text:
Jesus And The Witches of Salem
First, a little background on the Salem Witch trials, for those who don't know it, followed by a short quiz. (If you know the story, skip forward to the quiz).
The Salem witch trials were a series of hearings and prosecutions of people accused of witchcraft in colonial Massachusetts, between February 1692 and May 1693. Despite being generally known as the Salem witch trials, the preliminary hearings in 1692 were conducted in a variety of towns across the province: Salem Village (now Danvers), Ipswich, Andover and Salem Town.
The most infamous trials were conducted by the Court of Oyer and Terminer in 1692 in Salem Town. One contemporary writer summed the results of the trials thus:
"And now Nineteen persons having been hang'd, and one prest to death, and Eight more condemned, in all Twenty and Eight, of which above a third part were Members of some of the Churches of N. England, and more than half of them of a good Conversation in general, and not one clear'd; about Fifty having confest themselves to be Witches, of which not one Executed; above an Hundred and Fifty in Prison, and Two Hundred more acccused; the Special Commision of Oyer and Terminer comes to a period,..."
Robert Calef
At least five more of the accused died in prison.
"When I put an end to the Court there ware at least fifty persons in prision in great misery by reason of the extream cold and their poverty, most of them having only spectre evidence against them and their mittimusses being defective, I caused some of them to be lettout upon bayle and put the Judges upon consideration of a way to reliefe others and to prevent them from perishing in prision, upon which some of them were convinced and acknowledged that their former proceedings were too violent and not grounded upon a right foundation ... The stop put to the first method of proceedings hath dissipated the blak cloud that threatened this Province with destruccion;..."
Governor William Phips, February 21st, 1693
The episode is one of the most notorious cases of mass hysteria, and has been used in political rhetoric and popular literature as a vivid cautionary tale about the dangers of isolationism, religious extremism, false accusations and lapses in due process. It was not unique, being an American example of the much larger phenomenon of witch trials in the Early Modern period, but many have considered the lasting impressions from the trials to have been highly influential in subsequent American history.
Wikipedia - Salem Witch Trials
Okay, that's the background, now for the short quiz:
Do you believe any of the fifty people convicted (or who confessed), the twenty executed and the eight condemned but reprieved, for witchcraft in the Salem Witch Trials really were witches? Yes or no?
Do you believe that Jesus existed and was who the Bible claims him to have been, i.e. a human manifestation of the God of the Bible? Yes or no?
If you've answered 'no' to 1 and 'yes' to 2, on what are those beliefs based? Evidence, maybe? On rejection of the idea that a group of (mostly) women can suddenly be possessed by evil spirits which take control of them and give them magical powers to control nature and cause bad things to happen?
If the latter, why would you reject that idea yet believe the Bible's account of Jesus driving out evil spirits? (Mark 1:23-26, Luke 4:33-36, Matthew 8:28-32).
Maybe your opinions are based on evidence, not incredulity? So how does the relative evidence stack up?
First, hundreds of people were involved in concluding that the accused were witches. They testified in court, signed sworn affidavits, and demonstrated their utter conviction that the accused were witches. Furthermore, the people attesting to the witchcraft charge came from diverse backgrounds and social strata. They included magistrates, judges, the governor of Massachusetts, respected members of the community, husbands of the accused, and so on. These people had a great deal to lose by being correct - men would lose their wives, children would lose their mothers, community members would lose friends they cared about. It seems very unlikely that they could have had ulterior motives. Accusing a friend or wife of being a witch would very likely have the horrible outcome of getting them executed.
How good was the evidence-gathering process at the time? The trials were a part of thorough, careful, exhaustive investigations. They deliberately gathered evidence and made a substantial attempt to objectively sort out truth from falsity. In the court trials, they attempted to carefully discern the facts. That there were witch trials in Salem and that many people were put to death has been thoroughly corroborated by a range of other historical sources (whereas no such trials, investigations, or efforts are recorded concerning the resurrection of Jesus). It also seems abundantly clear that the accusers, or at least a significant number of them, were utterly convinced that the women were witches. Why else would so many people agree and act so decisively and with such conviction? It strains credibility to suggest that there was a conspiracy or a mass hallucination shared by all of the hundreds of people involved. The same hallucination cannot be had by large groups of people.
What about the state of the evidence as it was passed to us, centuries later? The Salem Witch Trials were historically recent, so we have hundreds of the actual documents that were part of the evidence. We have the signed, sworn testimonies of the very eyewitnesses claiming to have seen the magic performed - again, not as it was repeated and relayed for decades to unknown others, but from the witnesses themselves immediately after it occurred. We even have whole volumes written by witnesses to the trials such as Cotton Mather and John Hale. How much evidence do we have? Enough to fill a truck. Modern archives at the University of Virginia and elsewhere have thousands of documents, books, records, transcripts, affidavits, testimonials, and other works detailing the events. That there were witch trials that convicted the women is beyond a shadow of historical doubt. We have nothing like any of this for the resurrection of Jesus.
Dr Matt McCormick, 2011-10-20 The Salem Witch Trials and the Evidence for the Resurrection -
The End of Christianity (Ed. John W. Loftus); pp. 208-209. Prometheus Books. Kindle Edition.
And what of the evidence for Jesus? Where are these sworn affidavits? Where are all the eye-witness accounts?
There are none. Not a single source document written or dictated by a single contemporaneous witness. There is not a single mention of the name of Jesus in the entire first century CE. No documents, no inscriptions, no court records, nothing. The only historian, Philo-Judeaus, writing and living near Jerusalem at the time Jesus is reputed to have lived, never mentioned him. He seems to have missed all those claimed miracles, the Herodian massacre, the 'triumphal entry into Jerusalem', the 'crucifixion earthquake' and unnatural eclipse and the dead saints rising from their graves and walking around. Despite the constant claims of Christian apologists there are no reliable historical sources for the historicity of the biblical Jesus.
If you believe in the biblical Jesus but believe the Salem Witch Trials were a travesty; a miscarriage of justice; an outbreak of mass hysteria; maybe ignorant and superstitious people reading what they wanted to see into the evidence, being hoodwinked by devious council, misdirected by perverse magistrates or perhaps witnesses reporting as evidence something they wrongly believed they saw, you have to reconcile holding two sets of opposing beliefs simultaneously.
You have to reconcile:
rejecting the many testimonies of the witnesses, and the mass of existing 'evidence' which convinced the juries at the Salem Witch Trials, on the basis that whatever they thought they witnessed, it could not possibly be true because people are not really possessed by evil spirits which give them magical powers to change the natural world;
a belief that Jesus really existed, despite the complete absence of any evidence and that he cast out evil spirits which had possessed people and gave them magical powers to change the natural world.
If you believe in Jesus you have no possible logical reason to believe the Witches of Salem were innocent; and you have no possible reason to reject the idea of witches, witchcraft and people controlling the physical world with spells and incantations today.
If you believe in the biblical Jesus but not in the guilt of the Salem Witches you are holding diametrically opposed views simultaneously about the existence of controlling spirits and about the value of historical evidence and eye-witness accounts, even of confession evidence.
And if you believe in Jesus and rid yourself of the hypocrisy of compartmentalised beliefs, there is nothing to prevent you and like-minded people taking us back to the time when we burned women for witchcraft, should we ever be stupid enough to allow you the power again to do so.
Labels: History , Religion
sterlingfooshee 16 September 2012 at 21:36
An compelling argument, I see very few flaws as far as the inductions from the Christian faith, with which I am very impressed. However, your fundamental premise that all Christians believe that no women accused of witchery were, in fact, guilty is flawed. I honestly cannot tell you, nor do I think any person would be ambitious enough to take an absolutist approach to say that every person was guilty or no person was guilty. I cannot tell you, as I cannot judge the spiritual possession of the accused. However, I do believe that demon possession, witchcraft, or whatever form of spiritual manifestation this is is completely real. The Bible references you mentioned support my argument as well as yours, as they give testament only to the validity of the supernatural manifestations possible in the Salem Witch Trials. For your first question- I cannot absolutely say, but it is entirely possible, all Christians do not have to believe that they were all innocent. On your second question I answered yes, for I do believe that Jesus is God incarnate. These views are not diametrically opposed and cannot be used as evidence to negate the Christian beliefs or the existence of Jesus. As for all of the evidence testifying to the guilt of the accused witches, I will not try to refute that, only to say that it is entirely possible that they were guilty as charged or it may be attributed to the Puritain over-zealous righteousness. Either answer cannot support your claim that the Christian views are opposed.
1."If you believe in Jesus you have no possible logical reason to believe the Witches of Salem were innocent." Again, I am not bound by my faith to answer that they were all innocent. "you have no possible reason to reject the idea of witches, witchcraft and people controlling the physical world with spells and incantations today." A valid deduction, but based on your flawed premise. As a Christian, I believe it is real.
As for your last paragraph, I grieve that such misconceptions led to such destruction that is in every way opposed to the foundations of the Christian faith; I find there actions abhorrent.
Thank you again for the compelling argument.
Rosa Rubicondior 17 September 2012 at 07:42
>However, your fundamental premise that all Christians believe that no women accused of witchery were, in fact, guilty is flawed.
There was no such assumption.
>As for your last paragraph, I grieve that such misconceptions led to such destruction that is in every way opposed to the foundations of the Christian faith; I find there actions abhorrent.<
Perhaps you don't understand the meaning of the word 'if'.
Sterling Fooshee 17 September 2012 at 22:05
If there was no assumption, why was the rest of the article debunking Christianity through the two answers provided? If Christians answer those questions differently than what you provided, the Christian faith cannot be proved wrong on those answers.
I'm sorry about your limited ability at basic English comprehension.
I have to say, I thought where you were going with this was that people would either answer "yes" to both questions or "no" to both questions. You are probably right that a number of religious "moderates" would answer "no" to the first question, but all the religious nutjobs... I mean, err... fundamentalists... very much believe in witchcraft and demon possesion. I have, in fact, been accused of these things myself. But not put to death thankfully...
Bill Eddy 17 July 2013 at 09:26
Cognitive dissonance is actually a survival skill. Quite necessary if you work in corporate settings. Trying to eradicate it is a waste of time. We should recognize and manage it.
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The greater Baw Baw area is known for its natural landscapes, agricultural productivity and successful communities. Part of protecting these values includes the sustainable management of onsite domestic wastewater (septic systems).
The Baw Baw Shire Council like all other municipalities in Victoria manages onsite domestic wastewater in accordance with the Environment Protection Act 1970.
Poorly managed wastewater can cause negative health impacts both at the local scale (for example, a few people that come into contact with wastewater) to large numbers of people from untreated wastewater polluting drinking water supply.
Wastewater can increase the nitrogen and phosphorus present in local waterways. Increased nitrogen and phosphorus increases the growth of algae and weeds, negatively impacting the health of our aquatic ecosystems.
Had your septic tank cleaned recently?
