“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine

2014 ◽  
Vol 14 (4) ◽  
pp. 219-234 ◽  
Author(s):  
Marie Claire Van Hout
Keyword(s):  
Public Health ◽  
Real Time ◽  
Opioid Analgesics ◽  
Abuse Potential ◽  
Health Concern ◽  
Global Public Health ◽  
Real Time Monitoring ◽  
Over The Counter ◽  
Content Type ◽  
Recent Developments

Purpose – The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues. Design/methodology/approach – A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine. Findings – The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity. Practical implications – Further development of real-time monitoring processes with process evaluation is advised. Originality/value – This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.

scholarly journals The ZKIR Assay, a Real-Time PCR Method for the Detection of Klebsiella pneumoniae and Closely Related Species in Environmental Samples

2020 ◽  
Vol 86 (7) ◽  
Author(s):  
Elodie Barbier ◽  
Carla Rodrigues ◽  
Geraldine Depret ◽  
Virginie Passet ◽  
Laurent Gal ◽  
...  
Keyword(s):  
Public Health ◽  
Klebsiella Pneumoniae ◽  
Real Time ◽  
Real Time Pcr ◽  
Environmental Samples ◽  
Health Concern ◽  
Complex Matrices ◽  
Content Type ◽  
Novel Method ◽  
Pcr Method

ABSTRACT Klebsiella pneumoniae is of growing public health concern due to the emergence of strains that are multidrug resistant, virulent, or both. Taxonomically, the K. pneumoniae complex (“Kp”) includes seven phylogroups, with Kp1 (K. pneumoniae sensu stricto) being medically prominent. Kp can be present in environmental sources such as soils and vegetation, which could act as reservoirs of animal and human infections. However, the current lack of screening methods to detect Kp in complex matrices limits research on Kp ecology. Here, we analyzed 1,001 genome sequences and found that existing molecular detection targets lack specificity for Kp. A novel real-time PCR method, the ZKIR (zur-khe intergenic region) assay, was developed and used to detect Kp in 96 environmental samples. The results were compared to a culture-based method using Simmons citrate agar with 1% inositol medium coupled to matrix-assisted laser desorption ionization–time of flight mass spectrometry identification. Whole-genome sequencing of environmental Kp was performed. The ZKIR assay was positive for the 48 tested Kp reference strains, whereas 88 non-Kp strains were negative. The limit of detection of Kp in spiked soil microcosms was 1.5 × 10−1 CFU g−1 after enrichment for 24 h in lysogeny broth supplemented with ampicillin, and it was 1.5 × 103 to 1.5 × 104 CFU g−1 directly after soil DNA extraction. The ZKIR assay was more sensitive than the culture method. Kp was detected in 43% of environmental samples. Genomic analysis of the isolates revealed a predominance of phylogroups Kp1 (65%) and Kp3 (32%), a high genetic diversity (23 multilocus sequence types), a quasi-absence of antibiotic resistance or virulence genes, and a high frequency (50%) of O-antigen type 3. This study shows that the ZKIR assay is an accurate, specific, and sensitive novel method to detect the presence of Kp in complex matrices and indicates that Kp isolates from environmental samples differ from clinical isolates. IMPORTANCE The Klebsiella pneumoniae species complex Kp includes human and animal pathogens, some of which are emerging as hypervirulent and/or antibiotic-resistant strains. These pathogens are diverse and classified into seven phylogroups, which may differ in their reservoirs and epidemiology. Proper management of this public health hazard requires a better understanding of Kp ecology and routes of transmission to humans. So far, detection of these microorganisms in complex matrices such as food or the environment has been difficult due to a lack of accurate and sensitive methods. Here, we describe a novel method based on real-time PCR which enables detection of all Kp phylogroups with high sensitivity and specificity. We used this method to detect Kp isolates from environmental samples, and we show based on genomic sequencing that they differ in antimicrobial resistance and virulence gene content from human clinical Kp isolates. The ZKIR PCR assay will enable rapid screening of multiple samples for Kp presence and will thereby facilitate tracking the dispersal patterns of these pathogenic strains across environmental, food, animal and human sources.

scholarly journals In Vitro Efficacy of Gentamicin Alone and in Combination with Ceftriaxone, Ertapenem, and Azithromycin against Multidrug-Resistant Neisseria gonorrhoeae

2021 ◽  
Author(s):  
Xuechun Li ◽  
Wenjing Le ◽  
Xiangdi Lou ◽  
Biwei Wang ◽  
Caroline A. Genco ◽  
...  
Keyword(s):  
Public Health ◽  
Neisseria Gonorrhoeae ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Global Public Health ◽  
Public Health Concern ◽  
Content Type ◽  
New Treatment

