A layered approach is needed to prevent infections from becoming harder to treat

Credit: CC0 Public Domain

Counteracting antimicrobial resistance needs a multipronged approach, including training, labeling food products, working with the media and changing mindsets, according to a new study.

Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. It claimed 1.27 million lives in 2019. It threatens health, social and economic well-being, and spreads as a result of actions taken across human, animal, agricultural and environmental systems, sometimes referred to as the One Health system.

The study, conducted by researchers at the University of Waterloo, in partnership with colleagues and collaborators from Canada, Sweden and Switzerland, set out to identify the factors influencing antimicrobial resistance in the European food system and places to intervene.

The researchers conducted workshops over two days with participants representing perspectives from government, non-government and healthcare organizations, as well as industry and private consultants. Participants identified 91 factors across the One Health spectrum that influence antimicrobial resistance, with 331 connections between them and many feedback loops. They also identified possible places within this system to target their interventions, which were then classified as shallow or deep.

“Shallow leverage points for intervention are places in the system that may be easier to implement with less potential to change the behavior of the whole system that gives rise to antimicrobial resistance,” said Irene Lambraki, lead author and a researcher in the School of Public Health Sciences at Waterloo. An example would be increasing the number of staff trained in infection prevention and control in healthcare settings.

“Deep leverage points are places that are more challenging to change yet have greater potential to sustainably transform system behavior,” she said. “These include delivering information in the system to places where it’s currently missing or informing people of the consequences of their actions to motivate .

“The deepest lever participants identified was about changing the mindset that underpins how our systems operate, which is very profit-driven. For example, trying to get leaders to place on health rather than generating profits for shareholders and prioritizing the achievement of the Sustainable Development Goals could create ripple effects across the system in ways that transform antimicrobial use—a major driver of antimicrobial resistance—and mitigate antimicrobial resistance.”

Researchers also identified five additional overarching factors that impact the entire system: regulations, leadership, media, collaboration and .

“The study underscores the complexity of antimicrobial resistance problem, points to the need for global collaboration and coordinated multi-level and multipronged interventions targeting different sectors to effectively and sustainably address the antimicrobial resistance crisis,” said principal investigator Shannon Majowicz, also in the School of Public Health Sciences.

The study, “Factors influencing in the European food system and potential leverage points for intervention: A participatory, One Health study,” was published in PLOS ONE with researchers from Canada, Sweden, Switzerland and the U.K.

More information:
Irene Anna Lambraki et al, Factors influencing antimicrobial resistance in the European food system and potential leverage points for intervention: A participatory, One Health study, PLOS ONE (2022). DOI: 10.1371/journal.pone.0263914

A layered approach is needed to prevent infections from becoming harder to treat (2022, April 21)

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Hexbyte Glen Cove Selfies of missing persons before they disappear used for future forensic dental identification thumbnail

Hexbyte Glen Cove Selfies of missing persons before they disappear used for future forensic dental identification

Hexbyte Glen Cove

Credit: Pixabay/CC0 Public Domain

Selfies taken by missing persons before they disappear could prove key for future forensic dental identification, according to a researcher studying at the University of Dundee.

Selfies showing teeth and gum shields are just some of the new dental identifiers to now appear on a checklist designed to aid the police and forensic odontologists in missing person cases.

The Dental Identification Record Checklist, which is the first of its kind, was developed by Dr. Claire Sallis and her supervisor Dr. Scheila Mânica at the University of Dundee’s School of Dentistry.

It aims to speed up the process of forensic identification by allowing police to request more dental by-products than ever before, such as bleaching trays or teeth molds and helps remind law enforcement officers to check for supplementary evidence such as selfies that may portray the missing person’s teeth.

Working in collaboration with the British Association for Forensic Odontology and the UK Missing Persons Unit, Dr. Sallis hopes the free checklist, which has already been translated into 14 languages, will reduce the time it takes for police to gather important evidence, mitigating the emotional weight on families awaiting closure.

“You may not think about it but your teeth are incredibly individual to you,” said Dr. Sallis, a 29-year-old from Chester, who is studying MSc Forensic Dentistry in Dundee.

“When a dentist places a filling, they will never make the same filling ever again in their lifetime. That’s how unique they are and that’s why they are great for identifying missing people.

“It’s the role of forensic odontologists to identify the deceased by their teeth but this process can be frustrated by both general dentists and police not knowing exactly the types of evidence that could help speed up the process. The checklist should be applicable all across the world and so far it has been translated into Mandarin, Arabic and Malay amongst other languages and has been downloaded more than 200 times.

“Ultimately though, creating the list was about the families and relatives of missing people and helping reduce the time they might be anxiously waiting.”

A cheaper alternative to DNA-testing, Dr. Sallis says teeth play a larger part in identifying the missing or deceased than popular culture gives credit for.

“Fingerprints, DNA and comparative dental analysis are the three primary identifiers recognized by INTERPOL. In the UK we don’t have a national database of fingerprints unless you are a criminal; therefore, it is more likely that an individual has attended their dentist at some point than having had their prints taken. In certain situations, DNA can also be rendered unusable. For this reason, dental identifiers can be relied upon more frequently.

“We don’t tend to talk about how forensic odontology is used in books or films, but teeth are composed of one of the hardest tissues in your body-enamel—and therefore can last a very long time and withstand a variety of assaults. In cases where the bodies of the deceased have begun post-mortem changes, the police have been able to rely upon dental identification due to the natural resilience of teeth.

“Looking ahead, with less and fewer people needing root-canal treatments or fillings, selfies could prove particularly useful to help match up the deceased with missing person profiles, especially if the missing person has distinctive dental features such as rotations or gaps; or in the cases of missing children where we might not have any dental records at all.

“So, even if you think your are fine, getting a check-up to update your dental records could help should the worst ever happen.”

Dr. Sallis plans to return to work as a dentist in Chester but aspires to become a registered forensic odontologist with BAFO where she may be asked to help on missing persons cases in the UK or abroad. She believes her time at Dundee will play a significant role in her new career.

She said, “There are few international opportunities for dentists to gain expertise in forensic dentistry and Dundee is the only university in the UK that offers a one-year program within an active medicine department. It is thanks to amazing supervisors like Dr. Mânica that we are able to contribute to the field in such an important way.”

More information:
Dental Identification Record Checklist: dentalidrecordchecklist.com/

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