One Health training and research activities in Western Europe

Nurse educators' knowledge and opinions about the "One Health" approach

AIM

This study was conducted to reveal the knowledge and opinions of Turkish nurse educators about the One Health approach.

BACKGROUND

One Health is a collaborative, multisectoral, and transdisciplinary approach working at local, regional, national, and global levels to achieve optimal health (and well-being) outcomes recognizing the interconnections between people, animals, plants, and their shared environment. Despite nurses' unique position to address inequities in health care for all people around the world, the concept of One Health is a relatively new concept in nursing.

METHODS

This is a cross-sectional descriptive study involving a total of 272 nurse educators from various universities in Turkey. The email addresses of nurse educators were obtained from university websites, and the questionnaire form (created using the survey tool Google Forms) was then sent to them. Open-ended questions underwent content analysis, while multiple-choice questions were analyzed in terms of numbers and percentages.

RESULTS

Eighty-two percent of nurse educators had never heard of or encountered the One Health approach before. Ninety-six percent of nurse educators think that the One Health approach should be included in nursing education. Nurse educators asserted that nursing should be included as a discipline in the One Health approach due to its relationship with the environment, health prevention and promotion, and its close contact with society.

CONCLUSION

The results of this study underscore the necessity of enhancing One Health knowledge among nursing educators. It is particularly significant that the majority of nurse educators had not previously encountered or been aware of the One Health approach, highlighting an important gap in awareness and understanding.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing, silent in the realm of One Health, should integrate this approach, which encompasses human, animal, and environmental health, into nursing education, research, and practice. It is time for action to incorporate One Health into both undergraduate and graduate nursing education programs, conducting research in this area, and fostering collaborations.

Launching Austria's One Health network: paving the way for transdisciplinary collaborations

In the post-COVID-19 era, stakeholders, including policymakers, funders, and the public, are increasingly seeking for a cross-sectoral systems-based approach to health risks extending beyond conventional measures. Anchored on three health pillars -human, animal, and environmental- One Health offers a promising framework to effectively address this demand. While some nations have already implemented national One Health strategic plans, European countries, in general, are lagging behind the global agenda. On 22 February 2024, an initiative was launched in Austria toward addressing this gap, bringing together multiple sectors and disciplines, marking the initial step in creating a national One Health network. The workshop emphasized the importance of enhancing One Health education and addressed key topics, such as incorporating the environmental pillar of One Health as well as socio-economic and cultural drivers to further our understanding of outbreaks, and establishing trusted communication channels, including data sharing, between disciplines and sectors. Identified challenges encompassed the need for more funding of transdisciplinary research. Opportunities for advancement include initiating local One Health projects and showcasing their positive impacts. Moving forward, efforts will focus on establishing a mature and globally connected One Health framework in Austria and supporting the integration of One Health aspects into education curricula, research programs, and policies.

Mapping Research Trends in One Health: A Comprehensive Review

The One Health approach, which emphasizes the interconnection between human, animal, plant, and environmental health, has gained significant attention as a framework for addressing global health challenges. This study presents a thorough bibliometric analysis of One Health research, utilizing the Web of Science Core Collection database, covering the period from 1989 to 2024. The analysis uncovers a substantial increase in scientific output over the years, reflecting the growing importance of this interdisciplinary field. The research reveals a notable shift in focus from traditional areas such as microbiology and infectious diseases to broader public health issues, including healthcare management, policy development, and food security, with particular attention to plant health, crop production, and the use of pesticides. Through advanced tools like Biblioshiny and VOSviewer, this study identifies prolific authors, leading journals, and emerging research themes shaping the One Health domain. The findings highlight the critical role of international collaboration in advancing this field and underscore the need for interdisciplinary approaches in both established and emerging research areas. By offering a comprehensive overview of the current landscape, this bibliometric evaluation serves as a valuable guide for researchers, policymakers, and stakeholders, emphasizing the essential role of One Health in developing strategies to combat complex health issues on a global scale.