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Please ensure you send us your pumput receipts. Having this information from across the shire allows us to reduce the overall risk to public health, drinking water supply and the environment.
Find out what permit you need and how to get it. Also includes information about Land Capability Assessments.
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A failing septic system can be dangerous. Poorly managed wastewater can cause negative health impacts on both the local and wider community.
Information relating to how domestic wastewater is managed, types of septic systems, Declared Water Supply Catchments and who you can talk to for more information.
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The Tarago Reservoir Catchment Project is a water quality and public health initiative jointly funded by Melbourne Water and the Baw Baw Shire Council to manage the potential risk to public health and the environment from on-site domestic wastewater systems in the Tarago drinking water catchment.


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Coronavirus: Scientific insights and societal aspects
On a quarantine model of coronavirus infection and data analysis
Vitaly Volpert1,2,3*, Malay Banerjee4 and Sergei Petrovskii5
1 Institut Camille Jordan, UMR 5208 CNRS, University Lyon 1, 69622 Villeurbanne, France.
2 INRIA Team Dracula, INRIA Lyon La Doua, 69603 Villeurbanne, France.
3 Peoples Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya St, Moscow 117198, Russia.
4 Department of Mathematics & Statistics, IIT Kanpur, Kanpur 208016, India.
5 School of Mathematics & Actuarial Science, University of Leicester, Leicester LE1 7RH, UK.
* Corresponding author: volpert@math.univ-lyon1.fr
Attempts to curb the spread of coronavirus by introducing strict quarantine measures apparently have different effect in different countries: while the number of new cases has reportedly decreased in China and South Korea, it still exhibit significant growth in Italy and other countries across Europe. In this brief note, we endeavour to assess the efficiency of quarantine measures by means of mathematical modelling. Instead of the classical SIR model, we introduce a new model of infection progression under the assumption that all infected individual are isolated after the incubation period in such a way that they cannot infect other people. Disease progression in this model is determined by the basic reproduction number R0 (the number of newly infected individuals during the incubation period), which is different compared to that for the standard SIR model. If R0 > 1, then the number of latently infected individuals exponentially grows. However, if R0 < 1 (e.g. due to quarantine measures and contact restrictions imposed by public authorities), then the number of infected decays exponentially. We then consider the available data on the disease development in different countries to show that there are three possible patterns: growth dynamics, growth-decays dynamics, and patchy dynamics (growth-decay-growth). Analysis of the data in China and Korea shows that the peak of infection (maximum of daily cases) is reached about 10 days after the restricting measures are introduced. During this period of time, the growth rate of the total number of infected was gradually decreasing. However, the growth rate remains exponential in Italy. Arguably, it suggests that the introduced quarantine is not sufficient and stricter measures are needed.
Mathematics Subject Classification: 92D30
Key words: Coronavirus infection / quarantine model / modes of infection development
Dynamics of COVID-19 pandemic at constant and time-dependent contact rates
Immuno-epidemiological model of two-stage epidemic growth
Prediction of confinement effects on the number of Covid-19 outbreak in Algeria
Accounting for Symptomatic and Asymptomatic in a SEIR-type model of COVID-19
Inferring key epidemiological parameters and transmission dynamics of COVID-19 based on a modified SEIR model

redpajama_set_name: RedPajamaCommonCrawl


text:
Piglet Gut and in-Barn Manure from Farms on a Raised without Antibiotics Program Display Reduced Antimicrobial Resistance but an Increased Prevalence of Pathogens
Efficacy of Novel Bacteriophages against Escherichia coli Biofilms on Stainless Steel
10.3390/antibiotics10101151
Seok Hoon Jeong
Related Info Link
Poss-Doering, R.
Kronsteiner, D.
Kamradt, M.
Kaufmann-Kolle, P.
Andres, E.
Wambach, V.
Bleek, J.
Wensing, M.
ARena-Study Group, .
Szecsenyi, J.
Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena
Regina Poss-Doering
1,*,† ,
Dorothea Kronsteiner
2,†,
Martina Kamradt
Petra Kaufmann-Kolle
Edith Andres
Veit Wambach
Julian Bleek
Michel Wensing
1 , ARena-Study Group ‡ and
Joachim Szecsenyi
Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
aQua Institute, Maschmuehlenweg 8-10, 37073 Goettingen, Germany
Agentur Deutscher Arztnetze e.V., Friedrichstraße 171, 10117 Berlin, Germany
AOK-Bundesverband, Rosenthaler Straße 31, 10178 Berlin, Germany
These authors contribute equally to this work.
Membership of the ARena-Study Group is provided in the Acknowledgments.
Antibiotics 2021, 10(10), 1151; https://doi.org/10.3390/antibiotics10101151
Received: 6 September 2021 / Revised: 22 September 2021 / Accepted: 23 September 2021 / Published: 24 September 2021
Review Reports Versions Notes
The three-armed cluster-randomized trial ARena (sustainable reduction of antibiotic-induced antimicrobial resistance) aimed to foster appropriate antibiotic use and reduce overprescribing in German ambulatory care to counter antibiotic resistance. Multi-faceted interventions targeted primary care physicians, teams and patients. This study examined the effectiveness of the implementation program. ARena was conducted in 14 primary care networks with 196 practices. All arms received data-based feedback on antibiotics prescribing and quality circles. Arms II and III received different add-on components each. Primary outcome examined is the prescribing rate for systemic antibiotics for cases with non-complicated acute infections (upper respiratory tract, bronchitis, sinusitis, tonsillitis, otitis media). Secondary outcomes refer to the prescribing of quinolones and guideline-recommended antibiotics. Based on pseudonymized quarterly claims data, mixed logistic regression models examined pre-post intervention antibiotic prescribing rate changes and compared to matched standard care. A significant rate reduction (arm I 11.7%; arm II 9.9%; arm III 12.7%) and significantly lower prescribing rates were observed for all arms (20.1%, 18.9% and 23.6%) compared to matched standard care (29.4%). Fluoroquinolone prescribing was reduced in all intervention arms and rates for recommended substances generally increased. No significant post-interventional difference between intervention arms was detected. Findings indicate implementation program impact compared to standard care.
antimicrobial resistance; antibiotic prescribing; acute non-complicated infections; primary care; data-based feedback; mixed logistic regression model; multi-faceted intervention
On a global and on national scale, the development and increase of antimicrobial resistance are advanced by over-consumption of antibiotics in human and veterinary healthcare and by inappropriate prescribing. In Germany, about 85% of the used antibiotics are prescribed during consultations in the primary care sector [1,2]. Compared to antibiotic consumption in other countries, the use of antibiotics in Germany is considered moderate [3,4]. However, there is a potential for a lowering of prescribing rates for specific conditions treated in primary care, where antibiotics are prescribed by general practitioners in 41% of all consultations for acute respiratory tract infections (ARTI) [2] and only 52% of these prescriptions correspond to prevailing clinical recommendations [5].
In the context of the national strategy to reduce antibiotic consumption and counteract antimicrobial resistance [1], the ARena trial (sustainable reduction of antibiotic-induced antimicrobial resistance) was conducted as a (non-blinded) three-armed cluster randomized trial between 2017 and 2020. The aim of the trial was to examine the impact of a complex multifaceted implementation program intended to foster the rational use of antibiotics and reduce antibiotic prescribing for acute non-complicated infections of viral origin in primary care settings. The comprehensive program was developed in collaboration with the participating primary care networks (PCNs) and based on relevant published research identified in a literature review [6,7,8,9,10]. PCNs can be understood as formalized collaborations of healthcare providers who interact on a regular basis, standardize care, share patients, discuss concerns, support practice management and attend continuing education [11]. Such collaborative healthcare provider networks support coordination of care and contribute to improvements in care quality and safety [12]. Thus, they were expected to amplify the impact of the implementation program.
The ARena implementation program used multi-faceted interacting components to address knowledge, attitudes and experiences of primary care physicians (General Practitioners, Gynecologists, Otolaryngologists, Urologists, and Pediatricians), care teams and patients about the use of antibiotics in PCNs across two German federal states (Bavaria and North Rhine-Westphalia). The program used different strategies to reduce undesirable prescribing rates. All three intervention arms received a base module of intervention components comprising e-learning on communication for physicians to limit misinterpretation of patient preferences, moderated quality circles (QCs) with data-based feedback on antibiotics prescribing for physicians to facilitate appropriate prescribing, public information campaigns including social media, performance-based additional reimbursement, and culture-sensitive print information material for patients. Based on program developers' assessment of barriers for implementation, arm II received e-learning on communication and separate QCs addressing the team of medical assistants in participating practices, and tablet pcs providing patient information in waiting areas. Including the medical assistants was assumed to be supportive for rational prescribing since sensitizing practice teams for a stronger interaction with patients might facilitate a relieve of the physician's workload and contribute to optimized decision-making [13,14]. Considering the developments in German healthcare, add-ons in arm III were future-orientated and comprised of multidisciplinary, cross-sectoral QCs and a computerized decision support system (CDSS) to be used in the practice admin system. All QCs were offered to promote assessment and critical discussion of clinical practice and focused on care quality and appropriate use of antibiotics regarding respiratory tract infections, urinary tract infections, community acquired pneumonia and multi-resistant pathogens. Current evidence of all base module intervention components validated positive effects on physician prescribing [8,15,16,17]. Evidence regarding effects of add-on components in arms II and III was still limited [16,18,19], or inconclusive [16,20,21]. Nevertheless, effects were expected to be higher in arms II and III than in arm I, since add-ons targeted specific barriers for change and were assumed to be promising tools for reducing errors in medical decision-making [22]. A more detailed description of the study design and intervention components used can be found elsewhere [18].
The primary objective of this study was to examine and compare the change of prescribing rates for targeted index diagnoses in the ARena intervention arms and compare prescribing rates to non-participating standard care, matched to participating PCNs, based on quarterly claims data.
A total of 87,377 patient cases with ARena index diagnoses during the intervention period (Q4 2017-Q2 2019) were included for analysis, which exceeded the target of 79,685 cases calculated for the evaluation. Sample sizes differ between primary and secondary outcomes, because they focus on subgroups of the primary outcome population. One patient might represent several cases.
Physicians working in general practice were the largest group of prescribers in PCNs (76.5%) and in standard care (75.8%) (Supplementary File S1, Table S1 details medical specialty groups distribution). Study populations differed per indexed consultation reason regarding number of cases and age of patients. The sample sizes in the three intervention arms were as follows: in intervention arm I pre 9673 and post 10,143 cases, in intervention arm II pre 4583 and 6730 post cases, and in intervention arm III pre 3951 and post 5076 cases. For the matched standard care cohort, 25,385 cases pre and 25,144 post-intervention were included. Patient characteristics for the included cases are presented in Table 1 (see Supplementary File S1, Table S2 for a detailed description pre- and post-intervention).
