Patrick Timpel

Seasonality of antibiotic prescriptions for outpatients and resistance genes in sewers and wastewater treatment plant outflow

To test the hypothesis of a seasonal relationship of antibiotic prescriptions for outpatients and the abundance of antibiotic resistance genes (ARGs) in the wastewater, we investigated the distribution of prescriptions and different ARGs in the Dresden sewer system and wastewater treatment plant during a two-year sampling campaign. Based on quantitative PCR (qPCR), our results show a clear seasonal pattern for relative ARGs abundances. The higher ARGs levels in autumn and winter coincide with the higher rates of overall antibiotic prescriptions. While no significant differences of relative abundances were observed before and after the wastewater treatment for most of the relative ARGs, the treatment clearly influenced the microbial community composition and abundance. This indicates that the ARGs are probably not part of the dominant bacterial taxa, which are mainly influenced by the wastewater treatment processes, or that plasmid carrying bacteria remain constant, while plasmid free bacteria decrease. An exception was vancomycin (vanA), showing higher relative abundance in treated wastewater. It is likely that a positive selection or community changes during wastewater treatment lead to an enrichment of vanA. Our results demonstrate that in a medium-term study the combination of qPCR and next generation sequencing corroborated by drug-related health data is a suitable approach to characterize seasonal changes of ARGs in wastewater and treated wastewater.

Antibiotikaeintrag in das urbane Abwasser

Antibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.ZusammenfassungAntibiotika sind zur erfolgreichen Behandlung bakterieller Infektionen unerlässlich. Zuletzt sind jedoch die zunehmende Resistenzproblematik und die Auswirkungen von Antibiotikarückständen in der Umwelt in den wissenschaftlichen Fokus gerückt. Ziel des hier vorgestellten ANTI-Resist-Verbundprojekts war die Untersuchung von Antibiotikaeinträgen und die Analyse der Bildung und Verbreitung von Antibiotikaresistenzen im urbanen Abwassersystem der Stadt Dresden. Der vorliegende Beitrag stellt zentrale Ergebnisse der Sekundärdatenanalyse zur Ermittlung des ambulanten und stationären Antibiotikaverbrauchs vor und gibt einen Einblick in die Komplexität der Thematik Antibiotika im Abwasser. Auf Basis der ambulanten Verschreibungsdaten der AOK PLUS für den Zeitraum 2005 bis 2013 wurden 13 Fokussubstanzen identifiziert, um den Antibiotikaverbrauch abzuschätzen. Außerdem standen Lieferdaten von Krankenhausapotheken dreier Krankenhäuser in Dresden zur Verfügung. Je nach den betrachteten Substanzen konnten Saisonalitäten und Altersabhängigkeiten festgestellt werden. Die Ergebnisse auf regionaler Ebene decken sich überwiegend mit bundesweiten Trends. Dabei ist festzustellen, dass der Antibiotikaeinsatz insgesamt über den betrachten Zeitraum hinweg konstant bleibt, die Verschreibung von Fluorchinolonen jedoch zunimmt. Vor dem Hintergrund der vor allem im gram-negativen Bereich zunehmenden Resistenzsituation sind diese Befunde besonders kritisch zu hinterfragen. Durchgeführte Abwasseranalysen konnten zeigen, dass Kläranlagen nicht dazu geeignet sind, Antibiotika und deren Metabolite vollständig aus dem Abwasser zu entfernen. Über die Kläranlage gelangen die Rückstände in Oberflächengewässer. Die genauen Auswirkungen sind derzeit noch nicht absehbar und müssen weiter untersucht werden.AbstractAntibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.

Towards a Unified Understanding of eHealth and Related Terms - Proposal of a Consolidated Terminological Basis.