Global One Health post-graduate programmes: a review

BACKGROUND

The One Health (OH) approach recognises that humans, animals, plants, and the environment are interrelated, and therefore seeks to facilitate collaboration, communication, coordination, and capacity building between relevant stakeholders to achieve a healthier ecosystem. This calls for integrating OH into established governance, policy, health, education, and community structures, and requires OH professionals equipped with the necessary inter and trans-disciplinary skillset. Therefore, numerous OH training programmes are currently being offered globally. However, the coordination and contents of some of these trainings have been criticised as inconsistent and inadequately standardised, and therefore could serve as a barrier to OH implementation. In this study, an up-to-date repository of a subset of OH academic programmes offered globally was provided, and their curricula contents was critically assessed.

METHODS

Between December 2022 and April 2023, an online search for key terms 'ONE HEALTH MASTERS COURSES', and 'ONE HEALTH MASTERS PROGRAMMES' together with variations of 'AFRICA', 'NORTH AMERICA', 'ASIA', 'AUSTRALIA', 'EUROPE', 'GLOBAL' was conducted. Details about course title, delivery mode, joint administration status, curricula contents, language of instruction, years to completion, host university, country, and continent were collected.

RESULTS

Forty-three programmes met inclusion criteria of the study, and almost all (n = 36, 83.7%) were tailored towards infectious diseases and population/global health, compared to the environmental and conservation perspectives. Compiled curricula contents clustered into one of these 12 sub-headings: 'principles and concepts of OH', 'epidemiology and biostatistics', 'major branches of OH', 'internship/externship/research project', 'infectious diseases, zoonoses, and surveillance', 'risk analysis and crises management', 'food safety, microbiology, immunology, and allied', 'communication', 'ethics', 'economics, policy, and management' and 'others. Of these, infectious disease themes were the most common. Regarding geography and organising institutions, North America and Europe, and veterinary institutions, respectively, were the most represented.

CONCLUSION

Despite the multi-level diversity observed, uniformity still exists across the programmes which favours interdisciplinary cross-talks. Future pedagogical studies that objectively assess the alignment of module contents with the OH core competencies and the impacts of these OH programmes is recommended. With this study, a critical information gap that has existed for long in the OH field has been bridged.

Integrons in the development of antimicrobial resistance: critical review and perspectives

Antibiotic resistance development and pathogen cross-dissemination are both considered essential risks to human health on a worldwide scale. Antimicrobial resistance genes (AMRs) are acquired, expressed, disseminated, and traded mainly through integrons, the key players capable of transferring genes from bacterial chromosomes to plasmids and their integration by integrase to the target pathogenic host. Moreover, integrons play a central role in disseminating and assembling genes connected with antibiotic resistance in pathogenic and commensal bacterial species. They exhibit a large and concealed diversity in the natural environment, raising concerns about their potential for comprehensive application in bacterial adaptation. They should be viewed as a dangerous pool of resistance determinants from the "One Health approach." Among the three documented classes of integrons reported viz., class-1, 2, and 3, class 1 has been found frequently associated with AMRs in humans and is a critical genetic element to serve as a target for therapeutics to AMRs through gene silencing or combinatorial therapies. The direct method of screening gene cassettes linked to pathogenesis and resistance harbored by integrons is a novel way to assess human health. In the last decade, they have witnessed surveying the integron-associated gene cassettes associated with increased drug tolerance and rising pathogenicity of human pathogenic microbes. Consequently, we aimed to unravel the structure and functions of integrons and their integration mechanism by understanding horizontal gene transfer from one trophic group to another. Many updates for the gene cassettes harbored by integrons related to resistance and pathogenicity are extensively explored. Additionally, an updated account of the assessment of AMRs and prevailing antibiotic resistance by integrons in humans is grossly detailed-lastly, the estimation of AMR dissemination by employing integrons as potential biomarkers are also highlighted. The current review on integrons will pave the way to clinical understanding for devising a roadmap solution to AMR and pathogenicity. Graphical AbstractThe graphical abstract displays how integron-aided AMRs to humans: Transposons capture integron gene cassettes to yield high mobility integrons that target res sites of plasmids. These plasmids, in turn, promote the mobility of acquired integrons into diverse bacterial species. The acquisitions of resistant genes are transferred to humans through horizontal gene transfer.

