[Rational Use of Antibiotics Data form a Survey from 2014 within the mrdo Network Compared to Nationwide Data from 2009]. / Rationaler Antibiotikaeinsatz Daten aus dem mre-netz regio rhein-ahr aus einer Umfrage von 2014 und Vergleich mit bundesweiten Daten von 2009.

INTRODUCTION: To combat multi-resistant gram-negative bacteria as the cause of life-threatening infections, antibiotic stewardship activities are of great importance. OBJECTIVE: To detect weaknesses when prescribing antibiotics in hospitals and compare the situation between 2009 and 2014. METHODS: In 2014, a questionnaire was sent to all 380 physicians employed in 7 hospitals. Primary, secondary and tertiary care hospitals were included. Investigated were: demographic data, position, certified specialization, presence of antibiotic prescription rules and behavior to follow them. 119 completed questionnaires of 2014 were compared to 3 613 obtained in 2009. RESULTS: 31% of the questionnaires were returned. 53.8% were interns. Half of these had a certified specialization. 32.8% were consultants and 12.6% were chief physicians. 22.6% were internists, 18.4% surgeons, 10.9% urologists and 9.2% anesthetists. The majority prescribed antibiotics on a daily routine, among the interns 66%. 23% of interns reported they would advise colleagues daily and 61% at least once a week. The most common indications for antibiotic use were antibiotic prophylaxis in surgery (35), urinary tract infection (32) and pneumonia (29). Standard duration of antibiotic therapy reported were 7 days for pneumonia, 5 days for urinary tract infections and 1 day for antibiotic prophylaxis in surgery, while almost 50% of surgeons widened the antibiotic prophylaxis to 3, 5, 7,8 and 10 days. 93.3% physicians reported the use of therapeutic guidelines either from their own hospital or from medical societies. Only 59.3% were provided with the antimicrobial resistance data of their hospital. 52.1% would not ask a consultant for advice before prescribing a broadband antibiotic. Compared to 2009, lack of knowledge about antimicrobial resistance, use of guidelines, and advice from a consultant improved about 5%-points each. CONCLUSION: Despite improvement compared to 2009, 38.9% of all physicians asked did not know their regional antibiotic resistant data and half of all surgeons still used surgical prophylaxis longer than 24 h. As the compliance to use guidelines is high with 93.3%, maintenance and development of antibiotic guidelines adjusted to the resistance data is of the greatest importance. Furthermore, antibiotic prophylaxis in surgery longer than 1 day adds to the risks of antibiotics without giving more benefit and must be critically analyzed.

A systematic review of water, sanitation and hygiene among Roma communities in Europe: Situation analysis, cultural context, and obstacles to improvement.

BACKGROUND: The Roma are Europe's largest ethnic minority. Their history has been shaped by marginalization, stigmatization, discrimination, slavery, persecution and murder, and to date, they continue to face prejudice and social exclusion. The Roma population is generally poor, living in crowded and low quality housing in segregated communities on the outskirts of cities, often lacking basic physical infrastructure, including adequate water, sanitation and hygiene (WASH). To better understand the obstacles the Roma are facing, we aimed to review and synthesize available peer-reviewed literature, and identify obstacles to improvement. METHODS: We conducted the first systematic review of peer-reviewed literature on water, sanitation and hygiene among Roma communities in Europe, published between 2000 and 2020. A total of 30 publications met the inclusion criteria. We extracted data relating to WASH conditions and services, associated risk factors, exposures and outcomes, examined the role of cultural norms in shaping health behaviors, and obstacles to improvement. RESULTS: Our review shows that across Europe, Roma communities face more challenges than the majority population with respect to access to WASH, waste management and environmental hygiene, appropriate housing and hygienic living environments. Prominent themes in the literature to describe WASH conditions about European Roma populations include limited access, affordability, and quality of WASH services; self-management of WASH as response and adaptive tactic; unsafe WASH as a reason for eviction; and health risks associated with substandard WASH services. The same factors determining the poor quality of WASH services and environmental health impede their improvement. Major barriers to WASH access and affordability among the Roma include discrimination, social exclusion, lack of formal education, poverty, geography, legal and social aspects, and cultural perceptions of health risks, political top-down approaches, lack of political will, and lack of involvement of the Roma community in planning. Besides, Roma are not well represented in national statistics, with data collection being complicated not only by difficulties of access and underfunding, but also by distrust and culturally distinctive health beliefs. CONCLUSIONS: The situation and cultural context of WASH among Roma is challenging and complex. Our review demonstrates not only the urgent need for action for Roma communities in particular, but may have broader applicability to ethnic and social minorities in other parts of the world. Future research to overcome obstacles to improvement needs to be inclusive, and involve community members as key informants, with their participation enhancing the reliability of data, contributing to social justice and solidarity, disseminating information, contributing to feasible recommendations and implementation of interventions.