2.1. Primary Outcome
Intervention arms showed different baseline prescribing rates and post-intervention prescribing rate reductions. A significant reduction of antibiotic prescriptions was observed in intervention arm II (post versus pre: OR = 0.547 95%-CI = [0.493;0.607], p < 0.001) and in intervention arm III (post versus pre: OR = 0.519 95%-CI = [0.467;0.576], p < 0.001). Additionally, in intervention arm I, the pre-post-comparison showed a significant reduction of antibiotic prescriptions (OR = 0.523 95%-CI = [0.485;0.563], p < 0.001). No significant difference was detected between intervention arms regarding within-group change in the RCT. Figure 1 illustrates the primary outcome as percentages of cases with index diseases in the intervention arms and matched standard care (pre vs. post).
The comparison of changes in each of the three intervention arms to the matched standard care was evaluated in logistic mixed regression models and considered pre/post intervention as covariate. For all intervention arms, a larger reduction of antibiotic prescribing compared to the matched standard care was observed (11.7% in arm I vs. 4.5% in standard care: OR = 0.596 95%-CI = [0.572;0.621], p < 0.001; 9,9% in arm II vs. 4.5% in standard care: OR = 0.661 95%-CI = [0.629;0.695], p < 0.001; 12.7% in III vs. 4.5% in standard care: OR = 0.726 95%-CI = [0.689;0.764], p < 0.001)). Table 2 describes the pre- post comparison of antibiotic prescribing rates, as well as the pre-post comparison between intervention arms and Table 3 the comparison to the matched standard care adjusted for additional covariates.
Adjusting the primary outcome model for further patient and practice characteristics indicated that the difference between interventions arms and matched standard care remained significant. Female gender, age, and Charlson index were associated with a higher likelihood for an antibiotic prescription. Specialists prescribed less antibiotics compared to general practitioners. Table 3 details the comparison of intervention arms to the matched standard care adjusted for additional covariates.
2.2. Secondary Outcomes
For the secondary outcome (SO) of fluoroquinolone prescribing, low pre-interventional rates were observed for trial participants, and these were further reduced during the intervention period (for details see Supplementary File S2, Table S3). At the same time, the prescribing rate of fluoroquinolones decreased in standard care as well. The comparison between intervention arms and matched standard care showed that fluoroquinolone prescribing was lower in all intervention arms (I vs. standard care: OR = 0.911 95%-CI = [0.811;1.021]; II vs. standard care: OR = 0.71 95%-CI = [0.594;0.844]; III vs. standard care: OR = 0.716 95%-CI = [0.613;0.833]).
Prescribing of guideline-recommended substances was evaluated for each index disease separately as percentage of patient cases who consulted primary care practices with one of the index diseases and required and received antibiotics. The highest prescribing rate of recommended substances for URTI was observed at baseline (pre-intervention) in matched standard care. At the post-intervention measuring point, prescribing of guideline-recommended antibiotics in the intervention arms had increased and was higher than in matched standard care (I vs. standard care: OR = 1.615 95%-CI = [1.435;1.816]; II vs. standard care: OR = 1.456 95%-CI = [1.254;1.687]; III vs. standard care: OR = 1.539 95%-CI = [1.336;1.769]).
For bronchitis, an increase in prescribing of recommended substances was recognized in all intervention arms and in matched standard care. Intervention arms I and III reached a substantially higher rate compared to standard care (I vs. standard care: OR = 1.634 95%-CI = [1.439;1.855]; II vs. standard care: OR = 0.987 95%-CI = [0.83;1,17]; III vs. standard care: OR = 1.374 95%-CI = [1.181;1.594]). For sinusitis, all intervention arms showed higher post-interventional prescribing of recommended antibiotics (I vs. standard care: OR = 1.338 95%-CI = [1.057;1.691]; II vs. standard care: OR = 1.372 95%-CI = [1.012;1.851]; III vs. standard care: OR = 2.198 95%-CI = [1.685;2.859]). Patients suffering from tonsillitis in intervention arm I had the highest chance of receiving a recommended substance for the pre timepoint (33.5% recommended antibiotics), while the highest absolute increase was observed in intervention arm III (pre 10.7%, post 25.7%). Comparing post-interventional prescribing, only intervention arm I shows a higher prescribing rate of recommended antibiotics compared to matched standard care (I vs. standard care: OR = 1.157 95%-CI = [0.95;1.406]; II vs. standard care: OR = 0.682 95%-CI = [0.535;0.864]; III vs. standard care: OR = 0.685 [0.503; 0.919]). The highest prescribing rates of antibiotics recommended for otitis media are 41.3% of observed cases in intervention arm II post the intervention period (pre: 33.3%) and 37.9% in intervention arm I (pre: 27.7%), compared to 29.3% in matched standard care (pre: 23.6%).
Figure 2 illustrates the percentage of patient cases who consulted participating PCN practices for one of the index diseases and received a prescription for fluoroquinolones or were treated with indication-specific guideline-recommended systemic antibiotics. A decrease was targeted for fluoroquinolone prescribing while for recommended antibiotics, an increase in prescribing was targeted for cases that required antibiotics. Supplementary File S2, Table S3 describes the observed changes in recommended antibiotics prescribing regarding the examined index diagnoses and indicates the size of the respective patient populations. Comparison of the intervention arms and to matched standard care regarding the SOs is detailed in Supplementary File S2, Table S4.
The implementation program focused on the reduction of antibiotic prescribing in primary care in Germany for non-complicated self-limiting infections without indication for antibiotics. A significant reduction was observed in the pre-post comparison of all intervention arms. No significant difference between the randomized intervention arms was found, so add-on intervention components in arms II and III did not increase the effect. However, the implementation program was associated with lower antibiotic prescribing than in matched standard care, suggesting that it had impact on professional practice.
Different strategies were used to aim for a reduction of undesirable prescribing including enabling measures such as feedback reports, thematically focused quality circles and e-learning modules on physician-patient communication. Enabling measures have been shown to be associated with better acceptance and combining them with restricting interventions was associated with sustainability of the latter [19]. For the ARena trial, a combination of enabling and potentially restrictive intervention components was applied. Effects were expected to be higher in intervention arms II and III than in arm I since the add-on components targeted specific barriers for change (arm II) and match with overall trends in healthcare (arm III). Enabling intervention components in arm II were not only targeted at prescribing physicians directly, but also addressed the practice teams, assuming their role in ambulatory care could be supportive for reduced prescribing by transferring knowledge and awareness to patients. Findings of the process evaluation conducted alongside ARena indicate that physicians in arm II viewed the additional components, particularly the involvement of the practice teams, as very valuable, since they perceived an increased health literacy among the more sensitized patients and a decrease in patient demand for antibiotics [20,21,23]. Providing health-related knowledge to patients via a tablet pc app, however, was perceived to potentially discriminate against older patients with a lesser digital affinity, pose hygiene-related challenges in the practice and increase the practice team's workload. These factors, and a general concern about potential theft of the provided tablet pcs, accounted for a somewhat reduced intervention fidelity regarding this component in arm II. [20]. Combined with an acknowledged lower than initially expected patient demand for antibiotics, this might explain why the estimated potential impact on prescribing could not be observed.
In intervention arm III, the add-on components related to interprofessional care and the increased relevance of information technology solutions in healthcare. PCNs participating in arm III offered cross-sectoral QCs on own initiative and due to internal factors, not all initially planned meetings could take place. The CDSS offered in arm III was implemented into administrative practice software to provide adequate prompts when index diagnoses were coded, which could be ignored or turned off. Its implementation was delayed due to technical difficulties, resulting in a shortened usage period for less practices than expected [20]. The process evaluation found that practices participating in arm III received new impulses from the interdisciplinary QCs and considered the CDSS a support for the integration of knowledge into daily care routines and the choosing of indication-appropriate antibiotics. However, a lower intervention fidelity regarding these two add-on components caused by delayed or incomplete implementation may be typical for newer approaches and might illustrate why the expected additional effect could not be detected.
The trial was conducted in the particular setting of PCNs. Prior research had concluded that such collaborative health professional networks can contribute to improving healthcare quality and safety [12] and interventions delivered by peer community can be expected to be more successful than those delivered by agencies less connected to program recipients [24]. Thus, the PCNs were expected to be an enabling factor for change of prescribing routines. This was also supported by process evaluation findings [20,25] which confirmed that it was an appropriate choice to conduct the ARena trial in the setting of PCNs. Observed antibiotic prescribing in the intervention arms at baseline [26] was both, lower than expected and lower than in matched standard care. It also differed between the three arms yet could be reduced significantly. As prescribing rate reduction effects tend to be stronger when initial rates are high, this can be seen as confirmation for appropriateness of the study setting and the chosen improvement program.
For the SO of fluoroquinolone prescribing, moderate prescribing still declined in all interventions arms as well as in the matched standard care. However, the chance of inappropriate antibiotic prescribing was substantially lower for cases in all intervention arms compared to cases in matched standard care. Prescribing of indication-specific guideline-recommended antibiotics for the observed index diseases (URTI, bronchitis, sinusitis, tonsillitis, otitis media) improved in the intervention arms and was higher than in matched standard care, with the exception of prescribing for otitis media in intervention arm III. Otitis media is a very common disease in early childhood [27,28,29,30] and one of the most common indications for prescribing antibiotics for children [31,32], though evidence and national guidelines might also recommend observation and close follow-up [33,34,35,36,37]. It can be assumed that it might also be recommended that antibiotic prescriptions for otitis media be written mainly by paediatricians who were underrepresented in the ARena intervention arms, and hence the matched standard care. This potentially explains prescribing of recommended antibiotics remaining somewhat low, since beside a nationwide decline in antibiotic prescribing to primary care patients in all age groups between 2010 and 2018, strong improvements and sustainable change in paediatric prescribing patterns have been identified [38].
For patients with co-morbidities, current guidelines in Germany recommend considering antibiotic treatment for non-complicated infections [39,40]. Prescribing rates of recommended antibiotics increased in all intervention arms, but compared to matched standard care, the likelihood for patients with acute tonsillitis to receive a guideline-recommended antibiotic was lower in intervention arms II and III. Prior research indicated that a physician's personal attitude might be a determining factor in whether a patient receives an antibiotic prescription, or not [41]. A recent study evaluated characteristics of high and low prescribers of antibiotics in German primary care by examining routinely collected claims data. The study confirmed previous findings of considerable differences in prescribing rates between physicians and concluded that due to the limitations of secondary data, further research including the linkage of primary and secondary data should aim to determine causal relationships [42]. However, the discrepancy in our findings cannot be explained by the analysis, yet among possible reasons could also be diagnostic uncertainties referring to younger patients, or recurrent incidence of the disease, known allergies in patients, or regional variations.