International stakeholder perspectives on One Health training and empowerment: a needs assessment for a One Health Workforce Academy

BACKGROUND

One Health is defined as an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems; this approach attracts stakeholders from multiple sectors, academic disciplines, and professional practices. The diversity of expertise and interest groups is frequently and simultaneously framed as (1) a strength of the One Health approach in the process of understanding and solving complex problems associated with health challenges such as pathogen spillovers and pandemics and (2) a challenge regarding consensus on essential functions of One Health and the sets of knowledge, skills, and perspectives unique to a workforce adopting this approach. Progress in developing competency-based training in One Health has revealed coverage of various topics across fundamental, technical, functional, and integrative domains. Ensuring that employers value the unique characteristics of personnel trained in One Health will likely require demonstration of its usefulness, accreditation, and continuing professional development. These needs led to the conceptual framework of a One Health Workforce Academy (OHWA) for use as a platform to deliver competency-based training and assessment for an accreditable credential in One Health and opportunities for continuing professional development.

METHODS

To gather information about the desirability of an OHWA, we conducted a survey of One Health stakeholders. The IRB-approved research protocol used an online tool to collect individual responses to the survey questions. Potential respondents were recruited from partners of One Health University Networks in Africa and Southeast Asia and international respondents outside of these networks. Survey questions collected demographic information, measured existing or projected demand and the relative importance of One Health competencies, and determined the potential benefits and barriers of earning a credential. Respondents were not compensated for participation.

RESULTS

Respondents (N = 231) from 24 countries reported differences in their perspectives on the relative importance of competency domains of the One Health approach. More than 90% of the respondents would seek to acquire a competency-based certificate in One Health, and 60% of respondents expected that earning such a credential would be rewarded by employers. Among potential barriers, time and funding were the most cited.

CONCLUSION

This study showed strong support from potential stakeholders for a OHWA that hosts competency-based training with opportunities for certification and continuing professional development.

One Health in the consciousness of veterinary students from the perspective of knowledge of antibiotic therapy and antimicrobial resistance: a multi-centre study

One Health (OH) is one of the most essential global programs to rebalance the animal, human, and plant environments that depend on and affect each other. One element of the OH program is to draw attention to the phenomenon of antimicrobial resistance (AMR), which poses a very high risk to human and animal health. OH is not only a health-promoting project but also has an educational dimension. Therefore, a survey was conducted among 467 veterinary students studying at top academic centers in Poland to find out whether they had heard of OH and whether knowledge of OH influences their knowledge and attitudes related to AMR. The study indicated statistically significant relationships between familiarity with the OH program and the year of study. The higher the year of study, the more students heard about OH. It was also shown that students who had heard of OH were significantly more likely-compared to students who had not heard of OH-to agree that increasing AMR is influenced by the overuse of antibiotics in veterinary medicine (70.7 vs. 55%; p = 0.014) and the use of too low doses of antibiotics in animals (49.8 vs. 28.6%; p = 0.016). The higher the year of study, the higher the percentage of students who say that carbapenems as antibiotics of last resort should be reserved only for humans (70% of final-year students vs. 30.8% of first-year students; p < 0.001). The study's results indicate the effectiveness of education in fostering positive attitudes toward AMR and the impact of knowledge of the OH program on knowledge of antibiotic therapy in the spirit of OH.

Translating One Health knowledge across different institutional and political contexts in Europe

BACKGROUND

Implementing a One Health approach is complex. It demands engaging different sectors and actors in the promotion and protection of human, animal and environmental health. A key challenge for successfully implementing the One Health approach are knowledge translation processes among scientists and policy-makers.

