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This study aims to study the distribution characteristics of antibiotic resistance in direct-eating food and analysis of Citrobacter freundii genome and pathogenicity. Residual antibiotics and antibiotic resistance genes (ARGs) in the environment severely threaten human health and the ecological environment. The diseases caused by foodborne pathogenic bacteria are increasing daily, and the enhancement of antibiotic resistance of pathogenic bacteria poses many difficulties in the treatment of disease.

In this study, six fresh fruits and vegetable samples were selected for isolation and identification of culturable bacteria and analysis of antibiotic resistance. The whole genome of Citrobacter freundii isolated from cucumber was sequenced and analyzed by Oxford Nanopore sequencing.

The results show that 270 strains of bacteria were identified in 6 samples. From 12 samples of direct food, 2 kinds of probiotics and 10 kinds of opportunistic pathogens were screened. The proportion of Citrobacter freundii screened from cucumber was significantly higher than that from other samples, and it showed resistance to a variety of antibiotics. Whole genome sequencing showed that Citrobacter freundii was composed of a circular chromosome containing signal peptides, transmembrane proteins and transporters that could induce antibiotic efflux, indicating that Citrobacter freundii had strong adaptability to the environment. The detection of genes encoding carbohydrate active enzymes is more beneficial to the growth and reproduction of Citrobacter freundii in crops. A total of 29 kinds of ARGs were detected in Citrobacter freundii, mainly conferring resistance to fluoroquinolones, aminoglycosides, carbapenem, cephalosporins and macrolides. The main mechanisms are the change in antibiotic targets and efflux pumps, the change in cell permeability and the inactivation of antibiotics and the detection of virulence factors and ARGs, further indicating the serious risk to human health.

The detection of genomic islands and prophages increases the risk of horizontal transfer of virulence factors and ARGs, which spreads the drug resistance of bacteria and pathogenic bacteria more widely.

Antibiotics shortages have become an increasingly common problem in Europe because of several reasons, including the offshoring of the production of active pharmaceutical ingredients for many of these products to low production cost countries, such as China and India. The problem has deteriorated because of the Covid-19 crisis that has put most global value chains (GVCs) under great stress. This situation has boosted extensive discussions among academics, practitioners and policymakers on possible changes to the configuration of GVCs. This paper aims to focus specifically on antibiotics supply chains from the perspective of a small country (Sweden), and analyse the pros and cons of backshoring and nearshoring alternatives, as a means to reduce drug shortages.

This work adopts a systemic perspective to capture the implications of reshoring for the different stakeholders involved in the antibiotics field. The present meso-analysis, focusing at the industry level, is based on multiple sources of primary data collected between 2014 and 2021, including participation in policy-related projects and interviews with over 100 representatives of key stakeholders in the antibiotics field.

This paper shows how reshoring can address the problems of drug shortages and reduce availability risk in antibiotics’ GVCs. However, the authors show that no simple and best solution exists because both alternatives of reshoring, i.e. backshoring and nearshoring, entail pros and cons for different stakeholders. The authors conclude with implications for policymakers and managers.

The analysis of pros and cons of both backshoring and nearshoring for various stakeholders offers relevant implications for research on operations and supply management, international business and economics/political science.

This paper looks at reshoring as a policy-driven decision and provides an innovative systemic perspective to analyse the implications for different stakeholders of two reshoring options concerning the antibiotics supply chain.

Bacterial vaginosis (BV) is quite common and linked with serious public health issues such as premature delivery and spread of sexually transmitted infections. The study aims to identify different genital mycoplasmas (GM) in high vaginal swabs (HVS) from adult females in Bahrain.

In total, 401 HVS were collected and cultured on MYCOFAST^® RevolutioN 2 test for identification and antibiotic susceptibility. Polymerase chain reaction (PCR) was performed for detection of Mycoplasma genitalium (Mg), Mycoplasma hominis (Mh) and Ureaplasma species. DNA-probe based detection for Gardnerella, Candida and Trichomonas was performed by BD Affirm Assay. Representative PCR amplicons were sequenced by Sanger sequencing.

