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Pharmaceutical residuals in water: social challenges and opportunities for upstream mitigation measures in home setting
Abstract
In recent years, the diversity of pharmaceutical residuals found in aquatic environments has raised concerns. Different paths have been proposed to reduce their presence. However, there are still uncertainties on which strategies, upstream or downstream, preventive or technical, global or local, should or could be applied. Among them is the classification of certain pharmaceutical treatments as requiring specific attention and precaution measures, including collecting patients’ body substances containing pharmaceutical residuals. This study assessed the existing status of patients’ excreta,
examined the social barriers and solutions for limiting pharmaceutical residuals missions through an upstream strategy. We used ethnographic (n=57) and quantitative (n=428) approaches among health professionals. Body substances were associated with taboo, and subject to recommendations in health sectors. Among field workers, attitudes of reluctance, skepticism, but also openness towards collecting body substances emerged. Health managers’ views were biased towards wastes from non-consumed pharmaceuticals. Currently, European regulation offers limited opportunities for effective measures. Encouraging the reanalysis of public health and environmental concerns together emerges as a promising path regarding pharmaceutical residuals.
... Aged infrastructure and predominantly impermeable surfaces in urban areas can generate floods, water pollution, and reduce groundwater recharge: these are primary issues that often need to be addressed at multiple governance levels [2,12,20,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] An additional factor not often discussed is corruption in the water and wastewater sector: a lack of transparency and non-existent citizen engagement are factors that enable corruption in the awarding of contracts, shortfalls in construction, and issues with infrastructure operations and maintenance. The table below addresses these issues and outlines how they are addressed in various locations. ...
This article reviews recent studies that address water sustainable management opportunities and challenges in megacities around the world, with an emphasis on the case of Rio de Janeiro Metropolitan Region, one of the two megacities in Brazil. With reference to recent debates on water, megacities, and the climate crisis, as well as UN Water and Global Report Initiative documents, we focused on the implementation of the 2030 Agenda Sustainable Development Goal 6: Clean Water and Sanitation for All. The new Brazilian sanitation legal framework regulates public–private partnerships. In this context, the manuscript discusses the main question concerning water, sanitation, and hygiene that arises in the Brazilian case study: is universality possible in profit-oriented models? Through the current technical and academic literature consulted, the paper compares initiatives involving multiple stakeholder governance models that depend on private resources to implement universal access to drinking water, sanitation, and water-related extreme event controls, pointing out alternatives that can help to achieve the targets of SDG. Validation by key informants supports the synthesis of the reviewed documents, and the findings illustrate that concerted public efforts together with market mechanisms can help to overcome challenges and surpass the profit-oriented logics of private companies to achieve access to healthy and safe water, adequate sanitation, and improved hygiene, especially for vulnerable populations. This finding has transferability to other megacities in emerging countries that are facing public–private partnership debates on the provision of clean water and sanitation for all.
The policies that can be implemented to promote environmentally friendly practices raise difficulties. According to our results, these problems result from a focus on objects. These policies must be expanded to social morphology (Mauss, 2001) and they should consider the integration of objects in existing social, political, economic, technical and spatial organisations. The paper argues that the integration of objects in the social morphology is the problem of the implementation of the current environmental policies; but it could be also the solution. In this analysis, the objects are considered as instruments in social activities. This analysis suggests that conditions and ways of action must be better considered in the development of environmental policies.
The extensive use of antibiotics leading to the rapid spread of antibiotic resistance poses high health risks to humans, but to date there is still lack of a quantitative model to properly assess the risks. Concerns over the health risk of antibiotic residues in the environment are mainly (1) the potential hazard of ingested antibiotic residues in the environment altering the human microbiome and promoting emergence and selection for bacteria resistance inhabiting the human body, and (2) the potential hazard of creating a selection pressure on environmental microbiome and leading to reservoirs of antibiotic resistance in the environment. We provide a holistic view of health risk assessment of antibiotic resistance associated with antibiotic residues in the environment in contrast with that of the antibiotic resistant bacteria and discuss the main knowledge gaps and the future research that should be prioritized to achieve the quantitative risk assessment. We examined and summarized the available data and information on the four core elements of antibiotic resistance associated with antibiotic residues in the environment: hazard identification, exposure assessment, dose-response assessment, and risk characterization. The data required to characterize the risks of antibiotic residues in the environment is severely limited. The main future research needs have been identified to enable better assessments of antibiotic resistance associated with antibiotic residues in the environment: (1) establishment of a standardized monitoring guide of antibiotic residues and antibiotic resistance in the environment, (2) derivation of the relationship between antibiotic levels and pathogenic antibiotic-resistance development in different settings, and (3) establishment of the dose-response relationship between pathogenic antibiotic resistant bacteria and various infection diseases. After identification of key risk determinant parameters, we propose a conceptual framework of human health risk assessments of antibiotic residues in the environment. Capsule: A holistic view of human health risk assessment of antibiotic residues in the environment was provided.
Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985,
1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is
found to be well supported by empirical evidence. Intentions to perform behaviors of different
kinds can be predicted with high accuracy from attitudes toward the behavior, subjective
norms, and perceived behavioral control; and these intentions, together with perceptions of
behavioral control, account for considerable variance in actual behavior. Attitudes, subjective
norms, and perceived behavioral control are shown to be related to appropriate sets of salient
behavioral, normative, and control beliefs about the behavior, but the exact nature of these
relations is still uncertain. Expectancy value formulations are found to be only partly
successful in dealing with these relations. Optimal rescaling of expectancy and value
measures is offered as a means of dealing with measurement limitations. Finally, inclusion of
past behavior in the prediction equation is shown to provide a means of testing the theory*s
sufficiency, another issue that remains unresolved. The limited available evidence concerning
this question shows that the theory is predicting behavior quite well in comparison to the
ceiling imposed by behavioral reliability.
A risk assessment for freshwater and marine ecosystems is presented for 48 pharmaceutical compounds, belonging to 16 therapeutic classes, and prescribed in northwestern France. Ecotoxicity data were obtained on two freshwater organisms, i.e., crustacean Daphnia magna and the green algae Pseudokirchneriella subcapitata, and on two marine organisms, i.e., the crustacean Artemia salina and the diatom Skeletonema marinoi. Measured environmental concentrations (MEC), in the Orne River and sea off Merville-Franceville in the Basse-Normandie region, were compared to the predicted environmental concentrations (PEC). Predicted no-effect concentrations (PNEC) were derived from acute data for each compound. Then, a risk assessment for each compound and the mixture was performed by calculating risk quotients (RQ as PEC or MEC/PNEC ratio). Results showed that no immediate acute toxicities were expected even if some compounds displayed strong toxicities at very low concentrations. Antibiotics, antidepressants, and antifungals would deserve attention because of their high or median ecological risk suspected on marine and freshwater ecosystems. Marine ecosystems would be more sensitive to pharmaceutical residues.
Popular procedures to control the chance of making type I errors when multiple statistical tests are performed come at a high cost: a reduction in power. As the number of tests increases, power for an individual test may become unacceptably low. This is a consequence of minimizing the chance of making even a single type I error, which is the aim of, for instance, the Bonferroni and sequential Bonferroni procedures. An alternative approach, control of the false discovery rate (FDR), has recently been advocated for ecological studies. This approach aims at controlling the proportion of significant results that are in fact type I errors. Keeping the proportion of type I errors low among all significant results is a sensible, powerful, and easy-to-interpret way of addressing the multiple testing issue. To encourage practical use of the approach, in this note we illustrate how the proposed procedure works, we compare it to more traditional methods that control the familywise error rate, and we discuss some recent useful developments in FDR control.
Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
Longtemps la recherche qualitative a été synonyme d'une sorte d'impressionnisme méthodologique : le chercheur fait des entretiens, tient un journal de ce qu'il a observé, prend des notes sur les réunions auxquelles il a pu participer, lit des documents. Muni d'un stabilo, il surligne ça et là ce qui le frappe, l'intéresse, le stimule, laissant dans l'ombre et l'oubli - nécessité fait loi - des pans massifs du matériau recueilli ; puis, en liaison avec ses lectures et ses intérêts théoriques, il combine le tout, hypothèses, propositions, concepts et extraits de matériau, en une synthèse - thèse, livre, article. La subjectivité éclairée du chercheur préside à une telle démarche. L'idée s'est imposée, en grande partie depuis le développement de la théorisation ancrée due à Barney G. Glaser et Anselm L. Strauss, que lorsqu'on pratique la démarche qualitative, il faut éviter cette situation peu rigoureuse, donc peu scientifique. Il faut pour cela coder son matériau. Les thèses que nous allons défendre (et qui ont fait l'objet de discussions animées entre les deux auteurs eux-mêmes) sont dérangeantes : 1. Le codage venant de la théorisation ancrée, que l'on peut qualifier d'" originel " ou de " pur ", est impossible en pratique. 2. La théorisation ancrée s'est fourvoyée dans une partie de sa démarche, en liant l'idée de codage à l'idée d'appliquer un mot-étiquette à un extrait de matériau (ce qui pourtant reste pour beaucoup d'auteurs l'essence même du codage). 3. La théorisation ancrée a établi un point fondamental : le coeur de la démarche est un travail systématique sur les ressemblances/différences (ce qui confirme la thèse 2 : le codage comme étiquetage ne permet justement pas bien ce type de travail). 4. C'est dans ce travail systématique que réside la rigueur du codage. Le codage lui-même comporte une dimension de bricolage. Les tentatives pour le rendre lui-même rigoureux (comme par exemple le double codage) se fourvoient. 5. Le codage doit être multiple et il peut exister des formes de codage multiples (nous en proposerons deux ici : le codage multinominal et le codage multithématique). 6. L'expression " codage théorique ", qu'on trouve souvent dans la littérature, est un oxymore et une contradiction dans les termes.
