULTS

The mean interest for the search term "antibiotics" and "antibiotic resistance" is found to be 78.02 ± 7.5 and 2.3 ± 0.8, which will increase at 2.56 % and 16 % per year. It was observed that there was a significant relationship between antibiotic consumption, the number of physicians, and individuals using the internet in the countries with the search term "antibiotics". The study also indicates that there is a peak in search volume for the term during the COVID-19 Pandemic.

CONCLUSION

Our study observed, that antibiotics related search questions on google by the public indicate the chances of antibiotic misuse. The study data suggest the need to raise public awareness about antibiotic use and antibiotic resistance, as well as there is need for intensive monitoring of dispensing and procurement patterns of antibiotics in developing countries.

Recent Advances in the Development of Lipid-, Metal-, Carbon-, and Polymer-Based Nanomaterials for Antibacterial Applications

Infections caused by multidrug-resistant (MDR) bacteria are becoming a serious threat to public health worldwide. With an ever-reducing pipeline of last-resort drugs further complicating the current dire situation arising due to antibiotic resistance, there has never been a greater urgency to attempt to discover potential new antibiotics. The use of nanotechnology, encompassing a broad range of organic and inorganic nanomaterials, offers promising solutions. Organic nanomaterials, including lipid-, polymer-, and carbon-based nanomaterials, have inherent antibacterial activity or can act as nanocarriers in delivering antibacterial agents. Nanocarriers, owing to the protection and enhanced bioavailability of the encapsulated drugs, have the ability to enable an increased concentration of a drug to be delivered to an infected site and reduce the associated toxicity elsewhere. On the other hand, inorganic metal-based nanomaterials exhibit multivalent antibacterial mechanisms that combat MDR bacteria effectively and reduce the occurrence of bacterial resistance. These nanomaterials have great potential for the prevention and treatment of MDR bacterial infection. Recent advances in the field of nanotechnology are enabling researchers to utilize nanomaterial building blocks in intriguing ways to create multi-functional nanocomposite materials. These nanocomposite materials, formed by lipid-, polymer-, carbon-, and metal-based nanomaterial building blocks, have opened a new avenue for researchers due to the unprecedented physiochemical properties and enhanced antibacterial activities being observed when compared to their mono-constituent parts. This review covers the latest advances of nanotechnologies used in the design and development of nano- and nanocomposite materials to fight MDR bacteria with different purposes. Our aim is to discuss and summarize these recently established nanomaterials and the respective nanocomposites, their current application, and challenges for use in applications treating MDR bacteria. In addition, we discuss the prospects for antimicrobial nanomaterials and look forward to further develop these materials, emphasizing their potential for clinical translation.

Tales of treatment and new perspectives for global health research on antimicrobial resistance

Global health champions modernism and biomedical knowledge but tends to neglect knowledge, beliefs and identities of rural communities in low-income and middle-income countries. The topic of antimicrobial resistance represents these common challenges, wherein the growing emphasis on public engagement offers a yet underdeveloped opportunity to generate perspectives and forms of knowledge that are not typically incorporated into research and policy. The medical humanities as an interdisciplinary approach to illness and health behaviour play a central role in cultivating this potential-in particular, through the field's emphasis on phenomenological and intersubjective approaches to knowledge generation and its interest in dialogue between medicine, the humanities and the broader public.We present a case study of public engagement that incorporates three medical humanities methods: participatory co-production, photographic storytelling and dialogue between researchers and the public. Situated in the context of northern Thailand, we explore subcases on co-production workshops with villagers, tales of treatment shared by traditional healers and dialogue surrounding artistic display in an international photo exhibition. Our starting assumption for the case study analysis was that co-produced local inputs can (and should) broaden the understanding of the sociocultural context of antimicrobial resistance.Our case study illustrates the potential of medical humanities methods in public engagement to foreground cultural knowledge, personal experience and 'lay' sensemaking surrounding health systems and healing (including medicine use). Among others, the engagement activities enabled us to formulate and test locally grounded hypotheses, gain new insights into the social configuration of treatment seeking and reflect on the relationship between traditional healing and modern medicine in the context of antimicrobial resistance. We conclude that medical-humanities-informed forms of public engagement should become a standard component of global health research, but they require extensive evaluation to assess benefits and risks comprehensively.

