Search Results (59)

Background: Saudi Arabia is undertaking a comprehensive reform of its healthcare system to improve the efficiency and accessibility of public healthcare services. A key aspect of this initiative is outsourcing outpatient pharmacy services within the public health sector to retail pharmacies through an electronic prescribing platform known as Wasfaty. The National Unified Procurement Company (NUPCO) manages this platform to ensure spending efficiency and patient accessibility to essential medications. However, there has been a lack of research evaluating the adherence of the Wasfaty e-prescribing platform to established best practices for Computerized Provider Order Entry (CPOE), which are commonly used to assess the performance of various ambulatory e-prescribing systems globally. Objective: This study aimed to assess the level of adherence of Wasfaty to best practices for CPOE. Methods: This descriptive cross-sectional single-center study reviewed filled prescriptions through Wasfaty from May 2022 to December 2023. A list of 60 functional features, including but not limited to patient identification and data access, medication selection, alerts, patient education, data transmission and storage, monitoring and renewals, transparency and accountability, and feedback, was utilized to evaluate adherence. The adherence level was categorized into four groups: fully implemented, partially implemented, not implemented, and not applicable. Two pharmacy interns, a clinical pharmacist, and a researcher, reviewed the prescriptions to determine the platform’s adherence to these 60 CPOE features. Results: From May 2022 to December 2023, a total of 1965 prescriptions were filled in retail pharmacies for out-of-stock medications for 1367 patients. These prescriptions included medications for various areas, with the following distribution: gastroenterology (44.10%), cardiology (18.14%), anti-infectives (2.42%), urology (8.85%), dermatology (3.6%), hematology (0.29%), muscle relaxants (0.8%), neurology (19.17%), pulmonology (1.46%), and other categories (1.23%). Of the 60 functional characteristics a CPOE platform should include, only 19 (31.66%) were fully implemented, while 10 (16.66%) were partially implemented. Conclusions: The Wasfaty platform is deficient in several key functional features necessary for e-prescribing, which are essential for ensuring patient safety and enhancing the satisfaction of both prescribers and patients. This study underscores the importance of improving the Wasfaty platform to reduce the risk of adverse drug events. Full article

This article examines the relationship between implementing sustainable development measures and financial risk in the context of global companies and the recycling economy. This study uses statistics from Forbes, TIME, and Statista on 50 global companies that actively embrace sustainable development and recycling-economy practices across various industries. As a result, we have compiled a Structural Equation Model (SEM), with the help of which we established that growth in the activity of their implementing the measures of sustainable development and the recycling economy by each 1 point leads to a reduction in the risk of a shortfall in global companies’ profit by USD 0.0741 billion and the risk of ousting global companies from the market by USD 1.8374 billion. It has also been revealed that a reduction in the risk of the shortfall in profit by each USD 1 billion is accompanied by an increase in the activity of global companies’ implementing the measures of sustainable development and the recycling economy by 0.3433 points, and a reduction in the risk of market displacement by each USD 1 billion is accompanied by a growth in this activity by 0.0073 points. The theoretical novelty of the research consists of substantiating the differences in the consequences of the development of the recycling economy for financial risks of companies from different sectors. Practical implications of the proposed recommendations for companies in different industries are that the authors’ recommendations for the development of the recycling economy will allow for systemic reduction in financial risks in the sectors “Automotive Industry & Suppliers”, “Banking, Insurance & Financial Services”, “Chemicals, Drugs & Biotechnology”, and “Retail, Wholesale & Consumer Goods”. We have also revealed the threat of growth of all financial risks in the course of the development of the recycling economy in the sphere “Transportation, Logistics & Aviation”. In “Electronics, Hardware & Equipment” and “Manufacturing & Industrial Production”, the implications are differentiated among financial risks, which require flexibility and care during the development of the recycling economy. We find that global companies’ implementation of sustainable development measures, recycling economy practices, and financial risks are mutually dependent organizational phenomena. Moreover, the risk to profits and market displacement manifest differently among global industries. Our conclusions support expediency in implementing sustainable development and recycling-economy measures to reduce the financial risks to global companies. Further, we propose practical recommendations for companies from different sectors of the world economy. Full article

