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Background Antimicrobial resistance (AMR) is an international health concern caused by the inappropriate use of antibiotics. This study sought to evaluate the perceived drivers of AMR and strategies for controlling it, supporting the World Health Organization’s (WHO) and Ghana’s national action plan on AMR. Methods This cross-sectional study was conducted between July and August 2022 among 200 staff members in medicine sales outlets in the Greater Accra region using a two-stage clustering and simple random sampling method. They completed an interviewer-administered questionnaire. The study used the maximum difference model to determine the perceived drivers of AMR and strategies for controlling it. Results The results showed that 68.5% of respondents were male. Among them, 83% had 1 to 5 years of experience, with 47.5% working as pharmacists in pharmacy stores. Additionally, 39% had participated in a Pharmacy Council-sponsored antimicrobial dispensing training program. The model results revealed that Non-adherence to antimicrobial prescription was highly prioritized as a driver of AMR (Utility estimate (UE) = 0.579, 95% CI 0.496, 0.664), followed by client’s familiarity with the availability of a pharmacist at the medicine outlet who can offer advice (UE = 0.115, 95% CI 0.038, 0.192), unnecessary antimicrobial prescribing and dispensing (UE = 0.111, 95% CI 0.034, 0.189), as well as random prescription of antibiotics (UE = 0.095, 95% CI 0.018, 0.173). These drivers can be effectively controlled by following medicine outlets’ staff advice for prescribed antibiotics (UE = 0.280, 95% CI 0.189, 0.372), organizing awareness campaigns and educative sessions for medical professionals (UE: 0.224, 95% CI 0.133, 0.316) and conducting antibiotic sensitivity testing before prescribing antibiotics (UE: 0.151, 95% CI 0.060, 0.242). Conclusions This study offers quantitative information that can enhance the management of antimicrobial use and the implementation of strategies to control antimicrobial resistance, supporting the WHO’s and Ghana’s national action plan on AMR.

Purpose – The purpose of this paper is to compare prices for fresh tomatoes, potatoes, peppers, and apples at direct-to-consumer sales outlets (e.g. farmers markets, roadside stands, on-farm stores) in the USA to grocery stores and supercenters, while controlling for other attributes. Design/methodology/approach – The author estimates a hedonic regression model to determine price differences at direct sales outlets, grocery stores, and supercenters in various regions and seasons of the year. The analysis is conducted using 2006 Nielsen Homescan data. Other product and market attributes are also considered, along with characteristics of the household sample. Findings – Prices at direct sales outlets are lower than grocery store prices throughout the year and across the USA. Prices at direct sales outlets for some product/location/season combinations were higher than or comparable to supercenter prices. Research limitations/implications – Future research is needed to examine how price differences may vary across the various types of direct marketing outlets. Originality/value – Few studies have examined price differences between direct sales outlets and conventional retail stores. No studies have used nationally representative data to analyze these price differences across produce type, season, and geographic areas.

Regulations on the availability of alcohol have been used to moderate alcohol problems in communities throughout the world for thousands of years. In the latter half of the 20th century, quantitative studies of the effects of these regulations on drinking and related problems began in earnest as public health practitioners began to recognize the full extent of the harmful consequences related to drinking. This article briefly outlines the history of this work over four areas, focusing on the minimum legal drinking age, the privatization of alcohol control systems, outlet densities, and hours and days of sale. Some historical background is provided to emphasize the theoretical and empirical roots of this work and to highlight the substantial progress that has been made in each area. In general, this assessment suggests that higher minimum legal drinking ages, greater monopoly controls over alcohol sales, lower outlet numbers and reduced outlet densities, and limited hours and days of sale can effectively reduce alcohol sales, use, and problems. There are, however, substantial gaps in the research literature and a near absence of the quantitative theoretical work needed to direct alcohol-control efforts. Local community responses to alcohol policies are complex and heterogeneous, sometimes reinforcing and sometimes mitigating the effects of availability regulations. Quantitative models of policy effects are essential to accelerate progress toward the formulation and testing of optimal control strategies for the reduction of alcohol problems. [PUBLICATION ABSTRACT]

The objective of this study was to examine the associations between alcohol availability types and community characteristics in randomly selected census tracts in Southern California and Southeastern Louisiana. Outlet shelf space and price by beverage type was collected from all off-sale alcohol outlets in 189 census tracts by trained research personnel. Three aspects of alcohol availability at the census tract level were considered—outlets per roadway mile, shelf space, and least price by beverage type. Using multivariate analyses, we examined the associations between census tract socioeconomic and demographic characteristics and alcohol availability types. Fifteen measures of alcohol availability were calculated—total shelf space and shelf space by beverage types (beer, malt liquor, and distilled spirits); outlets per roadway mile, per tract, and per capita; and least price by beverage type (including wine). In multivariate analyses controlling for state, male unemployment rate was inversely associated with total shelf space ( p  = 0.03) and distilled spirit shelf space ( p  = 0.05). Malt liquor shelf space was inversely associated with percent White ( p  = 0.02). Outlets per roadway mile was positively associated with household poverty ( p  < 0.0001), whereas percent African American was inversely associated with outlets per roadway mile ( p  = 0.03). Beverage-specific least prices were not associated with any socioeconomic or demographic community characteristics. Alcohol availability types, but not least price, were associated with some community characteristics. More research exploring how alcohol availability types vary by community and their relationship to alcohol-related harms should be conducted.