METHODS

An online survey reached 104 experts from 23 European countries, working at national agencies or institutes, universities, ministries, non-governmental organisations (World Health Organization, World Organisation for Animal Health), and European Union (EU) agencies. Qualitative and quantitative analyses were conducted to describe experts' perceptions.

RESULTS

This study indicated a lack of networks among scientists and between scientists and policy-makers. Relations of scientists and policy-makers were perceived as challenging due to different interests and priorities, leading to difficulties in reaching political attention for One Health topics. It also highlighted a favoured attention to some One Health topics (e.g. antimicrobial resistance) as opposed to others (e.g. environmental issues). Important international actors to push One Health policies forward were the Quadripartite organisations and EU agencies. National actors (government agencies, national research institutes, universities) were on average perceived to be more important than international actors due to their roles and influences. Factors influencing the knowledge translation process were the different languages spoken by scientists as well as politicians, and an equivocal understanding of the One Health approach.

CONCLUSION

The study shows the importance of leadership to establish interdisciplinary networks and to problematise One Health issues with clear scope and targets. This will help to link knowledge to needs and capabilities of policy-makers. Establishing strong relationships among national and international actors can encourage networks and raise awareness of the One Health approach to policy-makers. Lastly, promoting research communication skills of scientists can provide a valuable tool to reach policy-makers to enhance attention to One Health topics.

One health: A brief appraisal of the Tripartite - UNEP definition

In 2021, the Joint Tripartite WHO-FAO-OIE plus UNEP committed to a unifying definition of "One health", seemingly distinctive in its systems approach to health. The new definition preserves core aspects of previous One Health conceptualisations. However, it also introduces emerging currents of thought which promote integration and unification, emphasise ecosystem health, and may facilitate the exploration and adoption of traditional forms of knowledge. It is argued that the operationalisation of One Health will require a foundational understanding of the factors that underpin a health issue, along with ongoing development of educational curricula that promote One Health awareness, acceptance, and adoption. This article is protected by copyright. All rights reserved.

Antimicrobial resistance surveillance system mapping in different countries

OBJECTIVES:

Excessive use of antibiotics has increased antimicrobial resistance (AMR) worldwide, which is a major public concern among the countries. To control this threat proper monitoring of the antimicrobial usage with increasing rate of AMR is required. Moreover, alternatives for antibiotics are surveyed and are being researched for quick use in the future. Thus, multisector intervention is highly encouraged for better outcomes. In this research article, six different European countries are discussed in terms of antimicrobial usage and AMR in human and livestock sectors with the help of literature study and various reports published by different organizations.

METHODS:

Data study has been conducted to collect data for comparison study. Data sources of AMR and antimicrobial usage are analyzed and both antimicrobial use and AMR are compared.

RESULTS:

This article provides surveillance systems that are formed to keep a track on the upcoming situation of AMR and the consumption of antimicrobials by humans as well as animals. The article firmly allows the readers to get broad information about the AMR across six countries of Europe. These annual reports have hugely helped the government to decide for alternatives and have focused in many training activities to combat the AMR situation globally.

CONCLUSION:

As antibiotic resistance genes persist on an interface between environment and animal and animal health, an approach is required in all three areas that stress the concept of “One Approach to Health.”

Systemic factors for enhancing intersectoral collaboration for the operationalization of One Health: a case study in India

Background

One Health is a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. Operationalization of the One Health approach is still unclear for various local health systems with their respective targets. In this scenario, the empirical study of intersectoral collaboration between the human and animal health systems provides an opportunity to investigate the appropriate strategies and their enabling factors at the local health system level. Thus, this study documented and validated the innovative strategy for intersectoral collaboration, focusing on effectual prevention and control of zoonotic diseases with its enabling factors for a city in western India, Ahmedabad.