Antimicrobial-resistant Neisseria gonorrhoeae is a major global public health concern. New treatment options are urgently needed to successfully treat multidrug-resistant (MDR) Neisseria gonorrhoeae infections.

scholarly journals Honour based violence as a global public health problem: a critical review of literature

2016 ◽  
Vol 9 (3) ◽  
pp. 198-215 ◽  
Author(s):  
Sadiq Bhanbhro ◽  
Anna Cronin de Chavez ◽  
Adelaide Lusambili
Keyword(s):  
Public Health ◽  
Research Policy ◽  
Public Health Problem ◽  
Well Being ◽  
Health Concern ◽  
Global Public Health ◽  
Gender Based Violence ◽  
Content Type ◽  
Gender Based ◽  
Health And Well Being

Purpose “Honour”-based violence (HBV), a form of gender-based violence (GBV), has received increasing interest from media, human rights organisations, academics and the public. A significant increase in the occurrence and reporting of HBV in many parts of the world and its detrimental impact on the health and well-being of women, girls, communities and wider society; marks it as a major public health concern. However, awareness and recognition of HBV in the field of public health is low in many countries and there is little known about its nature, roots and distribution. The paper aims to discuss these issues. Design/methodology/approach The literature was searched using the Scopus database and a series of search terms related to HBV, GBV and health and well-being. Findings Definition of HBV and its forms is varied across cultures. There is a lack of consensus on how HBV can be identified over other forms of violence and no explicit theoretical perspectives have been sufficiently developed to deepen the understanding of HBV. Although the findings from the review suggest that HBV forms and patterns may be regionally distinct, causes emanate from gender-based and socio-economic inequalities. Research limitations/implications This review has limitations in that it included only English and Spanish language papers and those accessed through Scopus; it therefore may have excluded papers from other languages, countries and databases. Another major weakness in this review was a lack of papers specifically dedicated to HBV. Despite these weaknesses the paper is an attempt to raise awareness and recognition of HBV in public health research, policy and practice domain. Originality/value The findings from the review highlight the complexity of tackling HBV in a globalised world. They also provide insights on how a public health model can be used to analyse both the causes and prevention of HBV. Further, a non-culturalised, unprejudiced and inclusive definition is required to flag-up and record HBV cases.

scholarly journals Could Dampening Expression of theNeisseria gonorrhoeaemtrCDE-Encoded Efflux Pump Be a Strategy To Preserve Currently or Resurrect Formerly Used Antibiotics To Treat Gonorrhea?

mBio ◽  
2019 ◽  
Vol 10 (4) ◽  
Author(s):  
Shaochun Chen ◽  
Kristie L. Connolly ◽  
Corinne Rouquette-Loughlin ◽  
Alexander D’Andrea ◽  
Ann E. Jerse ◽  
...  
Keyword(s):  
Genital Tract ◽  
Efflux Pump ◽  
Health Concern ◽  
Third Generation ◽  
Global Public Health ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Genital Tract Infection ◽  
Infected Female ◽  
Content Type

ABSTRACTNeisseria gonorrhoeaehas developed resistance to every antibiotic introduced for treatment of gonorrhea since 1938, and concern now exists that gonorrheal infections may become refractory to all available antibiotics approved for therapy. The current recommended dual antibiotic treatment regimen of ceftriaxone (CRO) and azithromycin (AZM) is threatened with the emergence of gonococcal strains displaying resistance to one or both of these antibiotics. Non-beta-lactamase resistance to penicillin and third-generation cephalosporins, as well as low-level AZM resistance expressed by gonococci, requires overexpression of themtrCDE-encoded efflux pump, which in wild-type (WT) strains is subject to transcriptional repression by MtrR. Since earlier studies showed that loss of MtrCDE renders gonococci hypersusceptible to beta-lactams and macrolides, we hypothesized that transcriptional dampening ofmtrCDEwould render an otherwise resistant strain susceptible to these antibiotics as assessed by antibiotic susceptibility testing and during experimental infection. In order to test this hypothesis, we ectopically expressed a WT copy of themtrRgene, which encodes the repressor of themtrCDEefflux pump operon, inN. gonorrhoeaestrain H041, the first reported gonococcal strain to cause a third-generation-cephalosporin-resistant infection. We now report that MtrR production can repress the expression ofmtrCDE, increase antimicrobial susceptibilityin vitro, and enhance beta-lactam efficacy in eliminating gonococci as assessed in a female mouse model of lower genital tract infection. We propose that strategies that target the MtrCDE efflux pump should be considered to counteract the increasing problem of antibiotic-resistant gonococci.IMPORTANCEThe emergence of gonococcal strains resistant to past or currently used antibiotics is a global public health concern, given the estimated 78 million infections that occur annually. The dearth of new antibiotics to treat gonorrhea demands that alternative curative strategies be considered to counteract antibiotic resistance expressed by gonococci. Herein, we show that decreased expression of a drug efflux pump that participates in gonococcal resistance to antibiotics can increase gonococcal susceptibility to beta-lactams and macrolides under laboratory conditions, as well as improve antibiotic-mediated clearance of gonococci from the genital tract of experimentally infected female mice.