The particular strengths of this study are the randomized evaluation design, high validity of claims data, low drop out of participating physicians, thorough consideration of excluded ICD-10-coded diagnoses and the additional detailed analysis referring to the type of antibiotics (recommended, quinolones). All cases meeting the inclusion/exclusion criteria were considered. The main limitation of the randomized trial was the randomization at a high aggregation level (14 PCNs) with a risk of by-chance differences. In the observational comparison, the intervention arms were compared to matched standard care, not to a control group of practices from the participating PCNs, since the network structure and peer exchange likely would have led to contamination. At pre-intervention, observed prescribing rates differed between the arms and were lower than expected. Limitations also include the absence of blinding and health-related outcome measures, and the restriction on ICD-10 codes and claims-related health insurance data where disease, patient, and practice information were limited. Direct connection between ICD-10 codes and date of antibiotic prescription was not possible via the provided claims data. Therefore, ICD-10 codes and antibiotic prescriptions were matched at quarter level, which introduces a potential bias.
4.1. Study Design
ARena was conducted as a prospective (non-blinded) three-armed cluster randomized trial in two German federal states (Bavaria and North Rhine-Westphalia), with fourteen PCNs as units of randomization. The study was conducted with an intervention period of 21 months, and a two-part evaluation: (a) an outcome evaluation based on quarterly claims-data provided by the statutory health insurance provider AOK and (b) a process evaluation based on surveys [18]. Examined were the comparison of baseline and post-interventional prescribing rates, and differences between the intervention arms and the non-participant matched standard care generated from claims data.
4.2. Study Population
Fourteen PCNs in Bavaria (12 PCNs) and North Rhine-Westphalia (2 PCNs) were recruited by the aQua Institut, Göttingen, Germany, for participation in the ARena trial, and randomized into arm I (4 PCNs), arm II (5 PCNs), and arm III (5 PCNs) by a statistician at the Institute for Medical Biometry, University Hospital Heidelberg, Germany. Randomization considered the number of practices in each PCN, and based on the expected number of practices, aimed for comparable numbers of practices in each intervention arm. Due to intervention components to be offered on PCN level, randomization on practice level was not feasible. For administrative reasons, the focus was on cases in patients insured by AOK health insurance and registered within a specific healthcare delivery program (defined by German law § 140a SGB V a.F. and § 140a Abs. 1. S. 2 Alt. 1 SGB V n.F). At baseline, approximately 40,000 patients with AOK health insurance were registered in 196 participating primary care practices in the 14 PCNs. Medical specialties covered by participating physicians included general practice (largest group), otolaryngology, paediatrics, urology and gynaecology. Observed cases comprised patients who consulted a physician in participating PCNs or in the matched standard care for one of the following reasons: acute upper respiratory tract infection (URTI), acute bronchitis, acute sinusitis, tonsillitis, otitis media, urinary tract infection (UTI), community acquired pneumonia. All diagnoses were based on physician-recorded ICD-10 codes and prescribing information in the administrative data provided by the health insurer for quarterly reimbursement periods, which were linked by the pseudonymized individual insurance number. Cross-validation of recorded codes with patient charts was not possible due to data confidentiality regulations. Each physician-recorded ICD-10 code for defined index diagnoses in the observed quarters represents a case, and each patient could produce multiple cases. Diagnoses for other diseases and diagnoses that warrant an antibiotic therapy were not considered. (Supplementary File S3, Table S5 details diagnoses and related ICD-10 codes and Table S6 provides a list of disregarded diagnoses.) Note that prescribing information was derived from quarterly claims data provided by the health insurer. Patients were not actively recruited, but cases were automatically included when a participating physician claimed reimbursement for them from the health insurer. All participating physicians consented in the use of their claims data and signed a data release form. Due to data protection regulations, patients in North Rhine-Westphalia had to give additional written consent to their data being included for analysis.
4.3. Measures
The primary outcome references established indicators of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) [43], which were tailored to the specifics of ARena. It was defined as the percentage of patient cases with acute non-complicated infections receiving an antibiotic prescription without pathogen detection when consulting primary care practices (cases with acute bronchitis (age 18–75), sinusitis (>18 years), otitis media (>2 years), URTI (>1 year), or tonsillitis (>1 year)). Evaluation was based on quarterly claims data. The intervention period was planned for 24 months and reduced to 21 months (Q4 2017 to Q2 2019) due to delays in component development. As indicated by the study protocol [18], points of measurement were at baseline (Q3 2016–Q2 2017) and at the end of the intervention period (Q3 2018–Q2 2019). Diagnoses for streptococcal tonsilitis and other pathogen-caused acute forms of tonsillitis that warrant antibiotic therapy were not considered.
SOs examined in this study refer to the percentage of all observed cases with (SO 1) acute non-complicated infections receiving a quinolone prescription when consulting primary care practices (cases with acute bronchitis (age 18–75), sinusitis (>18), otitis media (>2), URTI (>1 year), or tonsillitis (age >1)); (SO 2) acute URTI (>1 year) receiving a prescription for recommended antibiotics (amoxicillin); (SO 3) acute bronchitis (age 18–75) receiving a prescription for recommended antibiotics (amoxicillin, doxycycline, macrolides); (SO 4) sinusitis (>18 years) receiving a prescription for recommended antibiotics (amoxicillin, cephalosporins 2nd Gen, doxycycline); (SO 5) tonsillitis (>1 year) receiving a prescription for recommended antibiotics (penicillin, cephalosporins, erythromycin); and (SO 6) otitis media (>2 years) receiving a prescription for recommended antibiotics (amoxicillin, cephalosporins 2nd Gen, erythromycin).
The ARena study protocol also defined SOs referring to cystitis and community-acquired pneumonia which were not considered here due to a very small numbers of cases. Specifications for patient age in all observed sub-groups adhere to study protocol [18]. All outcomes reported here relate to ICD-10 coded consultations in primary care and prescribing of systemic antibiotics, and indication-specific prescribing of currently guideline-recommended antimicrobials [39,40]. Recommended antibiotics were categorized based on existing evidence-based clinical guidelines developed by the German College of General Practitioners and Family Physicians (DEGAM) [40] and the Association of the Scientific Medical Societies in Germany (AWMF) [39]. (See Supplementary File S3, Table S7 for currently recommended and alternative antibiotics.)
The following patient-related sociodemographic, disease, and treatment characteristics were provided in the claims data and, as indicated by the study protocol [18], included for analysis: age, sex, Charlson comorbidity index (CCI) (predicts 1-year survival in patients based on sum of relevant comorbidities) [44,45], nationality (missing values were aggregated to "other"). For the primary care practices, type of location (urban, urbanized, countryside), type of practice (single or group) and medical specialty group are documented.
4.4. Data Analysis
Data were analysed using the statistical software R version 3.6.3 to compare four baseline quarters (Q3 2016–Q2 2017) to four quarters at the end of the intervention (Q3 2018–Q2 2019) for the intervention arms, between arms, and in comparison to matched standard care regarding the defined outcomes. The primary and secondary outcomes, documented data referring to patient and disease characteristics, treatment data, and distribution of medical specialty group were first analysed descriptively stratified by the intervention arm. For categorical variables, absolute and relative frequencies are provided. Note that patient and disease characteristics, treatment data and practice characteristics differ between outcomes, as considered cases are defined for each outcome by the respective disease and prescribing of antibiotics. Confirmatory analysis of the primary outcome was conducted based on the Intention-To-Treat (ITT) population. Since the pre/post reduction was of primary interest and reduction was assumed to be different in each intervention arm, a structured three-step, hierarchical test procedure was applied [46] to ensure a global significance level of 5% and assess the following hypotheses regarding the pre-post intervention comparison of the percentage of cases with acute non-complicated infections receiving antibiotic prescription when consulting primary care practices:
Step 1: Percentage of cases in intervention arms II and III are each lower post-intervention.
Step 2: Percentage of cases in intervention arm I is lower post-intervention.
Step 3: Compared to intervention arm I, the percentage is lower in intervention arms II and III each.
In Step 1, the pre-post-comparisons in intervention arms II and III were tested using a 2.5% significance level (Bonferroni correction). If at least one pre-post-comparison was significant, Step 2 was conducted (significant difference in one arm in step 1: 2.5% significance level, significant difference in both arms: 5% significance level). In case the pre-post-comparison in Step 2 was significant, the pre-post-comparisons between intervention arms were tested in Step 3 to examine intervention effectiveness. Logistic mixed effects models were used to explore the primary objective in the hierarchical procedure. The models considered the nested structure of the data with multiple cases per patient and patients nested in practices by including a random effect in the logistic mixed effects model for patients and practices. As fixed effects, timepoint (pre/post), gender, and age group (<18, 18–65, >65 years) were included in step 1 and 2. In step 3, the intervention arm was added as fixed effect.
The primary outcome was additionally analysed comparing the three intervention arms to matched standard care, using a logistic mixed effects model and taking the clustered structure into account. Standard care was matched on practices level by using a propensity score matching based on a logistic regression model under consideration of the matching variables specialist group, baseline number of cases, postal code (first 3 digits), and region. Considered fixed effects in that model are group (intervention arms vs. matched standard care), time-point (pre/post), gender, age, CCI as indication of health status, nationality, and region, town/countryside. Secondary outcomes were analysed using mixed logistic regression models comparing intervention arms with the matched standard care. All p-values for secondary analysis are of explorative nature. Findings reported here focus on the prescribing of antibiotics for upper respiratory tract infections.
Significantly reduced antibiotic prescribing for non-complicated infections in the intervention arms, compared to matched standard care show the impact of the implementation program. Further research should explore which interventions can increase the effects.
The following are available online at https://www.mdpi.com/article/10.3390/antibiotics10101151/s1, Supplementary File S1, Tables S1 and S2, Supplementary File S2, Tables S3 and S4, Supplementary File S3, Tables S5–S7. Table S1: Distribution of medical specialty groups pre and post-intervention, Table S2: Patients with index disease—pre-/post-intervention and comparison to matched standard care, Table S3: Percentage of cases with index disease receiving prescription for recommended antibiotics (pre-/post-intervention), Table S4: Comparison of intervention arms to standard care regarding secondary outcomes adjusted for additional covariates, Table S5: Diagnoses Primary Outcome, Table S6: Disregarded Diagnoses, Table S7: Currently recommended and alternative Antibiotics.
Conceptualization, R.P.-D., D.K., P.K.-K., E.A., V.W., J.B., M.W. and J.S.; Data curation, P.K.-K., E.A. and ARena-Study Group; Formal analysis, R.P.-D. and D.K.; Funding acquisition, ARena-Study Group and J.S.; Investigation, R.P.-D. and M.W.; Methodology, R.P.-D., D.K. and M.W.; Project administration, R.P.-D., M.K., P.K.-K., E.A. and ARena-Study Group; Resources, ARena-Study Group; Supervision, M.W. and J.S.; Validation, D.K. and M.K.; Visualization, R.P.-D., D.K. and M.K.; Writing–original draft, R.P.-D. and D.K.; Writing–review & editing, R.P.-D., D.K., M.K., P.K.-K., E.A., V.W., J.B., M.W. and J.S. All authors have read and agreed to the published version of the manuscript.