En combinant des ressources issues de la sociologie de la traduction et de la sociologie de l'action, l'auteur propose dans cet article un certain nombre de concepts permettant l'analyse de l'action avec des dispositifs techniques. Celle-ci peut être envisagée selon trois modalités qui effectuent chacune le lien entre contenus techniques et compétences des acteurs : traduction, coopération, coordination. L'article débouche sur une analyse des conditions d'infélicité dans l'action avec les dispositifs techniques.
Dans les discours savants ou grand public, le medicament est souvent reduit a une molecule, un principe actif permettant d'agir sur telle ou telle partie du corps humain : dans ces conditions, on se demande quels sont les mecanismes d'action, s'il a bien les effets qu'on lui prete, si ses effets secondaires sont supportables a tout point de vue, on cherche a preciser son domaine d'application, a affiner la posologie, etc. Mais on s'interesse assez peu a ce qui se trouve entre le laboratoire pharmaceutique qui produit et conditionne ce principe actif et le corps qui le recoit : or, pour que la molecule passe d'un point a un autre et effectue le travail qui est attendu d'elle, il faut qu'un certain nombre de conditions soient reunies et qu'un certain nombre d'acteurs se conforment plus ou moins a un ou des programmes d'action. Comment ces differentes exigences sont-elles portees, en totalite, partiellement ou pas du tout, par les medicaments eux-memes consideres dans toute leur materialite, c'est-a-dire non seulement le principe actif, mais sa forme, son emballage, les accessoires eventuels, la notice, le carton etc? Pour tenter de repondre a cette question, nous mobiliserons les apports de la sociologie des objets techniques ; en particulier, nous ferons l'hypothese qu'un medicament, tout comme un objet technique, definit par sa forme meme des acteurs et des relations entre ces acteurs, attribue certaines competences a ces acteurs, suppose un certain environnement pour “fonctionner”. Au travers d'exemples tires de l'experience commune, on essaiera de dresser un premier tableau des differentes modalites par lesquelles les usagers sont pris en compte dans le medicament et ce qui lui est associe.
through the use of predicted responses, to separate subjects with low observed responses from those with high responses Perils of Overfitting 4 # # Perils of Overfitting q Fitting a model with 20 patients and 20 variables (counting the intercept) will result in 5 # #no matter what the variables are q Analyzing too many variables for the available sample size will not cause a problem with apparent predictive accuracy q Calibration or discrimination accuracy assessed on a new sample will suffer q Caused by multiple comparison problems and trying to estimate too many parameters (regression coefficients) from the sample q To use standard statistical methods, need to have a certain number of subjects per candidate predictor a a The term candidate is used because one needs to count all varia
Wastewater treatment plants (WWTPs) have been considered as hotspots for pharmaceutical residues, such as antidepressants, antimicrobials and active ingredients of over-the-counter drugs. Despite evidence of ecotoxicological effects of these microcontaminants on exposed fish in the aquatic systems, there is currently no regulation in terms of the levels of pharmaceutical residues allowable for release into the environment. Depending on the extent of treatment employed in WWTPs removal of pharmaceutical residues are highly variable. This study compares the removal efficiencies for several antimicrobials, antidepressants, and other pharmaceuticals at different stages of the wastewater treatment process of seven WWTPs that employ varying treatment technologies including biological, physical, advanced chemical oxidation, and a combination of two or more of these technologies. The concentrations of the pharmaceuticals were measured by liquid chromatography/mass spectrometry at multiple points during the course of treatment. Additionally, the ecotoxicological effects of the WWTP effluents were also evaluated based on the behavioral effects in larval zebrafish. It was found that biological treatment process provided negative to low removal (<50%), while activated carbon and ozonation provided high removal (>95% over all removal) for 14 out of 15, and 9 out of 11 compounds detected in WWTP influents, respectively. Notably, the final effluents of the seven WWTPs in this study did not show any significant behavioral alterations in zebrafish, indicating that despite differences in removal efficiencies all the treatment processes investigated are sufficient in preventing short - term biological effects.