scholarly journals Normalisation and Stigmatisation of Obesity in UK Newspapers: a Visual Content Analysis

2013 ◽  
Vol 5 (1) ◽  
pp. 82-91 ◽  
Author(s):  
Mr. Chris Patterson ◽  
Dr. Shona Hilton
Keyword(s):  
Public Health ◽  
Content Analysis ◽  
Media Coverage ◽  
The Body ◽  
Health Concern ◽  
Global Public Health ◽  
Obese Adults ◽  
Manifest Content ◽  
Body Sizes ◽  
The Uk

Obesity represents a major and growing global public health concern. The mass media play an important role in shaping public understandings of health, and obesity attracts much media coverage. This study offers the first content analysis of photographs illustrating UK newspaper articles about obesity. The researchers studied 119 articles and images from five major national newspapers. Researchers coded the manifest content of each image and article and used a graphical scale to estimate the body size of each image subject. Data were analysed with regard to the concepts of the normalisation and stigmatisation of obesity. Articles’ descriptions of subjects’ body sizes were often found to differ from coders’ estimates, and subjects described as obese tended to represent the higher values of the obese BMI range, differing from the distribution of BMI values of obese adults in the UK. Researchers identified a tendency for image subjects described as overweight or obese to be depicted in stereotypical ways that could reinforce stigma. These findings are interpreted as illustrations of how newspaper portrayals of obesity may contribute to societal normalisation and the stigmatisation of obesity, two forces that threaten to harm obese individuals and undermine public health efforts to reverse trends in obesity.

scholarly journals The ZKIR Assay, a novel Real-Time PCR Method for the Detection of Klebsiella pneumoniae and Closely Related Species in Environmental Samples

2019 ◽  
Author(s):  
Elodie Barbier ◽  
Carla Rodrigues ◽  
Geraldine Depret ◽  
Virginie Passet ◽  
Laurent Gal ◽  
...  
Keyword(s):  
Public Health ◽  
Klebsiella Pneumoniae ◽  
Real Time ◽  
Real Time Pcr ◽  
Environmental Samples ◽  
Health Concern ◽  
Complex Matrices ◽  
Animal Pathogens ◽  
Novel Method ◽  
Pcr Method

ABSTRACTKlebsiella pneumoniae (Kp) is of growing public health concern due to the emergence of strains that are multidrug-resistant, virulent, or both. Taxonomically, Kp includes seven phylogroups, with Kp1 (K. pneumoniae sensu stricto) being medically prominent. Kp can be present in environmental sources such as soils and vegetation, which could act as reservoirs of animal and human infections. However, the current lack of screening methods to detect Kp in complex matrices limits research on Kp ecology. Here we analysed 4222 genome sequences and found that existing molecular detection targets lack specificity for Kp. A novel real-time PCR method, the ZKIR assay, was developed and used to detect Kp in 96 environmental samples. Results were compared to a culture-based method using SCAI agar medium coupled to MALDI-TOF mass spectrometry identification. Whole-genome sequencing of environmental Kp was performed. The ZKIR assay was positive for the 48 tested Kp reference strains, whereas 88 non-Kp strains were negative. The limit of detection of Kp in spiked soil microcosms was 1.5 × 10-1 CFU g-1 after enrichment for 24 h in LB supplemented with ampicillin, and 1.5 × 103 to 1.5 × 104 CFU g-1 directly after soil DNA extraction. The ZKIR assay was more sensitive than the culture method. Kp was detected in 43% of environmental samples. Genomic analysis of the isolates revealed a predominance of phylogroups Kp1 (65%) and Kp3 (32%), a high genetic diversity (23 MLST sequence types), a quasi-absence of antibiotic resistance or virulence genes, and a high frequency (50%) of O-antigen type 3. This study shows that the ZKIR assay is an accurate, specific and sensitive novel method to detect the presence of Kp in complex matrices, and indicates that Kp isolates from environmental samples differ from clinical isolates.IMPORTANCEThe Klebsiella pneumoniae species complex (Kp) includes human and animal pathogens, some of which are emerging as hypervirulent and/or antibiotic resistant strains. These pathogens are diverse and classified into seven phylogroups, which may differ in their reservoirs and epidemiology. Proper management of this public health hazard requires a better understanding of Kp ecology and routes of transmission to humans. So far, detection of these microorganisms in complex matrices such as food or the environment has been difficult due to a lack of accurate and sensitive methods. Here, we describe a novel method based on real-time PCR, which enables detection of all Kp phylogroups with high sensitivity and specificity. We used this method to detect Kp isolates from environmental samples, and show based on genomic sequencing that they differ in antimicrobial resistance and virulence gene content, from human clinical Kp isolates. The ZKIR PCR assay will enable rapid screening of multiple samples for Kp presence and will thereby facilitate tracking the dispersal patterns of these pathogenic strains across environmental, food, animal and human sources.