The ARena study received funding from the Innovation Committee at the Federal Joint Committee (G-BA), Berlin (01NVF16008). The funder had no role in the design, data-collection, data-analysis, interpretation, or writing of the paper.
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University (S-353/2017). Trial registration: ISRCTN, ISRCTN58150046.
Informed consent was obtained from all participants, confidentiality and anonymity were ensured throughout the study. Participants all gave written informed consent for participation and publication of findings.
All analyses generated for this study are included in this manuscript or Supplementary Materials. The original datasets that support the findings of this study are not publicly available due to restrictions stipulated by German law and the data provider. AOK can be contacted for access to the data.
The authors would like to thank the aQua Institute and their staff for taking the lead in the ARena consortium. In particular, we thank Linda Barnewold, aQua Institute, for supporting data management in this study and Andreas Gutscher, Gitta Friedrichs und Yvonne Giesler, aQua Institute, for their administrative support. We would also like to thank all involved ARena project partners for their advice, contributions and overall support in conducting the ARena study: Agency of German Practice Based Physicians (Agentur deutscher Arztnetze), statutory health insurers AOK Bayern, AOK Rheinland-Hamburg, and Federal AOK Association (AOK Bundesverband), and the Bavarian Association of Statutory Health Insurance Physicians (KV Bayerns). ARena-Study Group: Joachim Szecsenyi, Michel Wensing, Martina Kamradt, Regina Poss-Doering (Department of General Practice and Health Services Research, University Hospital Heidelberg); Dorothea Kronsteiner (IMBI Institute for Medical Biometry, Heidelberg); Petra Kaufmann-Kolle, Edith Andres (aQua Institute, Goettingen); Non-author contributors: Joerg Lindenthal (QuE Nuremberg); Alexander Günter (statutory health insurer AOK Bavaria (AOK Bayern)); Mara Plambeck and Witali Schleiz (statutory health insurer AOK Rheinland/Hamburg); Lutz Bader, Hanna Schürkämper and Sandra Hérault (Bavarian Association of Statutory Health Insurance Physicians (KV Bayerns)). KV Bayerns served as scientific advisors throughout the ARena study.
J.S. is founder, shareholder and managing director of the aQua Institute, Goettingen and Medical Director at the Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany. Edith Andres is co-founder and shareholder of the aQua Institut, Goettingen. All other authors declare that they have no conflicts of interests.
ARTI acute respiratory tract infections
AWMF Association of the Scientific Medical Societies in Germany
CAP community acquired pneumonia
CI confidence interval
CCI Charlson comorbidity Index
CDSS Computerized Decision Support System
DDD defined daily dose
DEGAM German College of General Practitioners and Family Physicians
ESAC-Net European Surveillance of Antimicrobial Consumption Network
GP general practitioners
ICD International Classification of Diseases
OR odds ratio
PCNs primary care networks
Q quarter
QC Quality circle
SO Secondary outcome
URTI upper respiratory tract infections
German Federal Ministry of Health. Bundesministerium für Gesundheit. DART 2020—Antibiotika-Resistenzen Bekämpfen Zum Wohl Von Mensch Und Tier; Bundesministerium für Gesundheit: Berlin, Germany, 2015. Available online: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/D/DART_2020/BMG_DART_2020_Bericht_dt.pdf (accessed on 27 June 2021).
Federal Office of Consumer Protection and Food Safety P-E-GfCeV. Germap 2015: Antimicrobial Resistance and Consumption; Report on the Consumption of Antimicrobials and the Spread of Antimicrobial Resistance in Human and Veterinary Medicine in Germany; Antiinfectives Intelligence: Rheinbach, Germany, 2016.
European Centre for Disease Prevention and Control. Surveillance of Antimicrobial Resistance in Europe 2018. Stockholm 2019. Available online: https://www.ecdc.europa.eu/sites/default/files/documents/surveillance-antimicrobial-resistance-Europe-2018.pdf (accessed on 27 June 2021).
European Centre for Disease Prevention Control. Antimicrobial Resistance Surveillance in Europe. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015. Stockholm: ECDC. 2017. Available online: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/antimicrobial-resistance-europe-2015.pdf (accessed on 27 July 2021).
Kraus, E.M.; Pelzl, S.; Szecsenyi, J.; Laux, G. Antibiotic prescribing for acute lower respiratory tract infections (LRTI)—Guideline adherence in the German primary care setting: An analysis of routine data. PLoS ONE 2017, 12, e0174584. [Google Scholar] [CrossRef]
Anthierens, S.; Tonkin-Crine, S.; Cals, J.W.; Coenen, S.; Yardley, L.; Brookes-Howell, L.; Fernandez-Vandellos, P.; Krawczyk, J.; Godycki-Cwirko, M.; Llor, C.; et al. Clinicians' Views and Experiences of Interventions to Enhance the Quality of Antibiotic Prescribing for Acute Respiratory Tract Infections. J. Gen. Intern. Med. 2015, 30, 408–416. [Google Scholar] [CrossRef][Green Version]
Meeker, D.; Linder, J.A.; Fox, C.R.; Friedberg, M.W.; Persell, S.D.; Goldstein, N.J.; Knight, T.K.; Hay, J.W.; Jason, N. Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial. JAMA 2016, 315, 562–570. [Google Scholar] [CrossRef] [PubMed]
Ivers, N.; Jamtvedt, G.; Flottorp, S.; Young, J.M.; Odgaard-Jensen, J.; French, S.; O'Brien, M.A.; Johansen, M.; Grimshaw, J.; Oxman, A.D. Audit and feedback: Effects on professional practice and healthcare outcomes. Cochrane Database Syst. Rev. 2012, 2012, CD000259. [Google Scholar] [CrossRef]
Wensing, M.; Broge, B.; Riens, B.; Kaufmann-Kolle, P.; Akkermans, R.; Grol, R.; Szecsenyi, J. Quality circles to improve prescribing of primary care physicians. Three comparative studies. Pharmacoepidemiol. Drug Saf. 2009, 18, 763–769. [Google Scholar] [CrossRef]
Köchling, A.; Löffler, C.; Reinsch, S.; Hornung, A.; Böhmer, F.; Altiner, A.; Chenot, J.-F. Reduction of antibiotic prescriptions for acute respiratory tract infections in primary care: A systematic review. Implement. Sci. 2018, 13, 47. [Google Scholar] [CrossRef] [PubMed]
Agentur deutscher Arztnetze (AdA). Ueber Netze. Was sind Arztnetze? Agentur deutscher Arztnetze. 2014. Available online: http://deutsche-aerztenetze.de/ueber_netze/was_sind_arztnetze.php (accessed on 16 June 2021).
Cunningham, F.C.; Ranmuthugala, G.; Plumb, J.; Georgiou, A.; Westbrook, J.I.; Braithwaite, J. Health professional networks as a vector for improving healthcare quality and safety: A systematic review. BMJ Qual. Saf. 2012, 21, 239–249. [Google Scholar] [CrossRef] [PubMed][Green Version]
Freund, T.; Everett, C.; Griffiths, P.; Hudon, C.; Naccarella, L.; Laurant, M. Skill mix, roles and remuneration in the primary care workforce: Who are the healthcare professionals in the primary care teams across the world? Int. J. Nurs. Stud. 2015, 52, 727–743. [Google Scholar] [CrossRef][Green Version]
Chapman, S.A.; Blash, L.K. New Roles for Medical Assistants in Innovative Primary Care Practices. Health Serv. Res. 2017, 52 (Suppl. 1), 383–406. [Google Scholar] [CrossRef][Green Version]
Tonkin-Crine, S.K.; Tan, P.S.; van Hecke, O.; Wang, K.; Roberts, N.W.; McCullough, A.; Hansen, M.P.; Butler, C.C.; Del Mar, C.B. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: An overview of systematic reviews. Cochrane Database Syst. Rev. 2017, 9, CD012252. [Google Scholar] [CrossRef][Green Version]
Little, P.; Stuart, B.; Francis, N.; Douglas, E.; Tonkin-Crine, S.; Anthierens, S.; Cals, J.; Melbye, H.; Santer, M.; Moore, M.; et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: A multinational, cluster, randomised, factorial, controlled trial. Lancet 2013, 382, 1175–1182. [Google Scholar] [CrossRef][Green Version]
Rohrbasser, A.; Harris, J.; Mickan, S.; Tal, K.; Wong, G. Quality circles for quality improvement in primary health care: Their origins, spread, effectiveness and lacunae- A scoping review. PLoS ONE 2018, 13, e0202616. [Google Scholar] [CrossRef] [PubMed]
Kamradt, M.; Kaufmann-Kolle, P.; Andres, E.; Brand, T.; Klingenberg, A.; Glassen, K.; Poß-Doering, R.; Uhlmann, L.; Hees, K.; Weber, D.; et al. Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: Study protocol of a cluster randomised trial. Implement. Sci. 2018, 13, 23. [Google Scholar] [CrossRef] [PubMed][Green Version]
Davey, P.; Marwick, C.A.; Scott, C.L.; Charani, E.; McNeil, K.; Brown, E.; Ramsay, C.R.; Wiffen, P.J.; Wilcox, M. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst. Rev. 2017, 2, CD003543. [Google Scholar] [CrossRef] [PubMed][Green Version]
Poss-Doering, R.; Kühn, L.; Kamradt, M.; Stürmlinger, A.; Glassen, K.; Andres, E.; Kaufmann-Kolle, P.; Wambach, V.; Bader, L.; Szecsenyi, J.; et al. Fostering Appropriate Antibiotic Use in a Complex Intervention: Mixed-Methods Process Evaluation Alongside the Cluster-Randomized Trial ARena. Antibiotics 2020, 9, 878. [Google Scholar] [CrossRef]
Poss-Doering, R.; Kamradt, M.; Stuermlinger, A.; Glassen, K.; Kaufmann-Kolle, P.; Andres, E.; Wensing, M. The complex phenomenon of dysrational antibiotics prescribing decisions in German primary healthcare: A qualitative interview study using dual process theory. Antimicrob. Resist. Infect. Control 2020, 9, 6. [Google Scholar] [CrossRef]
Mann, D.; Hess, R.; McGinn, T.; Richardson, S.; Jones, S.; Palmisano, J.; Chokshi, S.K.; Mishuris, R.; McCullagh, L.; Park, L.; et al. Impact of Clinical Decision Support on Antibiotic Prescribing for Acute Respiratory Infections: A Cluster Randomized Implementation Trial. J. Gen. Intern. Med. 2020, 35 (Suppl. 2), 788–795. [Google Scholar] [CrossRef] [PubMed]
Andres, E.; Szecsenyi, J.; Garbe, K.; Hartmann, J.; Petruschke, I.; Schulz, M.; Sturm, H.; Altiner, A.; Bauer, A.; Bornemann, R.; et al. Rational Use of Antibiotics: Impulses for Primary Care (a Symposium Report). Z. für Allg. ZFA 2020, 96, 109–115. Available online: https://www.online-zfa.de/fileadmin/user_upload/Heftarchiv/ZFA/article/2020/03/6189C7EE2967480BA1C5928DB04D521A_andres_rationaler_antibiotika_einsatz.pdf (accessed on 21 September 2021).