Veterinary drugs are extensively utilized in poultry farming for purposes such as disease prevention, disease treatment, and feed efficiency enhancement. However, the application of these drugs can lead to unacceptable residues in edible products. This study aimed to investigate the residue profiles of veterinary drugs in silkie chickens. A total of 130 chicken samples were collected from two major retail markets in Taiwan between 2022 and 2024. The analysis of drug residues was conducted using liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS). The overall detection rate of drug residues was 57.7%, and most of these residues were found to be below the maximum residue limits. Among the detected drugs, trimethoprim was the most prevalent, followed by nicarbazin, robenidine, decoquinate, diclazuril, and sulfamonomethoxine. Notably, there was a 31.4% chance that different samples from the same flock would yield varying results. Furthermore, a positive correlation was observed between drug residues and sample weight. In conclusion, this study provides valuable epidemiological data on drug residue profiles in silkie chickens in Taiwan. In the future, it is highly recommended that veterinary drug residues be continuously monitored, and food product sampling protocols be adjusted annually to ensure ongoing compliance with safety standards and protect consumer health. Full article

The rising prevalence of pathogenic bacteria in livestock meat poses a growing public health concern in China. The determination of antimicrobial resistance (AMR) is critical for the clinical management of foodborne infections stemming from livestock meat consumption. This study aimed to assess the prevalence of pathogenic bacteria in livestock meat (pork, beef, and mutton) sampled in China in 2021 and to identify the most common AMR patterns among the isolated pathogens. A total of 2515 raw livestock meat samples were collected across 15 provinces in China during 2021. Pathogen detection, including Listeria monocytogenes, Salmonella, and diarrheagenic Escherichia coli (DEC), followed China’s national food safety standards. All Salmonella isolates underwent serotyping via slide agglutination. Antimicrobial susceptibility of Salmonella and DEC isolates was assessed using the broth dilution method. The detection rates for L. monocytogenes, Salmonella, and DEC in raw livestock meat were 9.06% (228/2, 515), 10.54% (265/2, 515), and 6.16% (155/2, 515), respectively. Pork showed the highest contamination rates for Salmonella and DEC, with prevalence rates of 17.60% (214/1, 216, χ2 = 124.62, p < 0.05) and 7.89% (96/1, 216, χ2 = 14.466, p < 0.05), respectively. L. monocytogenes contamination was notably higher in chilled (14.43%, 84/582) and frozen (12.39%, 55/444) meat than in fresh meat (χ2 = 43.510, p < 0.05). In contrast, Salmonella (12.09%, 180/1489, χ2 = 15.173, p < 0.05) and DEC (7.25%, 108/1489, χ2 = 12.275, p < 0.05) were more prevalent in fresh meat than in chilled or frozen samples. The predominant Salmonella serotypes identified were Salmonella enterica subsp. enterica serovar Typhimurium, followed by Salmonella enterica serovar Derby, Salmonella enterica serovar Rissen, Salmonella enterica serovar London, and Salmonella enterica serotype Enteritidis. Enteroaggregative E. coli was the most frequent pathotype among DEC (84.7%, 133/157), followed by enteropathogenic E. coli (8.3%, 13/157) and enterohemorrhagic E. coli (5.1%, 8/157). Among the 14 tested antimicrobial agents, Salmonella isolates demonstrated an overall resistance rate of 87.50%, while DEC exhibited a resistance rate of 84.70%. Ampicillin and tetracycline showed the highest resistance rates in both pathogens. Multi-drug resistance (MDR) was observed in 67.53% of Salmonella isolates (183 isolates) and 57.96% of DEC isolates (91 isolates). This study highlights the significant contamination of retail raw livestock meat in China by L. monocytogenes, Salmonella, and DEC. The high resistance of MDR in both pathogens poses serious public health risks. Chinese food safety and veterinary authorities should implement stricter measures to control pathogen contamination and regulate the use of antimicrobials in livestock to mitigate these risks. Full article