Methods

This case study was conducted in three phases: phase I (qualitative data collection, i.e., vignette interview), phase II (quantitative data collection through modified policy Delphi), and phase III (participatory workshop). The vignette data were handled for content analysis, and the Delphi data, like other quantitative data, for descriptive statistics. The participatory workshop adapts the computerized Sensitivity Model^® developed by Vester to analyse the health system dynamics.

Result

Out of the possible 36 strategies, this study validated the top 15 essential (must-have) and five preferred (should-have) strategies for the study area. For operationalization of the One Health approach, the enabling factors that were identified through the systems approach are micro-level factors at the individual level (trust, leadership, motivation, knowledge), meso-level factors at the organizational level (human resource, capacity-building, shared vision, decision-making capacity, laboratory capacity, surveillance), macro-level factors at the system level (coordinated roles, relationships, common platform), and external factors outside of the system (guidelines/policies, community participation, a specific budget, political will, smart technology).

Discussion

This study reveals that the micro-level factors at the individual level are potential levers of the health system. More attention to these factors could be beneficial for the operationalization of the One Health approach. This study recommends a systems approach through a bottom-up exploration to understand the local health system and its enabling factors, which should be accounted for in formulating future One Health policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00727-9.

One Health information management: health system reforms to support social well-being in Thailand

Background and Aim: The information about the health problems interaction between animal health, ecosystems, and human health that the "One Health (OH)" concept is becoming more complex. This study focused on OH information in Thailand to develop guidelines for establishing a "One Health Information Management (OHIM)" system by drafting the structure of an OH information strategic plan. Materials and Methods: A mixed methods approach was used and included questionnaires, interviews, focus groups, and observations in agencies across the country to gather evidence about actions relating to the OH concept, such as the Memorandum of Agreements between the Ministry of Public Health and eight main agencies. Results: The study concentrated on the key issue that understanding the OH concept is difficult, as the environment and human health sectors include less knowledge of this concept than the animal health sector. Further, there are concerns about the comprehension of OH concepts, and high-level information management and data storage relating to OH, including medicine, cattle, wild animal, environment, and environmental resource management. Data from OH researchers and publicly accessible government data are less integrated and inconsistently managed across agencies. Conclusion: The study of OHIM strategic development should consist of four important points: (1) Clarity in the OH concept, (2) OH staff development, (3) development of an OHIM data network and innovation, and (4) research and academic development, and global OHIM academic exchange. All of these points will lead to health system reforms to support social well-being.

Mitigating Future Respiratory Virus Pandemics: New Threats and Approaches to Consider

Despite many recent efforts to predict and control emerging infectious disease threats to humans, we failed to anticipate the zoonotic viruses which led to pandemics in 2009 and 2020. The morbidity, mortality, and economic costs of these pandemics have been staggering. We desperately need a more targeted, cost-efficient, and sustainable strategy to detect and mitigate future zoonotic respiratory virus threats. Evidence suggests that the transition from an animal virus to a human pathogen is incremental and requires a considerable number of spillover events and considerable time before a pandemic variant emerges. This evolutionary view argues for the refocusing of public health resources on novel respiratory virus surveillance at human-animal interfaces in geographical hotspots for emerging infectious diseases. Where human-animal interface surveillance is not possible, a secondary high-yield, cost-efficient strategy is to conduct novel respiratory virus surveillance among pneumonia patients in these same hotspots. When novel pathogens are discovered, they must be quickly assessed for their human risk and, if indicated, mitigation strategies initiated. In this review, we discuss the most common respiratory virus threats, current efforts at early emerging pathogen detection, and propose and defend new molecular pathogen discovery strategies with the goal of preempting future pandemics.