scholarly journals Global Governance of Anti-microbial Resistance: A Legal and Regulatory Toolkit

2020 ◽  
pp. 401-420
Author(s):  
Calvin W. L. Ho ◽  
Tsung-Ling Lee
Keyword(s):  
Public Health ◽  
System Approach ◽  
Action Plan ◽  
World Health ◽  
Health Concern ◽  
Global Public Health ◽  
Agricultural Industry ◽  
Treatment And Prevention ◽  
Global Action ◽  
Health Organization

Abstract Recognizing that antimicrobial resistance (AMR) poses a serious threat to global public health, the World Health Organization (WHO) has adopted a Global Action Plan (GAP) at the May 2015 World Health Assembly. Underscoring that systematic misuse and overuse of drugs in human medicine and food production is a global public health concern, the GAP-AMR urges concerted efforts across governments and private sectors, including pharmaceutical industry, medical professionals, agricultural industry, among others. The GAP has a threefold aim: (1) to ensure a continuous use of effective and safe medicines for treatment and prevention of infectious diseases; (2) to encourage a responsible use of medicines; and (3) to engage countries to develop their national actions on AMR in keeping with the recommendations. While the GAP is a necessary step to enable multilateral actions, it must be supported by effective governance in order to realize the proposed aims. This chapter has a threefold purpose: (1) To identify regulatory principles embedded in key WHO documents relating to AMR and the GAP-AMR; (2) To consider the legal and regulatory actions or interventions that countries could use to strengthen their regulatory lever for AMR containment; and (3) To highlight the crucial role of the regulatory lever in enabling other levers under a whole-of-system approach. Effective AMR containment requires a clearer understanding of how the regulatory lever could be implemented or enabled within health systems, as well as how it underscores and interacts with other levers within a whole-of-system approach.

scholarly journals Dynamics of blaKPC-2 Dissemination from Non-CG258 Klebsiella pneumoniae to Other Enterobacterales via IncN Plasmids in an Area of High Endemicity

2020 ◽  
Vol 64 (12) ◽  
Author(s):  
Ana M. Rada ◽  
Elsa De La Cadena ◽  
Carlos Agudelo ◽  
Cesar Capataz ◽  
Nataly Orozco ◽  
...  
Keyword(s):  
Public Health ◽  
Klebsiella Pneumoniae ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistance ◽  
Health Interventions ◽  
Global Public Health ◽  
Public Health Interventions ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Long Read

ABSTRACT Carbapenem-resistant Enterobacterales (CRE) pose a significant threat to global public health. The most important mechanism for carbapenem resistance is the production of carbapenemases. Klebsiella pneumoniae carbapenemase (KPC) represents one of the main carbapenemases worldwide. Complex mechanisms of blaKPC dissemination have been reported in Colombia, a country with a high endemicity of carbapenem resistance. Here, we characterized the dynamics of dissemination of blaKPC gene among CRE infecting and colonizing patients in three hospitals localized in a highly endemic area of Colombia (2013 and 2015). We identified the genomic characteristics of KPC-producing Enterobacterales recovered from patients infected/colonized and reconstructed the dynamics of dissemination of blaKPC-2 using both short and long read sequencing. We found that spread of blaKPC-2 among Enterobacterales in the participating hospitals was due to intra- and interspecies horizontal gene transfer (HGT) mediated by promiscuous plasmids associated with transposable elements that was originated from a multispecies outbreak of KPC-producing Enterobacterales in a neonatal intensive care unit. The plasmids were detected in isolates recovered in other units within the same hospital and nearby hospitals. The gene “epidemic” was driven by IncN-pST15-type plasmids carrying a novel Tn4401b structure and non-Tn4401 elements (NTEKPC) in Klebsiella spp., Escherichia coli, Enterobacter spp., and Citrobacter spp. Of note, mcr-9 was found to coexist with blaKPC-2 in species of the Enterobacter cloacae complex. Our findings suggest that the main mechanism for dissemination of blaKPC-2 is HGT mediated by highly transferable plasmids among species of Enterobacterales in infected/colonized patients, presenting a major challenge for public health interventions in developing countries such as Colombia.

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