Pharmaceuticals are environmental contaminants that have been widely detected in aquatic media. In this review, the occurrence of pharmaceuticals in the environment, its major causes and implications along with effective procedures for their removal from contaminated water have been studied. Adsorption stands out as a promising treatment method, since it offers advantages like lower energy consumption and simpler operation conditions in comparison to other tertiary treatments. Although commercial activated carbon is extensively studied as adsorbent of pharmaceuticals, its large-scale application is limited by the high costs. Therefore, different non-conventional low-cost materials have been investigated and adsorbents based on clays, biochars, chitosan, agricultural and industrial wastes, and metal-organic frameworks have been addressed in many studies for pharmaceuticals uptake from water and wastewater. This article reviews key publications on this subject, discussing adsorption performance in terms of kinetics, equilibrium, thermodynamics, continuous fixed-bed process, regeneration capability and historical, economical and practical aspects.
Pharmaceuticals are indispensable for human and animal health. After use, the active agents and their metabolites are excreted and enter the environment via different pathways. For decades, pharmaceuticals and metabolites have been found in the environment, e.g. surface water, groundwater, drinking water, sediment, sewage sludge and manure. About half of the 2300 active ingredients used in Germany are considered to be potentially of environmental relevance. Monitoring in the environment is still under way, but an impact on living organisms has already been detected. There is still a lack of knowledge concerning: quantities of pharmaceuticals entering the environment, origin of the pharmaceutical active agents, metabolism and transformation pathways, the effects of the active substances, metabolites and transformation products on aquatic organisms, as well as their persistence or degradability in the environment. Sporadically, traces of drugs are detected in drinking water. The concentrations are usually far below the µg per liter range and below concentration levels, which might have an effect on humans. Long-term effects cannot be excluded, though, and should be investigated. Moreover, antibacterial agents and antibiotic-resistant bacteria enter the environment in different ways. They are widely distributed. There is an urgent need for concepts and priorities in order to eliminate the exposure by pharmaceuticals in the environment. The authors suggest short-, medium- and long-term measures for the reduction of pharmaceuticals in the environment, with a clear prioritization of preventive measures.
This opinion paper assesses for the UK, whether the current use of cytotoxic drugs, one of the most toxic pharmaceuticals in common use, could pose a risk to aquatic organisms and to humans through water recycling. A water quality model was set up for one of these drugs, 5-fluorouracil, in the Aire and Calder catchment in Northern UK. The study predicts 5–50 ng/L concentrations for long stretches of this catchment under low flow conditions. Due to their mode of action, practically all eukaryotic organisms are vulnerable to damage, with teratogenicity being the greatest concern at such levels. However, it is unclear to what extent the predicted low concentrations would affect flora and fauna in receiving waters but there may be an additive effect of a mixture of cytotoxic drugs which should be taken into account. The exposure of the pregnant mother, or more specifically her foetus, to these drugs via drinking water should be minimised. Current drinking water purification technology gives grounds for optimism on removal of these compounds, but no appropriate data exist yet.
Pharmaceutical residues in water are frequently analysed and discussed in connection with sewage treatment, ecotoxicity and, natural and drinking water quality. Among different localities hospitals are suspected, or implied, to be a major and highly variable source of pharmaceuticals that substantially contribute to the total wastewater load. In this study, the contribution of pharmaceuticals from a hospital to a sewage treatment plant (STP) serving around 45,000 inhabitants was evaluated. Approximately 200 hospital beds result in a hospital bed density of 4.4 beds per 1000 inhabitants, which is a typical value for developed world countries. Prior to sampling, a sound systems analysis was performed, and a sophisticated continuous flow-proportional sampling regime was applied. Hence, overall experimental uncertainty was reduced to a minimum, and measurements provide clear evidence that, for 28 of 59 investigated substances, over 85% of the pharmaceutical residue loads do not originate from the hospital when applying a conservative error estimation. Only for 2 substances, trimethoprim (18%) and roxithromycin (56%), was the maximum observed contribution of the hospital >15%. On average, the contribution of the hospital for the compounds detected in both, hospital effluent and sewage treatment plant influent was small and fairly constant. Five compounds were only detected in hospital wastewater, and 24 neither in the hospital wastewater nor in the total wastewater at the influent of the STP. For these compounds no experimental contribution could be calculated. For the compounds where audit data for both the national consumption and the specific hospital under investigation were available, a prediction of the fraction of pharmaceuticals originating from the hospital was performed. Three quarters of the compounds, classified with the existing audit data, were in the same "hospital contribution category" as determined by measurements. For most of the other compounds, plausible reasons could be identified to explain the observed deviations.
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