Valente, T.W.; Palinkas, L.A.; Czaja, S.; Chu, K.-H.; Brown, C.H. Social network analysis for program implementation. PLoS ONE 2015, 10, e0131712. [Google Scholar] [CrossRef][Green Version]
Poss-Doering, R.; Kamradt, M.; Glassen, K.; Andres, E.; Kaufmann-Kolle, P.; Wensing, M. Promoting rational antibiotic prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany. BMC Fam. Pract. 2020, 21, 51. [Google Scholar] [CrossRef]
Poss-Doering, R.; Kronsteiner, D.; Kamradt, M.; Andres, E.; Kaufmann-Kolle, P.; Wensing, M.; Szecsenyi, J. Antibiotic prescribing for acute, non-complicated infections in primary care in Germany: Baseline assessment in the cluster randomized trial ARena. BMC Infect. Dis. 2021, 21, 877. [Google Scholar] [CrossRef]
Kamtsiuris, P.; Atzpodien, K.; Ellert, U.; Schlack, R.; Schlaud, M. Prävalenz von somatischen Erkrankungen bei Kindern und Jugendlichen in Deutschland. Bundesgesundheitsblatt Gesundh. Gesundh. 2007, 50, 686–700. [Google Scholar] [CrossRef] [PubMed][Green Version]
Grobe, T.G.; Dörning, H.A.N.S.; Schwartz, F.W. Barmer Gek Arztreport; St. Augustin: Asgard. 2011. Available online: https://www.barmer.de/blob/36506/d5630a0f349e388b65fd28ad616b7257/data/arztreport-2011-pdf.pdf (accessed on 21 September 2021).
Holm, N.H.; Rusan, M.; Ovesen, T. Acute otitis media and antibiotics—A systematic review. Dan. Med. J. 2020, 67, A04200272. [Google Scholar] [PubMed]
Venekamp, R.P.; Mick, P.; Schilder, A.G.; Nunez, D.A. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst. Rev. 2018, 5, Cd012017. [Google Scholar] [CrossRef][Green Version]
Coker, T.R.; Chan, L.S.; Newberry, S.J.; Limbos, M.A.; Suttorp, M.J.; Shekelle, P.G.; Takata, G.S. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: A systematic review. JAMA 2010, 304, 2161–2169. [Google Scholar] [CrossRef][Green Version]
McBride, J.A.; Eickhoff, J.; Wald, E.R. Impact of COVID-19 Quarantine and School Cancelation on Other Common Infectious Diseases. Pediatr. Infect. Dis. J. 2020, 39, e449–e452. [Google Scholar] [CrossRef]
Britten, N. Patients' expectations of consultations. BMJ 2004, 328, 416–417. [Google Scholar] [CrossRef]
Mangione-Smith, R.; McGlynn, E.A.; Elliott, M.N.; Krogstad, P.; Brook, R.H. The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior. Pediatrics 1999, 103 Pt 1, 711–718. [Google Scholar] [CrossRef]
Venekamp, R.P.; Sanders, S.L.; Glasziou, P.P.; Del Mar, C.B.; Rovers, M.M. Antibiotics for acute otitis media in children. Cochrane Database Syst. Rev. 2015, 2015, Cd000219. [Google Scholar] [CrossRef] [PubMed][Green Version]
Shahbaznejad, L.; Talaei, E.; Hosseinzadeh, F.; Masoumi, B.; Rezai, S.; Rezai, M.S. Comparing Watchful Waiting Approach vs. Antibiotic Therapy in Children with Nonsevere Acute Otitis Media: A Randomized Clinical Trial. Int. J. Pediatr. 2021, 2021, 1–8. [Google Scholar]
Mather, M.W.; Drinnan, M.; Perry, J.D.; Powell, S.; Wilson, J.A.; Powell, J. A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. Int. J. Pediatr. Otorhinolaryngol. 2019, 123, 102–109. [Google Scholar] [CrossRef] [PubMed]
Holstiege, J.; Schulz, M.; Akmatov, M.; Kern, W.; Steffen, A.; Bätzing, J. The decline in outpatient antibiotic use—An analysis of nationwide prescription data from 2010 to 2018. Dtsch. Ärzteblatt 2020, 117, 679–686. [Google Scholar] [CrossRef] [PubMed]
Association of the Scientific Medical Societies in Germany (AWMF). Aktuelle Leitlinien (Current guidelines) Online: AWMF. Available online: https://www.awmf.org/leitlinien/aktuelle-leitlinien.html (accessed on 21 September 2021).
German College of General Practitioners and Family Physicians (DEGAM). Leitlinien der DEGAM. Available online: https://www.degam.de/degam-leitlinien-379.html (accessed on 21 September 2021).
De Sutter, A.I.; De Meyere, M.J.; De Maeseneer, J.M.; Peersman, W.P. Antibiotic prescribing in acute infections of the nose or sinuses: A matter of personal habit? Fam. Pract. 2001, 18, 209–213. [Google Scholar] [CrossRef][Green Version]
Hueber, S.; Kuehlein, T.; Gerlach, R.; Tauscher, M.; Schedlbauer, A. "What they see is what you get": Prescribing antibiotics for respiratory tract infections in primary care: Do high prescribers diagnose differently? An analysis of German routine data. PLoS ONE 2017, 12, e0188521. [Google Scholar] [CrossRef] [PubMed][Green Version]
Adriaenssens, N.; Coenen, S.; Versporten, A.; Muller, A.; Minalu, G.; Faes, C.; Vankerckhoven, V.; Aerts, M.; Hens, N.; Molenberghs, G.; et al. European Surveillance of Antimicrobial Consumption (ESAC): Outpatient antibiotic use in Europe (1997-2009). J. Antimicrob. Chemother. 2011, 66 (Suppl. 6), vi3–vi12. [Google Scholar] [CrossRef][Green Version]
Charlson, M.E.; Pompei, P.; Ales, K.L.; MacKenzie, C.R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 1987, 40, 373–383. [Google Scholar] [CrossRef]
Quan, H.; Sundararajan, V.; Halfon, P.; Fong, A.; Burnand, B.; Luthi, J.-C.; Saunders, L.D.; Beck, C.A.; Feasby, T.E.; Ghali, W.A. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med. Care 2005, 43, 1130–1139. [Google Scholar] [CrossRef]
Westfall, P.H.; Krishen, A. Optimally weighted, fixed sequence and gatekeeper multiple testing procedures. J. Stat. Plan. Inference 2001, 99, 25–40. [Google Scholar] [CrossRef]
Figure 1. Percentage of patient cases who consulted primary care practices with acute non-complicated infections (index diseases) and were treated with systemic antibiotics (primary outcome). I = intervention arm 1; II = intervention arm II; III = intervention arm III.
Figure 2. Percentage of patient cases who consulted primary care practices with acute non-complicated infections (index diseases) and received fluoroquinolones or were treated with recommended systemic antibiotics (subgroups). SO = Secondary Outcome.
Table 1. Patient characteristics of included cases (post-intervention).
(Cases)
Matched Standard Care
(No Intervention)
Arm I
Arm II
Arm III
(n = 10,143) (n = 6730) (n = 5076) (n = 25,144)
Age, n (%) <18 578 (5.7) 757 (11.2) 143 (2.8) 4210 (16.7)
18–65 7869 (77.6) 4684 (69.6) 3910 (77.0) 18,960 (75.4)
>65 1696 (16.7) 1289 (19.2) 1023 (20.2) 1974 (7.9)
Gender, n (%) Male 4405 (43.4) 2900 (43.1) 2074 (40.9) 11,891 (47.3)
Nationality, n (%) German 9115 (89.9) 5425 (80.6) 4144 (81.6) 18,681 (74.3)
CCI, n (%) 0 5734 (56.5) 3858 (57.3) 2604 (51.3) 17,412 (69.2)
1, 2 2926 (28.8) 1945 (28.9) 1609 (31.7) 6259 (24.9)
3, 4 781 (7.7) 453 (6.7) 492 (9.7) 830 (3.3)
≥5 702 (6.9) 474 (7.0) 371 (7.3) 643 (2.6)
Index diseases, n (%) Bronchitis 2442 (24.1) 1569 (23.3) 1457 (28.7) 5796 (23.1)
URTI 7620 (75.1) 4916 (73.0) 3719 (73.3) 17,663 (70.2)
Sinusitis 962 (9.5) 867 (12.9) 700 (13.8) 1642 (6.5)
Tonsillitis 507 (5.0) 335 (5.0) 220 (4.3) 1654 (6.6)
Otitis Media 474 (4.7) 357 (5.3) 263 (5.2) 1809 (7.2)
CCI: Charlson Comorbidity Index; URTI: upper respiratory tract infection.
Table 2. Comparison of antibiotic prescribing rates by mixed logistic regression (pre vs. post, primary outcome) and comparison between intervention arms adjusted for covariates (age, gender).
95% CI of OR
Intervention arm I post vs. pre 0.523 0.485 0.563 <0.001
Female vs. male 1.274 1.179 1.376 <0.001
Age < 18 vs. 18–65 0.675 0.559 0.815 <0.001
Age > 65 vs. 18–65 1.324 1.193 1.469 <0.001
Intervention arm II post vs. pre 0.547 0.493 0.607 <0.001
Age < 18 vs. 18–65 0.64 0.412 0.994 0.047
Age > 65 vs. 18–65 1.167 1.008 1.351 0.038
Intervention arm III post vs. pre 0.519 0.467 0.576 <0.001
Age < 18 vs. 18–65 0.676 0.494 0.925 0.014
Comparison between intervention arms Intervention arm II vs. I 0.863 0.658 1.130 0.284
Intervention arm III vs. I 1.019 0.781 1.331 0.888
Intervention arm III vs. II 1.182 0.895 1.561 0.239
post vs. pre 0.561 0.535 0.589 <0.001
Table 3. Comparison of antibiotic prescribing rates in intervention arms to matched standard care by mixed logistic regression (pre vs. post, primary outcome) adjusted for additional covariates.
Comparison to standard care Intervention arm I vs. standard care 0.596 0.572 0.621 <0.001
Intervention arm II vs. standard care 0.661 0.629 0.695 <0.001
Intervention arm III vs. standard care 0.726 0.689 0.764 <0.001
Age < 18 vs. 18–65 0.54 0.503 0.579 <0.001
CCI 1 and 2 vs. 0 1.584 1.531 1.638 <0.001
CCI ≥ 5 vs. 0 1.503 1.395 1.62 <0.001
Northern Europe vs. German 0.916 0.740 1.128 0.417
Eastern Europe, Turkey, Arabic states vs. German 0.978 0.935 1.022 0.321
Other vs. German 0.818 0.719 0.929 0.002
Southern Europe vs. German 1.087 0.994 1.189 0.066
urban vs. rural 0.736 0.712 0.761 <0.001
CCI: Charlson Comorbidity Index; vs.: versus; Northern Europe, Eastern, Europe, Southern Europe, Other: Nationality.