Nanotechnology as a Novel Approach in Combating Microbes Providing an Alternative to Antibiotics

The emergence of infectious diseases promises to be one of the leading mortality factors in the healthcare sector. Although several drugs are available on the market, newly found microorganisms carrying multidrug resistance (MDR) against which existing drugs cannot function effectively, giving rise to escalated antibiotic dosage therapies and the need to develop novel drugs, which require time, money, and manpower. Thus, the exploitation of antimicrobials has led to the production of MDR bacteria, and their prevalence and growth are a major concern. Novel approaches to prevent antimicrobial drug resistance are in practice. Nanotechnology-based innovation provides physicians and patients the opportunity to overcome the crisis of drug resistance. Nanoparticles have promising potential in the healthcare sector. Recently, nanoparticles have been designed to address pathogenic microorganisms. A multitude of processes that can vary with various traits, including size, morphology, electrical charge, and surface coatings, allow researchers to develop novel composite antimicrobial substances for use in different applications performing antimicrobial activities. The antimicrobial activity of inorganic and carbon-based nanoparticles can be applied to various research, medical, and industrial uses in the future and offer a solution to the crisis of antimicrobial resistance to traditional approaches. Metal-based nanoparticles have also been extensively studied for many biomedical applications. In addition to reduced size and selectivity for bacteria, metal-based nanoparticles have proven effective against pathogens listed as a priority, according to the World Health Organization (WHO). Moreover, antimicrobial studies of nanoparticles were carried out not only in vitro but in vivo as well in order to investigate their efficacy. In addition, nanomaterials provide numerous opportunities for infection prevention, diagnosis, treatment, and biofilm control. This study emphasizes the antimicrobial effects of nanoparticles and contrasts nanoparticles' with antibiotics' role in the fight against pathogenic microorganisms. Future prospects revolve around developing new strategies and products to prevent, control, and treat microbial infections in humans and other animals, including viral infections seen in the current pandemic scenarios.

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

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.

Open science, COVID-19, and the news: Exploring controversies in the circulation of early SARS-CoV-2 genomic epidemiology research

Some early English language news coverage of COVID-19 epidemiology focused on studies that examined how SARS-CoV-2 (the coronavirus that causes COVID-19) was evolving at the genetic level. The use of phylogenetic methods to analyse pathogen genetic sequence data to understand disease dynamics is called 'molecular' or 'genomic' epidemiology. Many research groups in this subfield utilise open science practices, which can involve the circulation of early unreviewed findings on publicly-accessible venues online. From March to May 2020, media outlets covered early SARS-CoV-2 genomic studies that claimed to have discovered types of SARS-CoV-2 that had mutated to be more transmissible. We use methods from Science and Technology Studies (STS) to examine three cumulative cases in which unripe facts about SARS-CoV-2 genomics moved out of scientific publics and into mainstream news. The three cases are: (1) 'A More "Aggressive" Strain of SARS-CoV-2?', (2) 'Eight SARS-CoV-2 Strains?', and (3) 'A "More Contagious," "Mutant" Strain?' In each case, findings were called into question and reporters' framing was overly sensational. We interpret the COVID-19 pandemic as a 'stress-test' for open science practices, and argue that it is important for stakeholders to understand changes in scientific publication and dissemination processes in the wake of the pandemic.