In PCR, Ureaplasma sp. was the most common GM, followed by Mg and Mh; the prevalence being 21.2, 5.2 and 1.5%, respectively. On the contrary, 10.7% samples showed positivity for Ureaplasma urealyticum (Uu) and 1.7% for Mh in MYCOFAST^® RevolutioN 2. The concordance rates between MYCOFAST^® RevolutioN 2 and PCR for Mh and Ureaplasma sp. were 97.7 and 84%, respectively. Considering PCR as gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of MYCOFAST^® RevolutioN 2 were 33.3, 98.8, 28.6, 98.9 and 37.7, 96.5, 74.4, 85.2% for Mh and Ureaplasma sp., respectively. The Uu and Mh isolates showed antibiotic-resistance ranging from 53%–58% and 71%–86%, respectively.

The prevalence of Ureaplasma sp. was high. Significant co-occurrence of GM was noticed with BV. MYCOFAST^® RevolutioN 2 had lower detection-rate than PCR, so a combination is suggested for wider diagnostic coverage.

The research reflects on status of prevalence of GM in adult females in Bahrain, and their co-occurrence with bacterial vaginosis. Diagnostic approach with combination of tests is suggested for wider coverage. The research has epidemiologic, diagnostic, and therapeutic implications.

This is the first report from the Kingdom of Bahrain reflecting on burden of GM from this geographic location. The diagnostic efficacy of MYCOFAST^® RevolutionN 2 test and polymerase chain reaction was evaluated for GM detection.

The purpose of this study was to determine the influence of environmental pH on production of biofilms and virulence genes expression in Pseudomonas aeruginosa.

Among 303 clinical and environmental samples 109 (61 + 48) isolates were identified as clinical and environmental P. aeruginosa isolates, respectively. Clinical samples were obtained from patients in the Al-Yarmouk hospital in Baghdad city, Iraq. Waste water from Al-Yarmouk hospital was used from site before treatment unit to collect environmental samples. The ability of producing biofilm at various pH levels was examined by microtiter plate and the prevalence of Alg D, Psl A and Pel A was determined by quantitative real time-polymerase chain reaction (qRT-PCR).

This study showed that the ability of clinical and environmental isolates to biofilm development was observed in 86.9% and 85.42% of clinical and environmental isolates, respectively. As well as, the environmental P. aeruginosa isolates showed the highest biofilm production at pH 7. Clinical isolates showed the highest genes expression of Alg D, Psl A and Pel A as compared to environmental isolates with pH change. In general, both clinical and environmental isolates formed biofilm and carried AlgD, PslA and PelA genes. Also, alkaline pH was favored for biofilm production.

There are very few studies done to find out the influence of environmental pH on production of biofilms and virulence genes expression in Pseudomonas aeruginosa. This study is unique as it has highlighted the influence of environmental pH on the ability of clinical and environmental isolates to biofilm development and genes expression.

This review aimed to identify and map published studies on self-care practices to manage common acute health conditions in the Philippines.

The authors conducted a scoping review in PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Central, Journal Storage (JSTOR) and the Philippine Council for Health Research and Development – Health Research and Development Information Network (HERDIN). The authors included all studies on self-care practices to manage common acute conditions, namely low back pain, allergic rhinitis, general acute pain, cough, cold, diarrhea, constipation and stress, published up to 2021 in the Philippines. Information on the article type, aim of the study, study design and setting, population characteristics and size, and self-practices employed for the conditions were extracted and synthesized.

The authors identified various self-care practices for acute conditions among the general population and indigenous peoples in the Philippines from 26 studies included in the review: the use of medicines with and without a prescription, appropriate and inappropriate antibiotic use, use of medicinal plants and other traditional and alternative therapies and products, recreational activities and healthy habits and behaviors, and self-management or seeking care from traditional healers (albularyo or manggagamot) or health professionals. A number of considerations influenced their decision on how to manage symptoms, including perceived severity of the condition, availability and perceived effectiveness of treatment, cost, and advice from trusted sources of health information.