Drug dispensing in retail pharmacies typically involves several manual tasks that often lead to inefficiencies and errors. This is the first published quality improvement study in Latin America, specifically in Brazil, investigating the operational impacts of implementing a robotic dispensing system in a retail pharmacy. Through observational techniques, we measured the time required for the following pharmacy workflows before and after implementing the robotic dispensing system: customer service, receiving stock, stocking inventory, separation, invoicing, and packaging of online orders for delivery. Time savings were observed across all workflows within the pharmacy, notably in receiving stock and online order separation, which experienced 70% and 75% reductions in total time, respectively. Furthermore, customer service, stocking, invoicing, and packaging of online orders, also saw total time reductions from 36% to 53% after implementation of the robotic dispensing system. This study demonstrates an improvement in the pharmacy’s operational efficiency post-implementation of the robotic dispensing system. These findings highlight the potential for such automated systems to streamline pharmacy operations, improve staff time efficiency, and enhance service delivery. Full article

Objective Campylobacter species are the main causes of foodborne illness worldwide, posing significant threats to public health. This study aimed to investigate the antibiotic resistance and genomic characterization of C. jejuni/C.coli from retail chickens in Beijing. Methods Antimicrobial susceptibility testing was conducted on 126 C. jejuni/C. coli isolated from retail chickens in Beijing, following CLSI protocols. Whole genomes of all isolates were sequenced using the Illumina platform. Results More C. coli (83.82%) showed multi-drug resistance than C. jejuni (8.62%). Genomic analysis demonstrated 42 sequence types (STs) and 12 clonal complexes (CCs), from which CC828 and CC52 were dominant. cdtA, cdtB and cdtC encoding cytotoxic protein were present spontaneously in most C. jejuni but not found in any C. coli isolates. The abundances of antibiotic resistance genes (ARGs) and virulence genes (VGs) in C. jejuni and C. coli were significantly different, with ARGs numbered in C. coli and VGs in C. jejuni. Conclusions High prevalence of multi-drug resistance C. coli and C. jejuni isolated from Beijing chickens were challenging clinical antibiotic usages in the treatment of Campylobacter infection. The surveillance of particular C. jejuni and C. coli STs correlated with higher resistance and virulence needs to be strengthened in the future. Full article

In the present study, a total of 720 samples were collected from retail raw meat from 13 upazilas in Sylhet District, Bangladesh, of which 225 samples were from cattle meat, 210 samples were from goat meat, and 285 samples were from chicken meat. Salmonella enterica serovars Typhimurium and Enteritidis were screened for extended-spectrum β-lactamase (ESBL) genes using multiplex PCR. Among the 720 samples, Salmonella spp. was detected in 28.06% (202 out of 720) of the samples, with S. Enteritidis and S. Typhimurium were identified in 11.53% (83 out of 720) and 12.22% (88 out of 720) of the samples, respectively. It was found that all Salmonella enterica serovars isolated from cattle meat displayed multidrug resistance (MDR) based on antimicrobial susceptibility testing. Notably, a significant proportion of S. Enteritidis isolates and all S. Typhimurium isolates from goat meat demonstrated complete resistance to multiple drugs (ampicillin, cefuroxime, and ceftazidime). Regarding chicken meat, out of 89 isolates encompassing both S. Typhimurium and S. Enteritidis, 57 isolates (64.04%) exhibited MDR. Additionally, bla_CTX-M-1 exhibited the highest occurrence at 15.69% for S. Typhimurium and 7.89% for S. Enteritidis in chicken meat. Moreover, bla_CTX-M-9 was only detected at 3.92% for S. Enteritidis in chicken meat. Furthermore, bla_OXA had the highest prevalence rate of 19.04% for S. Enteritidis and 25.80% for S. Typhimurium in cattle meat, followed by chicken meat. These findings highlight the urgency for monitoring ESBL-producing Salmonella in retail raw meat and the need for strict measure to manage antibiotic use to prevent the spread of multidrug-resistant and ESBL-producing Salmonella strains, thereby protecting humans and reducing public health risks. Full article