Support for global health and pandemic preparedness in medical education in Germany: Students as change agents

The COVID‐19 pandemic has reinforced Germany's role as global health player, but the education system is lagging behind and does not adequately prepare health professionals for the new challenges. This study aims to strengthen global health in undergraduate medical education in Germany. Major objectives include: to review the current situation, explore changing demand for global health and introduce innovative teaching models and the drivers for change. Mixed methods and an explorative approach were applied, comprising a scoping review, online surveys carried out at Hanover Medical School, March/April 2020. Target groups were undergraduate medical students (n = 384) and additionally lecturers (n = 172), and finally new multiprofessional teaching courses initiated by students and developed collaboratively. The results reveal only slow pace of change on the level of the education system, while demand for global health education has increased markedly in all actor groups, but strongest in the group of students in the preclinical phase. Implementation of global health programmes illustrates how students can become change agents and enhance institutional innovation bottom‐up. However, in order to achieve wider transformative potential, these efforts must be flanked by macro‐level policy changes and integrated in future pandemic preparedness strategies.

Biodiversity and Human Health Interlinkages in Higher Education Offerings: A First Global Overview

Introduction: Biodiversity is inextricably linked to human health. As an important area of research of the Convention on Biological Diversity and a key avenue for the dissemination of biodiversity and health knowledge, we investigated how well-embedded biodiversity and health interlinkages are in institutional higher education offerings.

Methods: Using One Health education programs as a starting point, we collected a global list of institutions potentially carrying out education in the links between biodiversity and health through previously published research, academic partners of global conglomerates, and our own networks. We then analyzed the offerings from these institutions to determine the degree of integration of biodiversity and health interlinkages.

Results: We found 105 educational offerings in biodiversity and health interlinkages from 89 institutions in 30 countries. These were primarily found in faculties of public health, veterinary sciences, and medicine, with varying degrees of coverage of the interlinkages.

Conclusion: Education incorporating the links between biodiversity and health exists globally, but should be more widely integrated, particularly through inter-faculty and inter-institutional collaboration.

Preparing for Emerging Zoonotic Viruses

The risk of emergence and spread of novel human pathogens originating from an animal reservoir has increased in the past decades. However, the unpredictable nature of disease emergence makes surveillance and preparedness challenging. Knowledge of general risk factors for emergence and spread, combined with local level data is needed to develop a risk-based methodology for early detection. This involves the implementation of the One Health approach, integrating human, animal and environmental health sectors, as well as social sciences, bioinformatics and more. Recent technical advances, such as metagenomic sequencing, will aid the rapid detection of novel pathogens on the human-animal interface.

Developing a Global One Health Workforce: The "Rx One Health Summer Institute" Approach

The One Health approach has gained support across a range of disciplines; however, training opportunities for professionals seeking to operationalize the interdisciplinary approach are limited. Academic institutions, through the development of high-quality, experiential training programs that focus on the application of professional competencies, can increase accessibility to One Health education. The Rx One Health Summer Institute, jointly led by US and East African partners, provides a model for such a program. In 2017, 21 participants representing five countries completed the Rx One Health program in East Africa. Participants worked collaboratively with communities neighboring wildlife areas to better understand issues impacting human and animal health and welfare, livelihoods, and conservation. One Health topics were explored through community engagement and role-playing exercises, field-based health surveillance activities, laboratories, and discussions with local experts. Educational assessments reflected improvements in participants' ability to apply the One Health approach to health and disease problem solving, as well as anticipate cross-sectoral challenges to its implementation. The experiential learning method, specifically the opportunity to engage with local communities, proved to be impactful on participants' cultural awareness. The Rx One Health Summer Institute training model may provide an effective and implementable strategy by which to contribute to the development of a global One Health workforce.

Clonal Spread of Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae Between Companion Animals and Humans in South Korea