Making sense of "superbugs" on YouTube: A storytelling approach

Antimicrobial resistance is one of the greatest challenges facing the world. With the rapid growth of social media, YouTube has become an influential social media platform providing publics with expert health knowledge. This article explores how antimicrobial resistance is communicated on YouTube. Drawing on qualitative media analyses of the most viewed YouTube videos 2016-2020, we identify seven different genres and two main storytelling approaches, personalized and fictionalized storytelling, used to make sense of antimicrobial resistance and its complexities. The study contributes new knowledge about YouTube as a platform for health communication and the types of videos about antimicrobial resistance that gets most traffic. This is useful, not the least for public health experts working to improve communication strategies that target hard-to-reach media publics.

Parental Knowledge, Attitude, and Practices on Antibiotic Use for Childhood Upper Respiratory Tract Infections during COVID-19 Pandemic in Greece

This cross-sectional study aims to assess parents' knowledge, attitude, and practices on antibiotic use for children with URTIs symptoms in Greece in the era of the COVID-19 pandemic. We distributed a questionnaire to a random sample of parents who visited primary health care centers in Patras, Greece. Out of 412 participants, 86% believed that most infections with common cold or flu symptoms were caused by viruses, although 26.9% believed that antibiotics may prevent complications. Earache was the most common symptom for which antibiotics were needed. Most of them (69%) declare being considerably anxious about their children's health during the COVID-19 pandemic. The majority (85%) knew that COVID-19 was of viral origin, yet half of them declared uncertain whether antibiotics were needed. All demographic characteristics, except for gender, were found to have a significant effect on parents' knowledge, attitude, and practices on antibiotic use for URTIs and COVID-19. Factor analysis revealed six groups of parents with common characteristics associated with misuse of antibiotics. Our findings highlight the need to decrease misconceptions regarding antibiotic use by providing relevant education for parents targeting particular characteristics, especially during the COVID-19 pandemic. Continuous education of healthcare providers in the field is also of paramount importance.

Metallic Nanoparticles-Friends or Foes in the Battle against Antibiotic-Resistant Bacteria?

The rapid spread of antibiotic resistances among bacteria demands novel strategies for infection control, and metallic nanoparticles appear as promising tools because of their unique size and tunable properties that allow their antibacterial effects to be maximized. Furthermore, their diverse mechanisms of action towards multiple cell components have suggested that bacteria could not easily develop resistance against nanoparticles. However, research published over the last decade has proven that bacteria can indeed evolve stable resistance mechanisms upon continuous exposure to metallic nanoparticles. In this review, we summarize the currently known individual and collective strategies employed by bacteria to cope with metallic nanoparticles. Importantly, we also discuss the adverse side effects that bacterial exposure to nanoparticles may have on antibiotic resistance dissemination and that might constitute a challenge for the implementation of nanoparticles as antibacterial agents. Overall, studies discussed in this review point out that careful management of these very promising antimicrobials is necessary to preserve their efficacy for infection control.

From universal frames to collective experimentation? Pursuing serious conversations about antimicrobial resistance

In the time of coronavirus disease 2019 (COVID-19) there are numerous attempts to compare across national boundaries and rank governments for their action against the virus. In this context the ‘universal’ ambition of the Wellcome Trust report on communicating antimicrobial resistance (AMR) is somewhat refreshing, and recalls some of the older ambition of the global health field. Though the report now feels some time ago – it was published in November 2019 - the pandemic does not mean AMR has gone away. Indeed, it may be worsened in the context of rescue prescribing, both for secondary infections following COVID-19 and other health conditions where antibiotics may stand in for scarce or compromised care. In this open letter we wish to respond to the Trust report – locating it in the field of social science work on AMR – and proposing some directions for further discussion. In particular, writing against the backdrop of the viral pandemic, we explore how both COVID-19 and AMR raise questions about our attachment to modern medicine, about the motivating value appeals to vulnerability and health inequality. We therefore call for the report and others to be the start of the further long-distance conversations and experimentation across different fields.

Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares?