Poss-Doering, R.; Kronsteiner, D.; Kamradt, M.; Kaufmann-Kolle, P.; Andres, E.; Wambach, V.; Bleek, J.; Wensing, M.; ARena-Study Group; Szecsenyi, J. Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena. Antibiotics 2021, 10, 1151. https://doi.org/10.3390/antibiotics10101151
Poss-Doering R, Kronsteiner D, Kamradt M, Kaufmann-Kolle P, Andres E, Wambach V, Bleek J, Wensing M, ARena-Study Group, Szecsenyi J. Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena. Antibiotics. 2021; 10(10):1151. https://doi.org/10.3390/antibiotics10101151
Poss-Doering, Regina, Dorothea Kronsteiner, Martina Kamradt, Petra Kaufmann-Kolle, Edith Andres, Veit Wambach, Julian Bleek, Michel Wensing, ARena-Study Group, and Joachim Szecsenyi. 2021. "Assessing Reduction of Antibiotic Prescribing for Acute, Non-Complicated Infections in Primary Care in Germany: Multi-Step Outcome Evaluation in the Cluster-Randomized Trial ARena" Antibiotics 10, no. 10: 1151. https://doi.org/10.3390/antibiotics10101151
Antibiotics, EISSN 2079-6382, Published by MDPI


The 1444 hull like a boat hull is distinguished by the perfection of its forms, very sharp arc. It is made of white plaster with high resistance. This material, very beautiful natural, can also be easily painted, before or after installation, for a perfect integration into your home. Measuring 58cm in length, this wall lamp 1444 is also available in large format, 74cm in length, called 1445. In addition, in each size it is possible to order this wall lamp in standard E27 socket version (which allows the use of bulbs incandescent or low-consumption fluorescent, LED), or in a version specifically designed to receive a high-power halogen tube. The manufacture of this wall lamp, particularly appreciated and used in the most prestigious projects, is done in the workshops of Sedap, near Nantes. See also models 1357 and 1523, 114cm and 174cm long respectively, visible under reference 13100241. This luminaire can be wired for a 110V electrical network on request.
Dimensions: model 1444 length 58cm, height 6cm, depth 16cm. Model 1445 length 74cm, height 10cm, depth 20cm.
Light source to be used with this luminaire: standard model, a screw bulb E14 (version 1444) or E27 (version 1445). Model for halogen tube, a type R7s of 78mm (150W) or 118mm (200W) respectively.


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Tag: FDA
CSIS Video: FDA as a Global Actor
October 24, 2012 August 13, 2015 by ihsection, posted in Information and Social Media
This post was written jointly by Sarah Simpson and myself.
The Food & Drug Administration, better known as the FDA, is the regulatory arm of the US government responsible for ensuring the safety of the food and drugs Americans consume. As our food, drugs and products travel from around the world to our table, the FDA's role has become increasingly more globalized.
Recently FDA commissioner Dr. Margaret Hamburg sat down with the Center for Strategic and International Studies (CSIS), Global Health Policy Center to discuss the FDA's more globalized role. She argues that the FDA serves an often underappreciated role in the global economy, and that it is important that they continue to receive funding to build partnerships, supply chains, and monitoring systems.
Because of this increasing globalization, the FDA has been pursuing more international partnerships and relationships to ensure the safety of imported goods as well as domestic ones. This has led them to create physical offices in several countries around the world such as Chile, South Africa, China, and India.
While the FDA by no means has an unblemished record, this is yet another example of a global health initiative threatened by budget cuts (particularly in an election year), and why we need to fight to maintain funding for global health programs.
Tagged CSIS, FDA, Food and Drug Administration, videoLeave a comment
July 29, 2012 July 29, 2012 by Vaani, posted in News
The U.S. Centers for Disease Control and Prevention (CDC) joins the World Health Organization to recognize the World Hepatitis Day July 27.
Obama administration announces ground-breaking public-private partnership to prevent health care fraud. It is designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings.
Doctors petition for limits on painkillers. They have urged the FDA to curtail the overuse and abuse of prescription painkillers by changing the labeling directions on how and when physicians should prescribe them.
African health experts- policy makers, advocates and researchers are meeting in Kampala, Uganda to reaffirm national and regional commitments to achieving Millennium Development Goal (MGD) 5, to ensure the health of girls and women become a regional priority.
A number of public health organizations in South Africa have extended their support for the amendments on the Tobacco Products Control Act which is meant to support the non-smokers.
Food and Drug Administration (FDA) has approved a new inhaled drug for the treatment of the lung disease COPD (Chronic Obstructive Pulmonary Disease).
According to congressional budget office Supreme Court health care law leaves 3 million more uninsured.
The Centers for Medicare & Medicaid Services will award inpatient rehabilitation facilities $140 million increase in Medicaid payments under the IRF prospective payment system in fiscal year 2013.
Singapore ratifies ILO (International Labor Organization) framework for occupational health and safety.
The Australian Health Department wants to outsource its operational and management responsibilities for the personally controlled e-health record system to a single provider.
The Centers for Medicare & Medicaid Services awarded Colorado Health Insurance Cooperative Inc. a $69.4 million loan to launch a Consumer Operated and Oriented Plan in Colorado.
Hospitals in Iowa provided $1.4 billion community benefits (health screenings, support groups etc.) in 2011.
$6.1 Million "Innovation Grant" awarded to test comprehensive care physician model.
Bungoma (Kenya) Hospital project hit by row.
In Sierra Leone, youth want a review of abortion law.
Energy, health care dominates agenda on the eve of Canada's annual summer summit.
A study published in the New England Journal of Medicine revealed that adult mortality rates fell after three states (New York, Maine, Arizona) Medicaid expansions.
Study finds drop in death rate in states that follow lines of Obama health law.
A new technique uses PET/CT imaging with a compound called choline (F-Flourocholine) to help doctors to detect prostate cancer earlier.
Trial signals major milestone in hunt for new TB drugs. The results presented at the 2012 International AIDS Conference reveal progress in the pursuit of an antiretroviral- compatible TB treatment for the patients with TB/HIV co-infection.
The results of a study of HIV treatment policies in 23 countries show that governments have made improvements to get better antiretroviral treatment (ART) to more people but implementation of innovative community-based strategies is lagging behind.
According to study published in the American Journal of Respiratory and Critical Care Medicine, lung function may decline slower in smokers with sufficient vitamin D levels as compared to smokers who are vitamin D deficient.
A study shows that people with serious mental illnesses such as schizophrenia or bipolar disorder are 2.6 times more prone to developing cancer.
A study shows that inactivity puts 1 in 3 adults at risk for disease.
According to a study some people are more physically active may be due to their genetic predisposition while evolutionary factors and the obesity, might also play a role in it.
Researchers have identified various successful and promising interventions to improve the opportunities for regular physical activity. Promoting exercise and community events through mass media campaigns as well as decision prompts and signage to motivate people are among the few identified as successful examples.
A study shows new way of delivering anti-scarring drug reduces the need for repeat injections by 40 percent. This process reduces post-surgical scarring of glaucoma patients.
Study shows that information and communication technologies could be an effective way of encouraging millions of people worldwide to become more physically active.
A paper in the Lancet says physical inactivity should be recognized as a pandemic.
Researchers have found that the drug resistant HIV is on rise in Africa.
Study suggests that short, cumulative exercise sessions are beneficial for health especially for maintaining a healthy blood pressure.
Diseases & Disasters
An earthquake of 3.8 magnitude hit Los Angeles on July, 25, 2012.
Five infant deaths signal serious whooping cough outbreak in UK.
According to the Ugandan health officials, about 14 people in western Uganda have been killed by the infection with the deadly Ebola virus. There is no cure or vaccine for the treatment or prevention from this deadly infection in Uganda. National emergency task force has been set up to prevent the spread of disease.
The typhoid outbreak in Zimbabwe is suspected to be caused by the consumption of contaminated water.
Mysterious nodding disease afflicts young Ugandans.
Whooping Cough epidemic in Washington State.
World Health Organization has expressed its concerns over the rise in cholera cases in eastern Democratic Republic of Congo amid clashes between the armed groups and government.
Tagged Abortion law, Adult mortality rates, Anti-scarring drugs, Antiretroviral treatment, Bipolar disease, cholera, Chronic Obstructive Pulmonary Disease (COPD), Community based strategies, e-health record system, Earthquake, Ebola virus, Epidemic, exercise, F-Flourocholine, FDA, Genetic predisposition, Glaucoma, health care, Health care billings, Health care law, Inactivity, Innovative grant, International Labor Organization, mental illnesses, Nodding disease, obesity, Occupational health and safety, Painkillers, pandemic, PET/ CT imaging, Policy makers, prostate cancer, schizophrenia, TB drugs, TB/HIV co-infection, the Center for Medicare and Medicaid services, The Centers for Disease Control and Prevention (CDC), Tobacco Products Control Act, Typhoid, vitamin D, whooping cough, World Health OrganizationLeave a comment
January 3, 2012 August 13, 2015 by ihsection, posted in News
The weekly news round-up for last week is posted below. Apologies for the delay. The holidays keep us all busy!
CDC's report on its contributions on women's health is available as the "Review on Women's Health for the Year 2011" (Source: http://www.cdc.gov/Features/WomensHealthReview/?s_cid=fb1332).
Democrat Charles Schumer asked Food and Drug Administration Commissioner to review the safety and legality of AeroShot Pure Energy caffeine inhaler (Source: http://www.washingtonpost.com/business/controversy-over-inhaled-caffeine-grows-as-as-sen-schumer-calls-for-fda-probe/2011/12/22/gIQAjQaVDP_story.html).
Due to concerns over bioterrorism the government advisory board that oversees biosecurity in the U.S. has asked the scientific journals Nature & Science to censor details on recent bird flu. It has asked the journals not to publish details on certain biomedical experiments (Source: http://www.thetakeaway.org/2011/dec/22/when-it-ok-censor-science/ and http://www.nytimes.com/2011/12/21/health/fearing-terrorism-us-asks-journals-to-censor-articles-on-virus.html).
New guidelines from the U.S. advisory committee on Immunization Packages have recommended Hepatitis B vaccination for the unvaccinated adults with type 1 and type 2 diabetes due to increased risk of HBV infection. The US Centers for Disease Control and Prevention published the guidelines in the Morbidity and Mortality Weekly Report (Source: http://yourlife.usatoday.com/health/story/2011-12-23/Hepatitis-B-vaccine-recommended-for-adults-with-diabetes/52188138/1).