The impact of digitization on healthcare gives rise to interdisciplinary concepts such as eHealth. However, achieving improvements in research and innovation requires a valid and unified understanding of the common terminology. Yet, a heterogeneous usage of different terms regarding eHealth can be observed. This leads to a deficient communication between researchers and practitioners, impeding the diffusion, i. e. extensive practical implementation of innovative health concepts. To address this problem, our aim is to consolidate and harmonize eHealth-related terminology. To this end, a literature analysis was conducted to identify established definitions and to formulate a terminological ontology for the related concepts. The current results show a consistent definition of the terms digitization, ICT, and telematics. In contrast, telemedicine, telehealth, eHealth, and mHealth were identified as conflictingly defined terms. Consequently, the proposed ontology serves as a first guidance to support an adequate use of the included terms. Further systematic research of terms is needed to verify the current concept of the ontology. Additionally, specifying the connection between the ontology and the elements of healthcare systems is required for a deeper understanding of the influence of digitization in healthcare.

Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial

Background: Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months. Method: The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated. Discussion: The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement.

IDENTIFYING PATIENT NEEDS IN CHRONIC CARE TO FORMULATE REQUIREMENTS FOR INDIVIDUALISED CHRONIC CARE MANAGEMENT

O August 31st 2015 at 8:30 am.Ubonratchathani Public Health Office was informed by the authorities of Epidemiology & Social Medicine in Sanpasitthiprasong Hospital, Thailand that a male patient aged 18 years sick with a fever, sore throat, body aches, available bleeding, diarrhea since 3 days. A staff nurse, nursing Prison Province had sent to receive further treatment. Sanpasitthiprasong Hospital. The study aims to understand the epidemiological aspects of meningococcal meningitis, finding the active cases along with the measures for the control of disease. Data were collected from the registeries of medical records. The results of this investigation is in contact with the patient in prison, as many people feel they should be monitored closely for a period of two times the incubation period and should increase awareness for the disease in the area. Investigation by team to the area to control the concentration has controled the disease effectively there by no patients increased.There are many ways to keep the memory of the late first African President of South Africa, Nelson Mandela alive and make a difference in the lives of communities. University of South Africa has a time to serve to inspire the communities. With regard to education and literacy, the university leads by example. College of Human Sciences Health Literacy Project is a community based initiative whose primary aim is that of empowering school age youth cricket players by providing health literacy shows to schools, sports clubs centers and public venues. The project aims to improve physical health of youth through sporting activity of cricket training to learners in the local schools of the Province. The study employed a qualitative research approach to explore the views and roles of cricket youth players with regard to health literacy. Three focus group discussions were conducted with 15 to 20 participants. The age of the participants ranged from seven to 18 years. All the participants were learners and residing with their parents. Youth expressed their views and roles with regard to health literacy in different ways. A theme with three sub-themes emerged from thematic content analysis of the collected data as awareness of basic health information, prevention of risky behaviours, studying further and the importance of nature conservation.Substance misuse in urban and peri-urban areas is a serious problem among adolescents and is associated with negative individual and social consequences. While plenty of information exists in the literature on causes and consequences of drug abuse among adolescents; very few studies have focused on family support for adolescents after rehabilitation. The purpose of this study was to explore how parents and guardians support their adolescent sons a year after rehabilitation from drug abuse. Semi-structured interviews were carried out with ten (10) families who had sons with drug use problems and had been admitted at the rehabilitation centre. Participants were selected by purposive sampling. Thematic analysis of data was used to identify the themes. The findings of this study challenges prior studies that parents of adolescents on substances are better placed to assist with the post-rehabilitation of their adolescent sons. Two major themes of associative stigma and approach-avoidance conflict confirm the reality that parents of adolescent sons are faced with a dilemma of the need to protect their sons and the knowledge that the use of drugs is harmful. The study concluded that parents are faced with ambivalent feelings in relation to offering support to their sons. Culturally congruent measures are needed to address drug use and misuse among adolescents. Further studies are needed to explore the use of drugs among adolescents especially in South Africa where there is paucity of information.