The authors searched five major databases and a local research database, but some studies may still have been missed in the review. The review also excluded intervention studies on the outcomes of self-care, which limits the authors' ability to make conclusions on the effectiveness of the different modalities of self-care.

Filipinos engage in a variety of “safe” (or evidence-informed) and “unsafe” (or harmful) self-care practices. While the term “self-care” is not routinely used by the general population and health providers, it is widely enculturated and practiced in the Philippines. Self-care benefits individuals and the health system, but there are also practices that increase risk of adverse outcomes and death including inappropriate antibiotic use, prescription sharing and reuse, and delays in seeking adequate treatment from a health professional. To leverage on self-care in advancing Universal Health Coverage (UHC) goals, the authors recommend a national strategy that provides guidance on how to practice responsible self-care, further research on the effectiveness and safety of alternative medicine and other priority areas, and better integration of self-care in the formal education and health systems. The authors also propose that the research agenda on self-care include acute health conditions, given their impact and burden on health and the economy.

This is the first published review of self-care practices for managing common acute health conditions, which captured practices of various groups and populations including indigenous peoples.

Amidst compounding crises and increasing global population’s nutritional needs, food supply chains are called to address the “diet–environment–health” trilemma in a sustainable and resilient manner. However, food system stakeholders are reluctant to act upon established protein sources such as meat to avoid potential public and industry-driven repercussions. To this effect, this study aims to understand the meat supply chain (SC) through systems thinking and propose innovative interventions to break this “cycle of inertia”.

This research uses an interdisciplinary approach to investigate the meat supply network system. Data was gathered through a critical literature synthesis, domain-expert interviews and a focus group engagement to understand the system’s underlying structure and inspire innovative interventions for sustainability.

The analysis revealed that six main sub-systems dictate the “cycle of inertia” in the meat food SC system, namely: (i) cultural, (ii) social, (iii) institutional, (iv) economic, (v) value chain and (vi) environmental. The Internet of Things and innovative strategies help promote sustainability and resilience across all the sub-systems.

The study findings demystify the structure of the meat food SC system and unveil the root causes of the “cycle of inertia” to suggest pertinent, innovative intervention strategies.

This research contributes to the SC management field by capitalising on interdisciplinary scientific evidence to address a food system challenge with significant socioeconomic and environmental implications.

The purpose of this study was to comprehend the current state of green supply chain management (GSCM) and its drivers and enablers in the pharmaceutical supply chains (PSCs).

This study developed a model consisting of the factors green drivers, green enablers and green practices. For this study, data were collected from 166 supply chain heads from 124 pharmaceutical companies operating in India. The data was empirically analysed using SmartPLS3 software.

The study revealed that in Indian PSCs, public pressure, supplier pressure and competitor pressure were the major drivers for GSCM practices and coercive pressures such as pressure from government and regulatory bodies were insignificant drivers. The results indicated that the influence of green drivers and green enablers altered with supply chain flow. Green drivers indicated higher influence at the upstream of PSCs whereas the influence of green enablers was higher at the downstream of PSCs. Furthermore, the study revealed that the factor “green enablers” was a good mediator for the relationship between “green drivers” and “GSCM practices” in PSCs.

This study was an extension work with the addition of external green drivers to the self-induced organizational activities. Further investigations can be done by including the “green barriers” construct in the conceptual model.

This research connected the institutional theory with the resource-based view to understanding the role of green drivers and green enablers in greening PSC. For managers and regulators, this study provided clear insights on how to approach different supply chain drivers and enablers to maximize the impact of GSCM practices. Moreover, the findings of this study helped in incorporating knowledge about GSCM into a framework that can be used for defining strategies for setting up a sustainable PSC for pharmaceutical products leading to the development and growth of the pharmaceuticals industry.

Most of the earlier studies on GSCM were at the firm level and some studies were at the supply chain level. To further enhance the scope of GSCM theory, this study was conducted at two different levels, first at the complete supply chain level and second at three different levels: upstream, firm-level and downstream.