Diabetes mellitus is a complex, multifactorial, progressive condition with a variety of approved therapeutic options. The purpose of this study was to offer an overview of the authorized antidiabetic medicines (excluding insulin) compared with marketed products in seven European countries. Data were obtained from primary sources, including the websites of national authorities and directly from specialists in the countries of interest. The range of marketed medicines compared with the authorized group was assessed in terms of active pharmaceutical ingredients (>60% in Bulgaria, France, Serbia), brand names (>70% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), pharmaceutical forms (>60% in all countries), strengths (>60% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), marketing authorization holder (≥50% in all countries) and the status of medicine. Spain was found to have the highest number of products based on most of these attributes. Over 90% of authorized medicines had a pharmacy price in Serbia. Regarding the newer class of GLP-1 receptor agonists, a retail price for all approved substances was available in Bulgaria, Romania, Serbia, and Spain. Only one brand name with one concentration was found available for some agents, being susceptible to drug shortages: glibenclamide (Romania, Serbia, Spain), glipizide (the Czech Republic, Poland, Romania, Spain), glisentide (Spain), acarbose (the Czech Republic), sitagliptin (Bulgaria, Poland), vildagliptin (the Czech Republic, Poland) and saxagliptin (the Czech Republic, France, Romania, Serbia). An overview of the national and international therapeutic options may allow competent authorities and health professionals to take rapid measures in case of supply problems or health crises. Full article

Since 2012, twenty-four states have legalized adult-use recreational cannabis. To varying degrees, state laws allow for the production, distribution, retail sale, and on-site consumption of cannabis in licensed businesses. Accompanying cannabis, some legalization has acknowledged that black and brown communities were disproportionately impacted by the war on drugs. To address this, social equity provisions have been a component of their public policies related to cannabis legalization. These provisions include measures to expunge cannabis-related criminal records and create social equity set-asides for cannabis business licenses. This paper’s research question asks if, under its current structure and implementation, recreational cannabis laws achieve social equity goals. The methods for the analysis apply content analysis to public policy documents and quantify recreational cannabis licensing outcomes. These methods were applied to a comparative analysis of social equity provisions in state and local cannabis laws applicable to large U.S. cities (2020 population > 600,000). This analysis focuses on the characteristics of set-asides for social equity licenses to sell recreational cannabis. The analysis examines the scope of social equity policies, their administration and implementation, and the characteristics of licensees. The findings from the analysis are used to identify a model policy framework and generate recommendations to strengthen social equity outcomes in recreational cannabis licensing. Full article