Trust in public health officials and the information they provide is essential for the public uptake of preventative strategies to reduce the transmission of COVID-19. This paper discusses how a model for developing and maintaining trust in public health officials during food safety incidents and scandals might be applied to pandemic management. The model identifies ten strategies to be considered, including: transparency; development of protocols and procedures; credibility; proactivity; putting the public first; collaborating with stakeholders; consistency; education of stakeholders and the public; building your reputation; and keeping your promises. While pandemic management differs insofar as the responsibility lies with the public rather than identifiable regulatory bodies, and governments must weigh competing risks in creating policy, we conclude that many of the strategies identified in our trust model can be successfully applied to the maintenance of trust in public health officials prior to, during, and after pandemics.

Design, Synthesis and Biological Evaluation of Novel Anthraniloyl-AMP Mimics as PQS Biosynthesis Inhibitors Against Pseudomonas aeruginosa Resistance

The Pseudomonas quinolone system (PQS) is one of the three major interconnected quorum sensing signaling systems in Pseudomonas aeruginosa. The virulence factors PQS and HHQ activate the transcription regulator PqsR (MvfR), which controls several activities in bacteria, including biofilm formation and upregulation of PQS biosynthesis. The enzyme anthraniloyl-CoA synthetase (PqsA) catalyzes the first and critical step in the biosynthesis of quinolones; therefore, it is an attractive target for the development of anti-virulence therapeutics against Pseudomonas resistance. Herein, we report the design and synthesis of novel triazole nucleoside-based anthraniloyl- adenosine monophosphate (AMP) mimics. These analogues had a major impact on the morphology of bacterial biofilms and caused significant reduction in bacterial aggregation and population density. However, the compounds showed only limited inhibition of PQS and did not exhibit any effect on pyocyanin production.

Addressing Individual Values to Impact Prudent Antimicrobial Prescribing in Animal Agriculture

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.

Sexual transmission of Zika virus on Twitter: A depoliticised epidemic

During global health crises, different narratives regarding infectious disease epidemics circulate in traditional media (e.g. news agencies, television channels) and social media. Our study investigated the narratives related to sexual transmission of Zika virus that circulated on Twitter during a public health emergency and analyzed the relationship between information on Twitter and on traditional media. We examined 10,748 tweets posted during the peaks of Twitter activity between January and March 2016. Posts in English, Spanish, French, and Portuguese and websites linked to tweets were manually reviewed and analyzed thematically. During the study period, there were three peaks of Twitter activity related to the sexual transmission of Zika. Most tweets in the first peak (n = 412) had humorous/sarcastic content (55%). Most tweets in the second and third peaks (n = 5,154 and n = 5,182, respectively) disseminated information (>93%). Across languages, textual and visual content on the websites were predominantly placed online by traditional media and highlighted epidemiological narratives published by public health agencies, with little or no mention of the concerns or experiences of individuals most affected by Zika. Prioritising epidemiological/clinical aspects of epidemics may have a depoliticising effect and contribute to overlooking socio-economic determinants of the Zika epidemic and issues related to reproductive justice.

The values and principles underpinning community engagement approaches to tackling antimicrobial resistance (AMR)

This paper presents seven values underpinning the application of Community Engagement (CE) approaches to the One Health challenge of antimicrobial resistance (AMR) developed during an international workshop in June 2019. We define a value as a quality or standard which a CE project is aiming for, whilst a principle is an objective which underpins the value and facilitates its achievement. The values of Clarity, Creativity, (being) Evidence-led, Equity, Interdisciplinarity, Sustainability and Flexibility were identified by a network of 40 researchers and practitioners who utilise CE approaches to tackle complex One Health challenges including, but not limited to, AMR. We present our understanding of these seven values and their underlying principles as a flexible tool designed to support stakeholders within CE for AMR projects. We include practical guidance on working toward each value, plus case studies of the values in action within existing AMR interventions. Finally, we consider the extent to which CE approaches are appropriate to tackle AMR challenges. We reflect on these in relation to the tool, and current literature for both CE and AMR research. Authors and co-producers anticipate this tool being used to scene-set, road map and trouble shoot the development, implementation, and evaluation of CE projects to address AMR and other One Health challenges. However, the tool is not prescriptive but responsive to the context and needs of the community, opening opportunity to build a truly collaborative and community-centred approach to AMR research.