The HPTN 052 study funded by US National Institute of Allergy and Infectious Diseases (NIAID) named as 2011 Breakthrough of the Year. It successfully demonstrated antiretroviral medications not only treat but also prevent transmission of HIV infection among heterosexual individuals (Source: http://news.xinhuanet.com/english/health/2011-12/23/c_131322368.htm).
Food and Drug Administration (FDA) has urged to double check the concentration of acetaminophen before giving it to infants. High concentration can lead to confusion in infants (Source: http://www.webmd.com/parenting/baby/news/20111223/infant-acetaminophen-dosage-change-may-cause-confusion).
Some mental, emergency care and non-communicable diseases drugs being included in the list of free drugs for distribution in Nepal (Source: http://www.namnewsnetwork.org/v2/read.php?id=180030).
Avastin has been approved by the European Commission, as a drug for treatment of newly diagnosed and advanced ovarian cancer (Source: http://www.reuters.com/article/2011/12/23/us-avastin-ovarian-cancer-idUSTRE7BM15A20111223).
India to start a nation-wide program, weekly iron and folic supplementation program (WIFS) to deal with the problem of anemia among its adolescents (Source: http://zeenews.india.com/news/nation/govt-evolves-programme-to-tackle-anaemia_748331.html).
United Nations population fund (UNFPA) with other agencies is working to provide necessary help to the pregnant and lactating women in the evacuation centers of topical storm hit areas. Team of doctors, midwives and other health care workers are being deployed in those areas. Reproductive health care supplies and medicines are being distributed. They will distribute clean delivery kits to for healthy and hygienic deliveries (Source: http://www.prweb.com/releases/reproductive_health/supplies_philippines/prweb9063252.htm).
Cardiac MRI more accurate ruling out coronary heart disease than stress MRI. The Single Photon Emission Computed Tomography (SPECT) though exposes patients to ionic radiations but its highly accurate (Source: http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/30369?pfc=101&spc=230).
A daily dose of 80mg aspirin reduces bowel cancer risk according to researchers at Dartmouth Medical School, New Hampshire(Source: http://www.dailymail.co.uk/health/article-170649/Aspirin-cut-bowel-cancer-risk.html).
According to a demonstration done by John Hopkins Malaria Research Institute, by genetically engineering immune system of Plasmodium falciparum, transmission of malaria parasite can be blocked. This will result in killing of large number of parasites which come into the mosquito's body when they suck the blood of an infected person. The fitness of genetically modified bacteria was almost the same as those who were nonmodified (Source: http://www.newswise.com/articles/scientists-engineer-mosquito-immune-system-to-block-malaria).
A study published in American Journal of Clinical Nutrition indicates that to avoid fondness towards salt, its reduced intake should begin early in life (Source: http://www.latimes.com/health/la-he-babies-salt-20111221,0,6606273.story).
Health department of Illinois has urged people to take a shot of whooping cough vaccine after looking into the reports of spread of this disease in Northern Illinois (Source: http://napervillesun.suntimes.com/news/9537068-418/whooping-cough-spreading-throughout-northern-illinois.html and http://www.thirdage.com/news/pertussis-outbreaks-trouble-illinois_12-18-2011).
Hospital wards closed in Britain due to Norovirus outbreak (Source: http://www.upi.com/Top_News/World-News/2011/12/23/Virus-outbreak-strikes-British-hospitals/UPI-91931324663834/?spt=hs&or=tn).
People in Nairobi, Kenya, are fearing of Ebola virus outbreak after the death of profusely bleeding 29 year old women (Source: http://www.globalpost.com/dispatches/globalpost-blogs/africa-emerges/ebola-makes-comeback).
People in topical storm hit areas in Philippines are in great need of milk for their babies (Source: http://www.abs-cbnnews.com/nation/regions/12/23/11/breastmilk-needed-flood-hit-mindanao).
Second bird found dead after infection with H5N1 in Hong Kong has raised health concerns in the city (Source: http://www.cbc.ca/news/health/story/2011/12/23/bird-flu-hong-kong.html).
These headlines were compiled by Vani Nanda, MPH Candidate at West Chester University PA.
Tagged acetaminophen, antiretrovirals, ARVs, aspirin, Avastin, avian influenza, biosecurity, bird flu, bowel cancer, Britain, CDC, Charles Schumer, coronary heart disease, Ebola, FDA, Global Health News, H5N1, hepatitis b vaccine, HIV/AIDS, Hong Kong, HPTN 052, Illinois, Kenya, malaria, MMWR, Nature, Nepal hbv vaccine, NIAID, norovirus, ovarian cancer, pertussis, salt, salt intake, Science, UK, UNFPA, whooping cough, Women's HealthLeave a comment
November 30, 2011 August 13, 2015 by ihsection, posted in News
Politics and Policies
The US federal government has awarded Iowa $7 million to prepare a computerized system that will help the small businesses and individuals to find affordable coverage. (Source: http://blogs.desmoinesregister.com/dmr/index.php/2011/11/29/feds-give-state-7-million-for-insurance-exchange-planning/ )
US federal agency has rejected Indiana's bid for an exemption from federal health care. (Source: http://www.cbsnews.com/8301-505245_162-57332830/feds-reject-ind-request-for-health-care-exemption/ )
The House of Delegates, at its interim meeting in November, directed the AMA to use screening tools from the National Institute of Drug Abuse and others to identify the patients likely to abuse prescription drugs. (Source: http://www.ama-assn.org/amednews/2011/11/28/prsd1128.htm )
From December 7-9, 2011, Kenya will hold its first national human resources for health conference which will avail a platform for placing health as a priority in the health strategy and national development towards vision 2030. The theme of the conference will be "Renewing commitment to the health workforce towards achievement of MDGs and vision 2030". (Source: http://allafrica.com/stories/201111291193.html )
AstraZeneca Canada Inc., in partnership with mindyourbody and Physical and Health Educators (PHE) of Canada, together with the active involvement of the youth, has organized a program in Ontario, Canada. It is focused on improving the mental health and emotional well-being of vulnerable adolescents. (Source: http://www.digitaljournal.com/pr/505390 )
The Capital Metropolitan Transportation Authority will be posting no smoke signs within 15 feet of bus stops in Austin, Texas, beginning from February 1st 2012 to prevent the non-smokers from inhaling the secondhand smoke. (Source: http://www.dailytexanonline.com/opinion/2011/11/28/capmetros-policy-breath-fresh-air )
A recent study done by Dr. Avi Dor, professor in the Department of Health Policy at the GW School of Public Health and Health Services indicates a need to develop policies to encourage medication compliance which will lead to cost savings through healthcare system in the long run. (Source: http://www.newswise.com/articles/higher-patient-adherence-to-disease-modifying-therapies-reduced-costs-for-ms-patients )
An invitation for the bid for consultant on public health authorities' activities with the aim to protect the environment has been issued by the Ministry of Health of Azerbaijan. (Source: http://abc.az/eng/news_29_11_2011_60039.html )
The first WHO European Conference on the New European Policy for Health – Health 2020, held in Jerusalem, Israel has called for working together across sectors for health and well-being. (Source: http://www.epha.org/spip.php?article4859 )
In the 44th Annual Meeting of the American Society of Nephrology, it was said that Healthy People 2010 met the goal of lower CVD deaths in CKD patients. (Source: http://www.medscape.com/viewarticle/754362 )
The Global Fund will not be able to fund to fight AIDS, Tuberculosis and Malaria until the year 2014. (Source: http://www.cbsnews.com/8301-202_162-57331033/massive-global-health-fund-says-its-broke/ )
A study done by a team at Harvard University involving stem cell transplant in the brain circulatory of mice could pave a way for effective treatment of Parkinson's disease and autism. (Source: http://www.thehindu.com/health/medicine-and-research/article2659553.ece )
According to a study done by the scientists at Indiana School of Medicine in Indianapolis, playing video games can make you aggressive. The research showed that the areas of the brain most affected were the left inferior frontal lobe and the anterior cingulate cortex. Once the gamers stopped playing, these areas of brain came back to normal. (Source: http://www.hindustantimes.com/Lifestyle/Wellness/Violent-video-games-make-you-aggressive/Article1-775010.aspx )
In a recent study done by scientists at Harvard School of Public Health, a relationship was found between coffee consumption and rate of occurrence of endometrial cancer. They found an inverse relationship and found that the women who drank four or more cups of coffee had significant reduction (25%) in the risk of endometrial cancer than those who limit themselves to one cup of coffee per day. (Source: http://www.hindustantimes.com/Lifestyle/Wellness/Four-cups-of-coffee-can-prevent-womb-cancer/Article1-773052.aspx )
The US Food and Drug Administration (FDA) has developed a new wet AMD drug known as EYLEA. This drug, when injected into the eye, will prevent the growth of abnormal blood vessels in the eye under retina to prevent their bleeding and preventing an abnormal blood loss. (Source: http://www.ffb.ca/research/research_news/eyelea.html )
A new treatment for severe emphysema has been brought to light by the team of doctors at Thoraxklinik in Heidelberg, Germany. They used first endoscopic lung volume reduction system known as InterVapor that does not leave any foreign materials in the lungs but utilizes the body's self-healing process for the treatment of this problem. (Source: http://www.reuters.com/article/2011/11/29/idUS125291+29-Nov-2011+PRN20111129 )
Diseases and Disasters
According to a CDC report, of the 1.2 million Americans who have HIV, 20% are unaware of their status. (Source: http://www.cbsnews.com/8301-504763_162-57333212-10391704/cdc-240000-americans-have-hiv-and-dont-know-it/?tag=pop;stories )
Egyptian scientists prepare an anti-diabetes drug from balsam pear. It has properties similar to bovine insulin and it will be taken orally, which will be a relief for the patients on insulin injections. (Source: http://www.dawn.com/2011/11/29/egyptian-scientists-to-make-diabetes-drug-from-bitter-fruit.html )
The 2010 data indicates that in India, the state of Andhra Pradesh has the highest prevalence of HIV/ AIDS. (Source: http://www.thehindu.com/news/cities/Hyderabad/article2663262.ece )
Nearly 6% of the population of Pakistan (about 10 million people) are infected with hepatitis C (Source: http://www.dailytimes.com.pk/default.asp?page=2011%5C11%5C28%5Cstory_28-11-2011_pg7_4 )
The children in South Sudan are dying of preventable diseases. According to the UN, malaria is a hyper-epidemic in this country. It is said to be one of the biggest causes of miscarriage in pregnancy. (Source: http://www.iol.co.za/news/africa/s-sudan-children-dying-of-preventable-diseases-1.1188555 )
The countries in East Africa have been hit by the nanana wilt and the Cassava Brown Streak disease which has affected the household incomes and raised the famine threat. A warning has been issued by the Food and Agriculture Organization (FAO). (Source: http://digitaljournal.com/article/315074 )
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