The United States (US) opioid epidemic is a persistent and pervasive public health emergency that claims the lives of over 80,000 Americans per year as of 2021. There have been sustained efforts to reverse this crisis over the past decade, including a number of measures designed to decrease the use of prescription opioids for the treatment of pain. This study analyzed the changes in federal production quotas for prescription opioids and the distribution of prescription opioids for pain and identified state-level differences between 2010 and 2019. Data (in grams) on opioid production quotas and distribution (from manufacturer to hospitals, retail pharmacies, practitioners, and teaching institutions) of 10 prescription opioids (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, and tapentadol) for 2010 to 2019 were obtained from the US Drug Enforcement Administration. Amounts of each opioid were converted from grams to morphine milligram equivalent (MME), and the per capita distribution by state was calculated using population estimates. Total opioid production quotas increased substantially from 2010 to 2013 before decreasing by 41.5% from 2013 (87.6 MME metric tons) to 2019 (51.3). The peak year for distribution of all 10 prescription opioids was between 2010 and 2013, except for codeine (2015). The largest quantities of opioid distribution were observed in Tennessee (520.70 MME per person) and Delaware (251.45) in 2011 and 2019. There was a 52.0% overall decrease in opioid distribution per capita from 2010 to 2019, with the largest decrease in Florida (−61.6%) and the smallest in Texas (−18.6%). Southern states had the highest per capita distribution for eight of the ten opioids in 2019. The highest to lowest state ratio of total opioid distribution, corrected for population, decreased from 5.25 in 2011 to 2.78 in 2019. The mean 95th/5th ratio was relatively consistent in 2011 (4.78 ± 0.70) relative to 2019 (5.64 ± 0.98). This study found a sustained decline in the distribution of ten prescription opioids during the last five years. Distribution was non-homogeneous at the state level. Analysis of state-level differences revealed a fivefold difference in the 95th:5th percentile ratio between states, which has remained unchanged over the past decade. Production quotas did not correspond with the distribution, particularly in the 2010–2016 period. Future research, focused on identifying factors contributing to the observed regional variability in opioid distribution, could prove valuable to understanding and potentially remediating the pronounced disparities in prescription opioid-related harms in the US. Full article

Antimicrobial dispensing without a prescription has been identified as a significant contributor to the burgeoning crisis of antimicrobial resistance. To combat this, the Saudi Ministry of Health introduced a stringent antimicrobial restriction policy in mid-2018, mandating prescriptions for all antimicrobial drug dispensations at pharmacies. Therefore, this study aimed to assess the immediate impact of this policy on retail antimicrobial sales. To do so, we analyzed annual sales data from 2017 to 2019 sourced from the IQVIA-MIDAS^® database, which included a range of antimicrobials, such as antibiotics, antifungals, and other related agents. The analysis revealed a notable reduction in overall antimicrobial sales by 23.2%, decreasing from 818.9 million SAR in 2017 to 648.4 million SAR in 2019. While the Wilcoxon signed-rank test indicated a statistically significant median reduction in total antimicrobial sales post-policy implementation (p = 0.0397), it is important to acknowledge that the long-term effects and adherence to the policy require further investigation. Notably, sales of amoxicillin dropped by 70% in 2019 compared to 2017, contributing largely to the decline. Conversely, a continuous increase in sales of some antimicrobial drugs following the restriction policy was observed, led by amoxicillin/clavulanic acid. Our data support the implementation of antimicrobial restriction measures as an effective means of controlling excessive antimicrobial sales and dispensing without prescriptions. Full article

Milk and milk products are the main nutritional foods for all age groups, especially for infants and children. Milk may be dangerous to consume due to the presence of a harmful substance called Aflatoxin M1 (AFM1). The objective of this study was to assess the levels of AFM1 in milk, particularly those that exceed the standards set by the European Union (50 ng/L), the Food and Drug Administration (500 ng/L), and the Iranian National Standards Organization (100 ng/L). The study included one hundred and eighty samples of raw cow’s milk from various retail dairy markets in Gorgan, with 45 samples collected during each season. The level of Aflatoxin M1 in the samples was measured using the enzyme-linked immunosorbent assay (ELISA) technique. AFM1 was detected in 139 (72.2%) raw cow milk samples with a range of 3.5–357 ng/L. All of the samples collected had Aflatoxin M1 concentration levels that were below the maximum limit of 500 ng/L set by the FDA. However, 41 samples (22.7%) exceeded the EU’s limit of 50 ng/L, and 26 samples (14.4%) exceeded the INSO’s limit of 100 ng/L for Aflatoxin M1 in raw cow’s milk. The lowest and highest AFM1 levels of contamination were detected in the summer and winter seasons, which constituted 32 (71.1%) and 38 (84.4%) samples, respectively. The consumption of raw cow milk can lead to health risks for individuals from various age groups because regulatory limits are not being followed. Full article