Global Internet Data on the Interest in Antibiotics and Probiotics Generated by Google Trends

Data from the Google search engine enables the assessment of Google users’ interest in a specific topic. We analyzed the world trends in searches associated with the topics “antibiotics” and “probiotics” from January 2004 to June 2019, using Google Trends. We analyzed the yearly trends and seasonal variation. We performed an R-Spearman rank correlation analysis of the relative search volume (RSV) of the topics in 2015 with antibiotic consumption, health expenditure per capita, and the 2015 Human Development Index (HDI) of the country. The mean interest in the topic of antibiotics was equal to RSV = 57.5 ± 17.9, rising by 3.7 RSV/year (6.5%/year), while that of probiotics was RSV = 14.1 ± 7.9, which rose by 1.7 RSV/year (12.1%). The seasonal amplitude of antibiotics was equal to RSV = 9.8, while probiotics was RSV = 2.7. The seasonal peaks for both topics were observed in the cold months. The RSV of probiotics, but not antibiotics, was associated with antibiotic consumption (Rs = 0.35; p < 0.01), health expenditure (Rs = 0.41; p < 0.001), and HDI (Rs = 0.44; p < 0.001). Google users’ interest in antibiotic- and probiotic-related information increases from year to year, and peaks in cold months. The interest in probiotic-related information might be associated with antibiotic consumption, health expenditure, and the development status of the Google users’ country.

Investigating Understandings of Antibiotics and Antimicrobial Resistance in Diverse Ethnic Communities in Australia: Findings from a Qualitative Study

This paper explores the understandings of antibiotics and antimicrobial resistance (AMR) among ethnically diverse informants in Melbourne, Australia. A total of 31 face-to-face semi-structured qualitative interviews were conducted with a sample of ethnic in-patients who were admitted with an acquired antimicrobial infection in a public hospital (n = 7); five hospital interpreters; and ethnic members of the general community (n = 19) as part of a broader study of lay understandings of AMR. Thematic analysis revealed there was poor understanding of AMR, even among informants being treated for AMR infections. Causes of the increasing incidence of AMR were attributed to: weather fluctuations and climate change; a lack of environmental cleanliness; and the arrival of new migrant groups. Asian informants emphasized the need for humoral balance. Antibiotics were viewed as ‘strong’ medicines that could potentially disrupt this balance and weaken the body. Travel back to countries of origin sometimes involved the use of medical services and informants noted that some community members imported antibiotics from overseas. Most used the internet and social media to source health information. There is a lack of information in their own languages. More attention needs to be given to migrant communities who are vulnerable to the development, transmission and infection with resistant bacteria to inform future interventions.

Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia

INTRODUCTION

Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research.

OBJECTIVE

To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers.

DESIGN

Observational study: cross-sectional rural health behaviour survey, representative of the population level.

SETTING

General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018.

PARTICIPANTS

2141 adult members (≥18 years) of the general rural population, representing 712 000 villagers.

OUTCOME MEASURES

Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels.

FINDINGS

Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like 'anti-inflammatory medicine' in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and 'ampi' in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90).

CONCLUSIONS

Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming 'knowledge deficits' alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards 'AMR-sensitive interventions' that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov identifier NCT03241316.

