Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Influência da largura de banda de formantes na qualidade vocal Formant bandwidth influences in voice quality

OBJETIVO: investigar os valores da largura de banda dos três primeiros formantes (B1, B2 e B3) e sua correlação com a análise perceptivo-auditiva da qualidade vocal das emissões orais de indivíduos disfônicos e comparar com o grupo controle. MÉTODOS: o grupo estudado foi representado por amostras de voz e julgamentos perceptivo-auditivos da qualidade vocal do banco de dados do Laboratório Integrado de Análise Acústica e Cognição (LIAAC-PUCSP) de 17 indivíduos do sexo feminino, com idades variadas entre 30 e 65 anos, todos com diagnóstico de disfonia, cujas amostras foram anteriomente exploradas quanto à freqüência dos formantes e 5 indivíduos do sexo feminino sem diagnóstico de alterações vocais (grupo controle). Os resultados foram considerados de forma qualitativa e quantitativa por meio dos testes Qui-quadrado e correlacionados aos dados da análise perceptivo-auditiva. RESULTADOS: os ajustes da qualidade vocal que revelaram influência nos valores das medidas de banda de formantes no grupo estudado foram a nasalidade, escape de ar, ajuste de faringe (constrição-expansão), altura de língua (alta-baixa) e também a aperiodicidade, característica de ajustes com vocal fry, voz crepitante e voz soprosa. As medidas de B1 e B2 mostraram diferenças significativas em ambas as repetições (gata 1 e 2) com respectivos valores de B1 p-valor= 0,023 e B2 p-valor= 0,000 (para gata 1) e B1 p-valor= 0,064 (para gata 2). CONCLUSÃO: os valores de B1 e B2 revelaram diferenças estatisticamente significantes entre o grupo estudado portador de disfonia por alteração glótica e grupo controle.PURPOSE: to investigate the first three forms of bandwidth values (B1, B2 and B3) and their correlation with auditory perception analysis of oral output for dysphonic individuals and compare them with a control group. METHODS: the studied group was represented by a voice sample and auditory quality perception judgment from the data bank of the Integrated Laboratory for Analysis of Acoustics and Cognition (LIAAC-PUCSP), the sample being 17 individuals, all female, of various ages between 30 and 65-old, all had been diagnosed with dysphonia. Samples were previously examined as for the frequency of group members and 5 other individuals (female) not having diagnosed any vocal alterations (CONTROL GROUP). The results were considered in a qualitative and quantitative manner by means of Qui-square tests and correlated to the auditory perception analysis data. RESULTS: the variations in vocal quality reveal an influence on the average band values of the study group members were: nasality, air escape, pharynx movement (contraction and expansion), tongue height (high-low) and also from time to time, vocal characteristic of adjustments with fry, crepitant voice and whispery voice. The B1 and B2 measurements demonstrate significant differences in both repetitions (gata 1 and 2) with respective values of B1 p-value=0.023 and B2 p-value=0.000 (for gata 1) and B1 p-value=0.064 (for gata 2). CONCLUSION: the B1 and B2 values reveal significant statistical differences between the study group members having dysphonia as a result of glotic alteration and the control group

Influence of the gonads and/or of LHRH analogue on gonadotropic function in testosterone-treated or untreated juvenile rainbow trout

International audienceThe influence of the gonads and/or of LHRH on gonadotropic function, and possibly on gonadal development, was studied in juvenile rainbow trout treated with low doses of testosterone or untreated. Whatever the treatment, all fish of both sexes remained sexually immature, although large individual variations in plasma GTH were observed in all experimental and control groups. This dispersion in the individual values of plasma GTH seemed to be the first sign of an increase in the previously low gonadotropic activity and might announce the beginning of a pubertal period several months before the onset of meiosis in males and of vitellogenesis in females. Castration did not change the plasma and pituitary GTH values, suggesting that control of the gonadotropic function did not depend mainly on sexual steroids during this period. In our experimental conditions, LHRH administration did not lead to any change in plasma or pituitary levels of GTH. Only the testosterone treatment (20 μg) had an effect, causing a higher pituitary GTH load in some fish which was not modified either by castration or by LHRH and decreased with time ; neither of these treatments changed the plasma GTH levels. Thus, the fact that the required amount of GTH was not released to initiate early onset of gametogenesis did not seem to be due to a repressive control by the gonads or to the absence of stimulation by an LHRH-like hypothalamic factor. The quantity of GTH accumulated in the pituitary gland and the dose of steroid used have been discussed

Influence of testosterone on precocious sexual development in immature rainbow trout

The influence of testosterone on plasma and pituitary levels of gonadotrophin (GTH) as well as on gonadal development was studied in immature rainbow trout. Among the animals receiving a testosterone-cocoa butter implant (200 μg) at the age of 5 months, gonadal puberty occurred 8 months later in half of the males (opposite to the controls which remained immature) and the beginning of oocyte maturation was observed in only one female. These animals were characterized by a higher pituitary GTH level. Owing to the multivariate statistical analyses made, it was possible to provide evidence for the presence of two populations with different reactions to the same steroid treatment. They also confirmed the existence of a positive testosterone feedback, in the male, leading to a precocious gonadal development. The pituitary GTH load obtained with 200 μg of testosterone seemed to be related to the age at first maturation. The secretion of an appropriate level of GTH resulting in the stimulation of gametogenesis required the availability of a relatively large pituitary GTH level and seemed to be possible because the animals were already in the pubertal period. The fact that the highest pituitary GTH level of the treated lot was found in the only female showing a beginning of sexual maturation suggests that testosterone may also act in females