Access to fresh, healthy, affordable foods is a pressing concern in cities worldwide. American cities are no exception. Although many scholars study food access in large cities, small and mid-sized American cities can provide valuable information about inequities in the food system. This paper focuses on two adjoining, racially mixed Mid-Michigan cities—Lansing and East Lansing. It examines the extent to which different food outlets exist in the cities and surrounding townships. It probes the following questions: (1) How are food outlets distributed throughout the cities and suburbs? (2) What is the relationship between neighborhood demographic characteristics and the distribution of food outlet types? We collected data on food outlets from September 2020 to June 2022 using Data Axle as our primary source of information. We used ArcGIS 10.8.1 for the spatial mapping and SPSS 28 for statistical analyses. We conducted regression analyses to identify the difference in the likelihood of finding food retailers in census tracts where 0–20% of the residents were People of Color (VL-POC), 20.01–40% of the inhabitants were People of Color (L-POC), 40.1–60% of the residents were People of Color (H-POC), and more than 60% of residents were People of Color (VH-POC). There were 1647 food outlets in the study area: 579 were in Lansing, 220 were in East Lansing, and the remaining 848 were in the surrounding townships. Restaurants dominated the food landscape, while small groceries and convenience stores were the grocery sector’s most common food outlet types. Supermarkets and large grocery stores comprised only 5.6% of the study area’s food outlets. The study finds a nonlinear relationship between the racial composition of census tracts and the prevalence of food outlets. The VH-POC census tracts had very few food outlets. For instance, the tracts had no supermarkets, mass merchandisers or supercenters, small grocery or convenience stores, pharmacies or drug stores, or farmers’ markets. The findings illustrate the diversity and complexity of the Lansing–East Lansing metropolitan area’s food landscape. Full article

Salmonella spp. is considered one of the most important causes of food-borne illness globally. Poultry and its products are usually incriminated in its spread. Treatment with antibiotics is the first choice to deal with such cases; however, multi-drug resistance and biofilm formation have been recorded in animals and humans. This study aimed to detect the antibiotic profile of isolated traits from different sources and to find innovative alternatives, such as MOFs. A total of 350 samples were collected from randomly selected retailed poultry shops in Beni-Suef Province, Egypt. Their antimicrobial susceptibility against eight different antibiotics was tested, and multi-drug resistance was found in most of them. Surprisingly, promising results toward MOF were detected. Cu/Ni/Co-MOF (MOF3) showed superior antibacterial efficiency to Cu/Ni-MOF (MOF2) and Cu-MOF (MOF1) at p value ≤ 0.01. These findings highlight the tendency of Salmonella spp. to develop MDR to most of the antibiotics used in the field and the need to find new alternatives to overcome it, as well as confirming the ability of the environment to act as a source of human and animal affection. Full article

The aim of this study was to characterize C. difficile isolates from the farm, abattoir, and retail outlets in Ireland in terms of ribotype and antibiotic resistance (vancomycin, erythromycin, metronidazole, moxifloxacin, clindamycin, and rifampicin) using PCR and E-test methods, respectively. The most common ribotype in all stages of the food chain (including retail foods) was 078 and a variant (RT078/4). Less commonly reported (014/0, 002/1, 049, and 205) and novel (RT530, 547, and 683) ribotypes were also detected, but at lower frequencies. Approximately 72% (26/36 tested) of the isolates tested were resistant to at least one antibiotic, with the majority of these (65%; 17/26) displaying a multi-drug (three to five antibiotics) resistant phenotype. It was concluded that ribotype 078, a hypervirulent strain commonly associated with C. difficile infection (CDI) in Ireland, was the most frequent ribotype along the food chain, resistance to clinically important antibiotics was common in C. difficile food chain isolates, and there was no relationship between ribotype and antibiotic resistance profile. Full article