Antibiotikaeintrag in das urbane Abwasser@@@Release of antibiotics into urban wastewater: Eine sekundärdatenbasierte Analyse zur Eintragsabschätzung am Beispiel der Stadt Dresden@@@A secondary-data based analysis for the input assessment using the city of Dresden as an example

Antibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.ZusammenfassungAntibiotika sind zur erfolgreichen Behandlung bakterieller Infektionen unerlässlich. Zuletzt sind jedoch die zunehmende Resistenzproblematik und die Auswirkungen von Antibiotikarückständen in der Umwelt in den wissenschaftlichen Fokus gerückt. Ziel des hier vorgestellten ANTI-Resist-Verbundprojekts war die Untersuchung von Antibiotikaeinträgen und die Analyse der Bildung und Verbreitung von Antibiotikaresistenzen im urbanen Abwassersystem der Stadt Dresden. Der vorliegende Beitrag stellt zentrale Ergebnisse der Sekundärdatenanalyse zur Ermittlung des ambulanten und stationären Antibiotikaverbrauchs vor und gibt einen Einblick in die Komplexität der Thematik Antibiotika im Abwasser. Auf Basis der ambulanten Verschreibungsdaten der AOK PLUS für den Zeitraum 2005 bis 2013 wurden 13 Fokussubstanzen identifiziert, um den Antibiotikaverbrauch abzuschätzen. Außerdem standen Lieferdaten von Krankenhausapotheken dreier Krankenhäuser in Dresden zur Verfügung. Je nach den betrachteten Substanzen konnten Saisonalitäten und Altersabhängigkeiten festgestellt werden. Die Ergebnisse auf regionaler Ebene decken sich überwiegend mit bundesweiten Trends. Dabei ist festzustellen, dass der Antibiotikaeinsatz insgesamt über den betrachten Zeitraum hinweg konstant bleibt, die Verschreibung von Fluorchinolonen jedoch zunimmt. Vor dem Hintergrund der vor allem im gram-negativen Bereich zunehmenden Resistenzsituation sind diese Befunde besonders kritisch zu hinterfragen. Durchgeführte Abwasseranalysen konnten zeigen, dass Kläranlagen nicht dazu geeignet sind, Antibiotika und deren Metabolite vollständig aus dem Abwasser zu entfernen. Über die Kläranlage gelangen die Rückstände in Oberflächengewässer. Die genauen Auswirkungen sind derzeit noch nicht absehbar und müssen weiter untersucht werden.AbstractAntibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.

[Release of antibiotics into urban wastewater: A secondary-data based analysis for the input assessment using the city of Dresden as an example].

Antibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.ZusammenfassungAntibiotika sind zur erfolgreichen Behandlung bakterieller Infektionen unerlässlich. Zuletzt sind jedoch die zunehmende Resistenzproblematik und die Auswirkungen von Antibiotikarückständen in der Umwelt in den wissenschaftlichen Fokus gerückt. Ziel des hier vorgestellten ANTI-Resist-Verbundprojekts war die Untersuchung von Antibiotikaeinträgen und die Analyse der Bildung und Verbreitung von Antibiotikaresistenzen im urbanen Abwassersystem der Stadt Dresden. Der vorliegende Beitrag stellt zentrale Ergebnisse der Sekundärdatenanalyse zur Ermittlung des ambulanten und stationären Antibiotikaverbrauchs vor und gibt einen Einblick in die Komplexität der Thematik Antibiotika im Abwasser. Auf Basis der ambulanten Verschreibungsdaten der AOK PLUS für den Zeitraum 2005 bis 2013 wurden 13 Fokussubstanzen identifiziert, um den Antibiotikaverbrauch abzuschätzen. Außerdem standen Lieferdaten von Krankenhausapotheken dreier Krankenhäuser in Dresden zur Verfügung. Je nach den betrachteten Substanzen konnten Saisonalitäten und Altersabhängigkeiten festgestellt werden. Die Ergebnisse auf regionaler Ebene decken sich überwiegend mit bundesweiten Trends. Dabei ist festzustellen, dass der Antibiotikaeinsatz insgesamt über den betrachten Zeitraum hinweg konstant bleibt, die Verschreibung von Fluorchinolonen jedoch zunimmt. Vor dem Hintergrund der vor allem im gram-negativen Bereich zunehmenden Resistenzsituation sind diese Befunde besonders kritisch zu hinterfragen. Durchgeführte Abwasseranalysen konnten zeigen, dass Kläranlagen nicht dazu geeignet sind, Antibiotika und deren Metabolite vollständig aus dem Abwasser zu entfernen. Über die Kläranlage gelangen die Rückstände in Oberflächengewässer. Die genauen Auswirkungen sind derzeit noch nicht absehbar und müssen weiter untersucht werden.AbstractAntibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.