Small scale producers in developing countries lack easy access to efficient logistics services. They are faced with long distances from both domestic and international markets. Unless they consolidate their trade volumes they face high costs which diminish their ability to trade. However, the process of consolidation is not without cost nor does it occur on its own accord. As a result, the consolidation is typically handled by intermediaries. Using case studies of sisal and soybean supply chains in Brazil and India respectively, this study explores the role and impact of intermediaries in facilitating trade in lagging regions. The study assesses the horizontal relationships between the small scale producers in thin markets and the vertical connections between different tiers of the same supply chain. The study analyzes the traditional approach to linking producers namely through cooperatives and itinerant traders and the relatively newer innovations using ICT. The study finds that farmers linked through the different mechanisms are more integrated to international supply chains or are able to better manage supply chains longer than would otherwise be the case. Intermediaries play several roles including providing transport services and facilitating market exchanges, payments, risk sharing and quality improvements. Generally, information technology driven innovations make it easier to integrate adjacent steps in the value chain. This report on logistics performance at the sub-national level is an on-going endeavour. Similar analysis is being carried out in some countries in Africa to identify the evolving role of intermediaries in low income regions. The results will be developed into a major publication on this topic, with recommendations on how development agencies, civil society and the private sector can improve the design of strategies to reduce logistics costs in low income areas.

The study of individual risk factors is inadequate to address the current public health challenges associated with HIV/AIDS. Rather, an ecological epidemiological study of HIV/AIDS is needed to address these challenges. A socioecological framework has been proposed for HIV/AIDS, including influences at the individual level, the interpersonal level, the neighborhood level, and the societal level. This framework provides the basis for a conceptual model with specific risk factors at each of these levels and cross-level associations. The nature of the associations also is important, in particular the assumption that the neighborhood alcohol environment exerts its effect on HIV risk through both direct and indirect pathways.

Alcohol availability and advertising are disproportionately concentrated in racial/ethnic minority communities. Although research on alcohol availability and alcohol advertising in racial/ethnic minority communities is limited, evidence does show a relationship between minority concentration, alcohol outlet density, and alcohol problems. This article reviews research showing that certain neighborhood characteristics, such as alcohol outlet density, can be stronger predictors of homicide and violence than are race or ethnicity.

Geographic factors, such as the location of alcohol outlets or of neighborhoods with different socioeconomic status within an area, can influence the patterns of alcohol use and alcohol-related problems in that area. Geographic information systems (GIS)--computer-based systems to capture, store, retrieve, analyze, and display spatial data--are increasingly used to investigate the effects of such geographic factors. GIS offer several key capabilities that facilitate alcohol-related geographic analyses, including geocoding (the linking of descriptive data, such as driving-while-intoxicated [DWI] events, to a location on a map), informative visual displays, and calculation of distance and adjacency. Using GIS-based data, researchers can perform complex spatial analyses of alcohol-related behaviors and problems, such as determining the correlation between DWI rates and geographic locations. These types of analyses may help investigators to understand environmental influences on alcohol-related problems and to plan and target appropriate prevention and intervention approaches.

Alcohol availability, measured in terms of geographic density of alcohol-sales outlets, is linked to specific patterns of alcohol-related motor vehicle crashes in communities. To curb alcohol-related problems such as violence, traffic crashes, and drinking and driving, community advocates often focus on reducing alcohol availability through modifications of zoning laws and licensing requirements. In developing interventions and policy activities to reduce alcohol availability, community policymakers should assess the effects of outlet density using an adequate community \"biogeography\" of the interrelationships among drinkers, their drinking environments, the locations of alcohol outlets, and the locations of alcohol problems. Communities also should consider that the economic development of downtown areas, which is often accompanied by the rapid growth of alcohol outlets, is likely to affect the incidence and prevalence of alcohol-related problems in surrounding areas.

The research question addressed in the present study, with ARIMA time-series analyses, was the extent to which changes in economic and physical availability had an effect on sales of alcohol in four Canadian provinces during the second half of the 20th century. The annual sales, by type of beverage (spirits, wine and beer) as well as total sales, measured in pure alcohol per inhabitant age 15 and above in each province, were used as dependent variables in the analyses. The inhabitants' real disposable income, the real price of alcohol, and the number of on- and off-premise outlets per 100,000 inhabitants were used as independent variables. All the time-series were differenced to remove long-term trends. The main study period was 1951–2000. In some of the analyses the study periods were shorter, primarily due to lack of data. Changes in economic availability in general, and in price in particular, had larger effects on sales than physical availability. Among the beverages analyzed in the study, the demand for spirits was most sensitive to changes in availability. Economic availability had a greater effect on sales than the number of outlets. However, one might question to what extent the number of outlets really is a feasible measure of transaction costs associated with purchases of alcohol.