New impulses from international development for more comprehensive and balanced public engagement evaluation

Public engagement in health research has gained popularity because of its potential to co-create knowledge, generate dialogue, and ground research in the priorities and realities of the target groups. However, public engagement that achieves these objectives could still entail unforeseen negative consequences or a wasteful use of resources. Although the evaluation of public engagement has evolved in recent years, we lack consistent evaluation criteria for systematic and transparent assessments of success and failure. This article introduces standard evaluation criteria from the field of development aid evaluation (effectiveness, efficiency, impact, relevance, sustainability) to promote more systematic and comprehensive evaluation practice. I apply these criteria to the public engagement component of a recent research project into antimicrobial resistance, antibiotic use, and health behaviour in Thailand and Laos. Considering village-level engagement workshops, international exhibitions of photo narratives of traditional healing in northern Thailand, and social media communication, I demonstrate that activities that seem to achieve their objectives can still have problematic characteristics in other dimensions. I conclude that these five generic evaluation criteria can broaden our understanding of public engagement. Their more widespread use in evaluations can help build a more comprehensive and balanced evidence base, even if only a sample of public engagement projects and programmes can be evaluated systematically.

Antimicrobial Effects of Biogenic Nanoparticles

Infectious diseases pose one of the greatest health challenges in the medical world. Though numerous antimicrobial drugs are commercially available, they often lack effectiveness against recently developed multidrug resistant (MDR) microorganisms. This results in high antibiotic dose administration and a need to develop new antibiotics, which in turn requires time, money, and labor investments. Recently, biogenic metallic nanoparticles have proven their effectiveness against MDR microorganisms, individually and in synergy with the current/conventional antibiotics. Importantly, biogenic nanoparticles are easy to produce, facile, biocompatible, and environmentally friendly in nature. In addition, biogenic nanoparticles are surrounded by capping layers, which provide them with biocompatibility and long-term stability. Moreover, these capping layers provide an active surface for interaction with biological components, facilitated by free active surface functional groups. These groups are available for modification, such as conjugation with antimicrobial drugs, genes, and peptides, in order to enhance their efficacy and delivery. This review summarizes the conventional antibiotic treatments and highlights the benefits of using nanoparticles in combating infectious diseases.

The Consequences of AMR Education and Awareness Raising: Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR

Education and awareness raising are the primary tools of global health policy to change public behaviour and tackle antimicrobial resistance. Considering the limitations of an awareness agenda, and the lack of social research to inform alternative approaches, our objective was to generate new empirical evidence on the consequences of antibiotic-related awareness raising in a low-income country context. We implemented an educational activity in two Lao villages to share general antibiotic-related messages and also to learn about people’s conceptions and health behaviours. Two rounds of census survey data enabled us to assess the activity’s outputs, its knowledge outcomes, and its immediate behavioural impacts in a difference-in-difference design. Our panel data covered 1130 adults over two rounds, including 58 activity participants and 208 villagers exposed indirectly via conversations in the village. We found that activity-related communication circulated among more privileged groups, which limited its indirect effects. Among participants, the educational activity influenced the awareness and understanding of “drug resistance”, whereas the effects on attitudes were minor. The evidence on the behavioural impacts was sparse and mixed, but the range of possible consequences included a disproportionate uptake of antibiotics from formal healthcare providers. Our study casts doubt on the continued dominance of awareness raising as a behavioural tool to address antibiotic resistance.

Synergistic and antibiofilm properties of ocellatin peptides against multidrug-resistant Pseudomonas aeruginosa

AIM

To test ocellatin peptides (ocellatins-PT2-PT6) for antibacterial and antibiofilm activities and synergy with antibiotics against Pseudomonas aeruginosa.

MATERIALS & METHODS

Normal- and checkerboard-broth microdilution methods were used. Biofilm studies included microtiter plate-based assays and microscopic analysis by confocal laser scanning microscopy and atomic force microscopy.

RESULTS

Ocellatins were more active against multidrug-resistant isolates of P. aeruginosa than against susceptible strains. Ocellatin-PT3 showed synergy with ciprofloxacin and ceftazidime against multidrug-resistant isolates and was capable of preventing the proliferation of 48-h mature biofilms at concentrations ranging from 4 to 8× the MIC. Treated biofilms had low viability and were slightly more disaggregated.

CONCLUSION

Ocellatin-PT3 may be promising as a template for the development of novel antimicrobial peptides against P. aeruginosa. [Formula: see text].