未经批准:随着AMU预计增加,东南亚(SEA)面临着不成比例的健康风险,社会,以及抗菌素耐药性(AMR)造成的经济负担。我们的目标是通过整合该地区专家的观点来确定SEA食品系统中影响AMR的因素和干预场所,以告知政策和管理决策。
UNASIGNED:我们进行了两次6.5小时的研讨会和两次90分钟的访谈,涉及18名AMR和其他来自人类的学科专家,动物,和环境部门,他们集思广益地研究了影响AMR的因素,并确定了干预的杠杆点(地点)。成绩单和车间材料对因素及其联系进行了编码,并转录为因果循环图(CLD)。主题分析描述了SEA食物系统中的AMR动态和干预杠杆点。CLD和主题通过参与者反馈得到确认。
UNASSIGNED:参与者在SEA食物系统中构建了AMR的CLD,其中包含通过362个连接相互连接的98个因子。CLD因素反映了SEA食物系统的八个子领域(例如,政府)。七个主题[例如,抗菌剂和杀虫剂的使用和AMR传播(n=40报价)],影响整个AMR系统的六个“首要因素”[例如,生存的动力(n=12引号)],研讨会讨论中出现了针对CLD因素(n=5)和总体因素(n=2)的10个干预场所。
UNASSIGNED:参与者得出的SEA食品系统中影响AMR的因素的CLD表明,AMR是在“一个健康”范围内采取的许多相互关联的行动的产物,找到解决方案不是简单的任务。开发该模型可以识别整个人类中潜在有希望的杠杆点,动物,和环境部门,如果全面有针对性地使用多管齐下的干预措施,可以唤起减轻AMR的全系统变化。甚至针对一些杠杆点进行干预,例如增加对研究和能力建设的投资,并制定和执行法规以控制抗菌药物的供应,需求,和使用可以,反过来,转变心态,导致更难改变杠杆点的变化,例如重新定义利润驱动的意图,以改变AMU并可持续地减轻AMR的方式驱动系统行为。
UNASSIGNED: With AMU projected to increase, South East Asia (SEA) is at high risk of experiencing disproportionate health, social, and economic burdens due to antimicrobial resistance (AMR). Our objective was to identify factors influencing AMR in SEA\'s food system and places for intervention by integrating the perspectives of experts from the region to inform policy and management decisions.
UNASSIGNED: We conducted two 6.5 h workshops and two 90-min interviews involving 18 AMR and other disciplinary experts from human, animal, and environment sectors who brainstormed the factors influencing AMR and identified leverage points (places) for intervention. Transcripts and workshop materials were coded for factors and their connections and transcribed into a causal loop diagram (CLD). Thematic analysis described AMR dynamics in SEA\'s food system and leverage points for intervention. The CLD and themes were confirmed via participant feedback.
UNASSIGNED: Participants constructed a CLD of AMR in the SEA food system that contained 98 factors interlinked by 362 connections. CLD factors reflected eight sub-areas of the SEA food system (e.g., government). Seven themes [e.g., antimicrobial and pesticide use and AMR spread (n = 40 quotes)], six \"overarching factors\" that impact the entire AMR system [e.g., the drive to survive (n = 12 quotes)], and 10 places for intervention that target CLD factors (n = 5) and overarching factors (n = 2) emerged from workshop discussions.
UNASSIGNED: The participant derived CLD of factors influencing AMR in the SEA food system demonstrates that AMR is a product of numerous interlinked actions taken across the One Health spectrum and that finding solutions is no simple task. Developing the model enabled the identification of potentially promising leverage points across human, animal, and environment sectors that, if comprehensively targeted using multi-pronged interventions, could evoke system wide changes that mitigate AMR. Even targeting some leverage points for intervention, such as increasing investments in research and capacity building, and setting and enforcing regulations to control antimicrobial supply, demand, and use could, in turn, shift mindsets that lead to changes in more difficult to alter leverage points, such as redefining the profit-driven intent that drives system behavior in ways that transform AMU and sustainably mitigate AMR.