Extended-spectrum cephalosporin (ESC)-resistant Enterobacteriaceae is an increasingly important problem in both human and veterinary medicine. The aims of this study were to describe a comparative molecular characterization of Enterobacteriaceae carrying ESC resistance genes, encoding extended-spectrum β-lactamase (ESBL) and AmpC, isolated from human stool samples, rectal swabs from companion animals, and swabs from the environment of veterinarian hospitals in South Korea, and to examine their possible dissemination and transmission. The ESC resistance genes were identified by PCR and sequencing. Isolates with the predominant ESC resistance genes were assessed for their genetic relatedness by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. A total of 195 Escherichia coli and 41 Klebsiella pneumoniae isolates that exhibited ESC resistance were recovered on CHROMagar ESBL from human, companion animal, and the veterinary hospital environmental samples. In companion animals, most of the ESC resistance genes were bla_{CMY–2–like} (26.4%), followed by bla_{CTX –M–55} (17.2%) and bla_CTX–M–14 (16.1%), whereas bla_CTX–M–15 (28.6%) was predominant in human samples. The epidemiological relatedness of isolates carrying ESC resistance genes, including 124 E. coli and 23 K. pneumoniae isolates carrying CMY-2-like, DHA-1-like, or/and CTX-M-type, were analyzed by PFGE. The pulsotypes of five E. coli isolates (three from dogs and two from humans) carrying bla_{CMY–2–like}, which were attributed to sequence type 405, from different veterinary clinics showed >85% similarity. Our results indicate direct transmission and dissemination of ESC-resistant Enterobacteriaceae between humans and companion animals.

Prevalence of Integrons and Insertion Sequences in ESBL-Producing E. coli Isolated from Different Sources in Navarra, Spain

Mobile genetic elements play an important role in the dissemination of antibiotic resistant bacteria among human and environmental sources. Therefore, the aim of this study was to determine the occurrence and patterns of integrons and insertion sequences of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolated from different sources in Navarra, northern Spain. A total of 150 isolates coming from food products, farms and feeds, aquatic environments, and humans (healthy people and hospital inpatients), were analyzed. PCRs were applied for the study of class 1, 2, and 3 integrons (intI1, intI2, and intI3), as well as for the determination of insertion sequences (IS26, ISEcp1, ISCR1, and IS903). Results show the wide presence and dissemination of intI1 (92%), while intI3 was not detected. It is remarkable, the prevalence of intI2 among food isolates, as well as the co-existence of class 1 and class 2 (8% of isolates). The majority of isolates have two or three IS elements, with the most common being IS26 (99.4%). The genetic pattern IS26⁻ISEcp1 (related with the pathogen clone ST131) was present in the 22% of isolates (including human isolates). In addition, the combination ISEcp1⁻IS26⁻IS903⁻ISCR1 was detected in 11 isolates being, to our knowledge, the first study that describes this genetic complex. Due to the wide variability observed, no relationship was determined among these mobile genetic elements and β-lactam resistance. More investigations regarding the genetic composition of these elements are needed to understand the role of multiple types of integrons and insertion sequences on the dissemination of antimicrobial resistance genes among different environments.

A One Health Evaluation of the University of Copenhagen Research Centre for Control of Antibiotic Resistance

We applied the evaluation framework developed by the EU COST Action "Network of Evaluation of One Health" (NEOH) to assess the operations, supporting infrastructures and outcomes of a research consortium "University of Copenhagen Research Centre for Control of Antibiotic Resistance" (UC-CARE). This 4-year research project was a One Health (OH) initiative with participants from 14 departments over four faculties as well as stakeholders from industry and health authorities aiming to produce new knowledge to reduce the development of antimicrobial resistance (AMR). This was a case study focusing on assessing beneficial and counter-productive characteristics that could affect the OH outcomes. The study was also used to provide feedback to NEOH about the evaluation framework. The framework and evaluation tools are described in the introduction paper of this special journal issue. Data for the evaluation were extracted from the funding research proposal, the mid-term UC-CARE project evaluation report and supplemented with opinions elicited from project participants and stakeholders. Here, we describe the underlying system, theory of change behind the initiative and adapted questions from the NEOH tools that we used for semi-open interviews with consortium members throughout the evaluation process. An online survey was used to obtain information from stakeholders. The NEOH evaluation tools were then used for the qualitative and quantitative evaluation of the OH characteristics of UC-CARE. Senior UC-CARE researchers were interested and willing to be interviewed. Young scientists were more difficult to engage in interviews, and only 25% of stakeholders answered the online survey. Interviewees mentioned that the main benefit of UC-CARE was an increased awareness and general understanding of AMR issues. All interviewees stated that the adopted OH approach was relevant given the complexity of AMR. However, some questioned the applicability, and identified potentially counter-productive issues mainly related to the information sharing, collaboration and working methods across the consortium. A more integrated project organization, more stakeholder involvement and time for the project, flexibility in planning and a dedicated OH coordinator were suggested to allow for more knowledge exchange, potentially leading to a higher societal impact.

