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Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Pharmacology & Pharmacy 2024年第4期15卷 81-112页

作者： steward muden.a Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia

Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.

关键词： Antifungal Resistance Antifungal stewardship Antimicrobial Resistance Fungal Infections Global Burden Immunocompromised Mycosis

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COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

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Pharmacology & Pharmacy 2024年第5期15卷 147-166页

作者： steward muden.a Ruth Mbewe Manal Hadi Ghaffoori Kanaan Shafiq Mohamed Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Agriculture Technical Institute of Suwaria Middle Technical University Baghdad Iraq Medicines Management and Pharmacy Services St. James University Hospital Leeds Teaching Hospitals NHS Trust Leeds United Kingdom

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. Results: Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). Conclusion: This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had sid

关键词： COVID-19 Vaccines Pregnant Women Vaccine Acceptance Vaccine Hesitancy Zambia

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Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024:Findings and Future Implications

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Pharmacology & Pharmacy（药理与制药） 2024年第4期 81页

作者： steward muden.a

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Patients’Knowledge, Attitude and Practices on Disposal Methods of Expired and Unused Medicines: Implication for Creation of Drug Take-Back Program

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Pharmacology & Pharmacy 2024年第4期15卷 113-128页

作者： Martin Kampamba Zebedy Kalambwa Billy Chabalenge Janipher Zulu steward muden.a Tadious Chimombe Webrod Mufwambi Audrey Hamachila Mashebe Innocent Ngula Christabel Nang’andu Hikaambo Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Pharmacy School of Health Sciences Levy Mwanawasa Medical University Lusaka Zambia

Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (EUM). Improper disposal of expired and unused medicines is hazardous both to humans and the environment. Objective: This sought to measure patients’ knowledge, attitude, and practices on disposal methods of EUM. Methods: A cross-sectional study was carried out among 384 patients at three outpatient pharmacies at the University Teaching Hospitals (UTHs). The structured questionnaire was used to collect data and STAT version 15.1 was used to analyse the data. Results: 384 respondents participated in this study and, at some point, had EUM. In this study, 356 (92.7%) of the participants reported that they had never heard of a drug take-back system. Most of the participants 285 (74.2%) and 239 (62.2%) kept and donated their unused medicine, respectively. Additionally, 244 (63.5%), 212 (55.2%), and 176 (44.8%) of the participants disposed of expired medicines in the bin or garbage, flushed them in toilets or sinks, or burned them, respectively. Occupation was significantly associated with unsafe disposal of unused medicine [P-value = 0.019]. Conclusion and Relevance: Knowledge of safe disposal methods for EUM was good amongst most participants. However, used unsafe disposal methods. The majority of the participants exhibited positive attitude concerning safe disposal methods. This study highlights the need for drug-take-back program creation in Zambia.

关键词： Attitude Disposal Methods Expired Medicines Knowledge Practices Unused Medicines

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Roles of Community Pharmacists in Screening and Disseminating of Information about Non-Steroidal Anti-Inflammatory Drugs Risks: Implications for Drug Safety Assessment

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Pharmacology & Pharmacy 2024年第4期15卷 129-145页

作者： Martin Kampamba Progress Mulenga steward muden.a Billy Chabalenge Jenipher Zulu Tadius Chimombe Webrod Mufwambi Mashebe Innocent Ngula Audrey Hamachila Jimmy Hangoma Christabel Nang’andu Hikaambo Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Pharmacy School of Health Sciences Levy Mwanawasa Medical University Lusaka Zambia

Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to m

关键词： Community Pharmacists Non-Steroidal Anti-Inflammatory Drug Risk Screening

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COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women:A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

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Pharmacology & Pharmacy（药理与制药） 2024年第5期 147页

作者： steward muden.a Ruth Mbewe Manal Hadi Ghaffoori Kanaan Shafiq Mohamed

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Global urbanization as a shifting context for applying ecological science toward the sustainable city

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Ecosystem Health and Sustainability 2015年第1期1卷 44-59页

作者： steward T.A.Pickett Weiqi Zhou Cary Institute of Ecosystem Studies Box ABMillbrookNew York 12545 USA State Key Laboratory for Urban and Regional Ecology Research Center for Eco-Environmental SciencesChinese Academy of SciencesBeijing 100085 China

There is an abundance of conceptual frameworks relevant to sustainability in urban ***,to advance urban ecological science and its application to sustainable urban transformations,key existing frameworks must be *** paper is a conceptual synthesis cast in essay form in order to encompass a broad range of relevant *** starts from the premise that the familiar models of metropolitan and megalopolitan urban structure,of industrially driven urban development,and of the contrasts between urban and non-urban lands are manifestly inadequate representations of evolving global *** inadequacy is illustrated with examples from the United States and from *** the form and the interactions involved in contemporary urbanization and urban change suggest the need for a new integrated framework synthesizing two existing yet still evolving concepts:(1)The urban megaregion framework accommodates the spatial extent,interdigitation of contrasting land uses,and the linked spatial relations between nominally urban and nominally rural areas.(2)The new concept of the continuum of urbanity emphasizes the shifts in livelihood and lifestyle driven by regional and global teleconnections and their joint effects on local environments and *** these frameworks suggest a common conceptual structure for addressing urban areas of different ages,sizes,forms,and dynamics in both urbanizing and urbanized areas in developing and developed countries and *** synthesis of frameworks points to empirical research needs,and has the potential to better match sustainability plans and actions with the diverse urban forms and dynamics now appearing around the world.

关键词： development globalization megaregion sustainable city urban ecology urban theory urbanization

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Beyond city expansion:multi-scale environmental impacts of urban megaregion formation in China

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National Science Review 2022年第1期9卷 79-91页

作者： Weiqi Zhou Wenjuan Yu Yuguo Qian Lijian Han steward T.A.Pickett Jing Wang Weifeng Li Zhiyun Ouyang State Key Laboratory of Urban and Regional Ecology Research Center for Eco-Environmental Sciences Chinese Academy of Sciences College of Resources and Environment University of Chinese Academy of Sciences Cary Institute of Ecosystem Studies Beijing Urban Ecosystem Research Station Research Center for Eco-Environmental Sciences Chinese Academy of Sciences

Environmental degradation caused by rapid urbanization is a pressing global ***,little is known about how urban changes operate and affect environments across multiple *** on China,we found urbanization was indeed massive from 2000 to 2015,but it was also very uneven,exhibiting high internal city *** areas in China as a whole became less green,warmer,and had exacerbated PM2.5 ***,environmental impacts differed in newly developed versus older areas of *** impacts were prominent in newly urbanized areas,while old urban areas generally showed improved environmental *** addition,regional environmental issues are emerging as cities expand,connect and interact to form urban *** turn urbanization into an opportunity for,rather than an obstacle to,sustainable development,we must move beyond documenting urban expansion to understand the environmental consequences of both internal city dynamics and the formation of urban megaregions.

关键词： urbanization urban and regional sustainability landscape change air pollution urban heat island

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Integrating structure and function:mapping the hierarchical spatial heterogeneity of urban landscapes

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Ecological Processes 2020年第1期9卷 698-708页

作者： Yuguo Qian Weiqi Zhou steward T.A.Pickett Wenjuan Yu Dingpeng Xiong Weimin Wang Chuanbao Jing State Key Laboratory of Urban and Regional Ecology Research Center for Eco-Environmental SciencesChinese Academy of SciencesBeijing 100085China University of Chinese Academy of Sciences Beijing 100049China Cary Institute of Ecosystem Studies Box ABMillbrookNY 12545USA PowerChina Eco-environment Group Co. LtdShenzhen 518102China Shenzhen Environmental Monitoring Center Shenzhen 518049China

Background:Cities are social-ecological systems characterized by remarkably high spatial and temporal heterogeneity,which are closely related to myriad urban ***,the tools to map and quantify this heterogeneity are *** here developed a new three-level classification scheme,by considering ecosystem types(level 1),urban function zones(level 2),and land cover elements(level 3),to map and quantify the hierarchical spatial heterogeneity of urban ***:We applied the scheme using an object-based approach for classification using very high spatial resolution imagery and a vector layer of building location and *** used a top-down classification procedure by conducting the classification in the order of ecosystem types,function zones,and land cover *** classification of the lower level was based on the results of the higher *** used an objectbased methodology to carry out the three-level ***:We found that the urban ecosystem type accounted for 45.3%of the land within the Shenzhen city administrative *** the urban ecosystem type,residential and industrial zones were the main zones,accounting for 38.4%and 33.8%,*** canopy was the dominant element in Shenzhen city,accounting for 55.6%over all ecosystem types,which includes agricultural and ***,in the urban ecosystem type,the proportion of tree canopy was only 22.6%because most trees were distributed in the forest ecosystem *** proportion of trees was 23.2% in industrial zones,2.2%higher than that in residential *** information“hidden”in the usual statistical summaries scaled to the entire administrative unit of Shenzhen has great potential for improving urban ***:This paper has taken the theoretical understanding of urban spatial heterogeneity and used it to generate a classification scheme that exploits remotely sensed imagery,infrastructural data available at a municipal level,an

关键词： Social-ecological hybridity Object-based classification High-resolution imagery Ecosystem Urban function zones Land cover

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Evaluation of Deposit Insurance Fund Adequacy Using Credit Risk Model--An Indian Experience

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Chinese Business Review 2017年第5期16卷 211-233页

作者： steward Doss National Insurance Academy Pune India

There are two methods widely used for evaluating the adequacy of Deposit Insurance Fund：（i） Target Reserve Ratio and （ii） Credit Risk Model. Target Reserve Ratio is one of the macro level indicators more often set by Regulatory act on the basis of minimum Deposit Insurance Fund margin safety, Target Reserve Ratio is calculated as the ratio of Deposit Insurance Fund to the value of insured deposits. However, TRR does not take into consideration the level of Deposit Insurance potential liability, the Loss at Given Default （LGD） and the historical trend of default rate prevailing among the insured banks. It does not also consider the present condition of the economy and current scenario of the banking sector. This paper discusses primarily about development of Credit Risk Model for evaluating the Deposit Insurance Fund Adequacy. For this purpose, Econometric Credit Risk Model was developed based on the historical data of bank failures and the associated losses of the last 25 years from 1990-91 to 2014-15. The model assesses various possible factors impacting the Deposit Insurance Fund： Default rate, Deposit growth, Exposures, impact of macro-economic factors like GDP, GDS, Inflation and Interest rate changes, etc. on the Deposit Insurance Fund through econometric modeling. The model evaluates the adequacy of Deposit Insurance Fund under both （i） Normal scenarios where there is no （economic） systemic risk assumed and （ii） Worst case scenario at 1% level of significance using Monte Carlo Simulation. Since the model empirically validates all the critical factors impacting the assets and liabilities associated with Loss at Given Default, the model output can also be used to determine a suitable Target Reserve Ratio and such models are being used in countries like USA, Canada, Hong Kong, and Singapore, etc. （IADI, 2009）. More importantly, the model outputs are quite useful in determining the adequacy of deposit insurance fund which is an effective risk control measure that

关键词： default probability Loss at Given Default Target Reserve Ratio assessable deposits cash reserve ratio capital to risk weighted asset ratio

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