ESBL-producing Escherichia coli and Its Rapid Rise among Healthy People

Since around the 2000s, Escherichia coli (E. coli) resistant to both oxyimino-cephalosporins and fluoroquinolones has remarkably increased worldwide in clinical settings. The kind of E. coli is also identified in patients suffering from community-onset infectious diseases such as urinary tract infections. Moreover, recoveries of multi-drug resistant E. coli from the feces of healthy people have been increasingly documented in recent years, although the actual state remains uncertain. These E. coli isolates usually produce extended-spectrum β-lactamase (ESBL), as well as acquisition of amino acid substitutions in the quinolone-resistance determining regions (QRDRs) of GyrA and/or ParC, together with plasmid-mediated quinolone resistance determinants such as Qnr, AAC(6')-Ib-cr, and QepA. The actual state of ESBL-producing E. coli in hospitalized patients has been carefully investigated in many countries, while that in healthy people still remains uncertain, although high fecal carriage rates of ESBL producers in healthy people have been reported especially in Asian and South American countries. The issues regarding the ESBL producers have become very complicated and chaotic due to rapid increase of both ESBL variants and plasmids mediating ESBL genes, together with the emergence of various "epidemic strains" or "international clones" of E. coli and Klebsiella pneumoniae harboring transferable-plasmids carrying multiple antimicrobial resistance genes. Thus, the current state of ESBL producers outside hospital settings was overviewed together with the relation among those recovered from livestock, foods, pets, environments and wildlife from the viewpoint of molecular epidemiology. This mini review may contribute to better understanding about ESBL producers among people who are not familiar with the antimicrobial resistance (AMR) threatening rising globally.

Integron Digestive Carriage in Human and Cattle: A "One Health" Cultivation-Independent Approach

Objectives: Dissemination of antimicrobial resistance (AMR) is a global issue that requires the adoption of a "One-Health" approach promoting integration of human and animal health. Besides culture-dependent techniques frequently used for AMR surveillance, cultivation-independent methods can give additional insights into the diversity and reservoir of AMR genetic determinants. Integrons are molecular markers that can provide overall and reliable estimation of AMR dissemination. In this study, considering the "One-Health" approach, we have analyzed the integron digestive carriage from stools of humans and cattle living in a same area and exposed to different antibiotic selection pressures. Methods: Three collections of human [general population (GP) and intensive care unit patients (ICUs)] and bovine (BOV) stool samples were analyzed. The three main classes of integrons were detected using a multiplex qPCR both from total DNA extracted from stools, and from Gram-negative bacteria obtained by culture after an enrichment step. Results: With the cultivation-independent approach, integron carriage was 43.8, 52.7, and 65.6% for GP, ICU, and BOV respectively, percentages being at least twofold higher to those obtained with the cultivation-dependent approach. Class 1 integrons were the most prevalent; class 2 integrons seemed more associated to cattle than to humans; no class 3 integron was detected. The integron carriage was not significantly different between GP and ICU populations according to the antibiotic consumption, whatever the approach. Conclusion: The cultivation-independent approach constitutes a complementary exploratory method to investigate the integron digestive carriage of humans and bovines, notably within subjects under antibiotic treatment. The high frequency of carriage of integrons in the gut is of clinical significance, integrons being able to easily acquire and exchange resistant genes under antibiotic selective pressure and so leading to the dissemination of resistant bacteria.