Análise bibliométrica da produção sobre prazer e sofrimento no trabalho nos encontros da Associação Nacional de Pós-Graduação em Administração (2000-2010)

This article aims to identify and analyze the scientific production in the field of management with regard to studies that address the theme of pleasure and pain. We selected the items found in CD-ROMs related to the meetings of the National Association of Graduate Business Administration (EnANPAD) in the period 2000 to 2010, a total of 7,962 studies, considering all the academic divisions of that meeting. Out of the total of articles submitted, only 26 set out to address the issue of pleasure and pain at work, published in the annals of the academic divisions Relations Personnel Management and Labor (20), Organizational Studies (4) and the Teaching and Research Administration and Accounting (2) showing an expected distribution of the subject location. The sample was chosen intentionally, for the studies focus on pleasure and pain, what was clearly stated in the articles. The analysis was based on the following variables: science content, most cited authors and the conclusions of the studies analyzed. It was observed that the experiences of pleasure are connected to issues such as recoganition, flexibility, and power challenges. On the other hand, the experiences of suffering are linked to issues such as organizational context, interpersonal relations and rigidity of rules and standards organizations. At the end of this work, it can be concluded that the feeling of pleasure and pain is related to a hybrid combination of factors that depending on the subjectivity of the subject can become a pathology.Este artigo se propõe identificar e analisar a produção científica no campo da Administração no que diz respeito aos estudos que abordam a temática de prazer e sofrimento. Foram selecionados os artigos encontrados nos CD-ROMS referentes aos Encontros da Associação Nacional de Pós-Graduação em Administração (EnANPAD) no período de 2000 a 2010, o que perfaz um total de 7.962 trabalhos, considerando todas as divisões acadêmicas dos referidos encontros. Desse total de artigos apresentados, apenas 26 artigos se propuseram abordar o tema prazer e sofrimento no trabalho, publicados nos anais das divisões acadêmicas de Gestão de Pessoas e Relações de Trabalho (20), Estudos Organizacionais (4) e Ensino e Pesquisa em Administração e Contabilidade (2), e mostraram uma distribuição esperada quanto à localização temática. A amostra analisada foi escolhida intencionalmente, ao focar os estudos sobre prazer e sofrimento, explicitamente declarados nos artigos. A análise teve como base as seguintes variáveis: conteúdo científico, autores mais citados e conclusões dos estudos analisados. Observou-se que as vivências de prazer estão ligadas a questões como reconhecimento, flexibilização, desafios e poder. Já as vivências de sofrimento estão atreladas a questões como o contexto organizacional, as relações interpessoais e a rigidez das normas e regras das organizações. Ao final deste trabalho, pôde-se concluir que os sentimentos de prazer e de sofrimento estão relacionados a um conjunto híbrido de fatores que, dependendo da subjetividade dos sujeitos, podem transformar-se em uma patologia.Este artículo se propone identificar y analizar la producción científica en el campo de la Administración en lo que respecta a los estudios que abordan la temática del placer y el sufrimiento. Fueron seleccionados los artículos encontrados en los CD-ROMS referentes a los Encuentros de la Asociación Nacional de Posgrado en Administración (EnANPAD) en el período de 2000 a 2010, lo que totaliza 7.962 trabajos, considerando todas las divisiones académicas de los referidos encuentros. De ese total de artículos presentados, solamente 26 artículos se propusieron abordar el tema placer y sufrimiento en el trabajo, publicados en los anales de las divisiones académicas de Gestión de Personas y Relaciones de Trabajo (20), Estudios Organizacionales (4) y Enseñanza e Investigación en Administración y Contabilidad (2), y mostraron una distribución esperada en relación a la localización temática. La muestra analizada fue escogida intencionalmente, al focalizar los estudios sobre placer y sufrimiento, explícitamente declarados en los artículos. El análisis tuvo como base las siguientes variables: contenido científico, autores más citados y conclusiones de los estudios analizados. Se observó que las vivencias de placer están relacionadas a cuestiones como reconocimiento, flexibilización, desafíos y poder. Ya las vivencias de sufrimiento están relacionadas a cuestiones como el contexto organizacional, las relaciones interpersonales y la rigidez de las normas y reglas de las organizaciones. Al final de este trabajo, se pudo concluir que los sentimientos de placer y de sufrimiento están relacionados a un conjunto híbrido de factores que, dependiendo de la subjetividad de los sujetos, pueden transformarse en una patología

Análise bibliométrica da produção sobre prazer e sofrimento no trabalho nos encontros da Associação Nacional de Pós-Graduação em Administração (2000-2010)

Este artigo se propõe identificar e analisar a produção científica no campo da Administração no que diz respeito aos estudos que abordam a temática de prazer e sofrimento. Foram selecionados os artigos encontrados nos CD-ROMS referentes aos Encontros da Associação Nacional de Pós-Graduação em Administração (EnANPAD) no período de 2000 a 2010, o que perfaz um total de 7.962 trabalhos, considerando todas as divisões acadêmicas dos referidos encontros. Desse total de artigos apresentados, apenas 26 artigos se propuseram abordar o tema prazer e sofrimento no trabalho, publicados nos anais das divisões acadêmicas de Gestão de Pessoas e Relações de Trabalho (20), Estudos Organizacionais (4) e Ensino e Pesquisa em Administração e Contabilidade (2), e mostraram uma distribuição esperada quanto à localização temática. A amostra analisada foi escolhida intencionalmente, ao focar os estudos sobre prazer e sofrimento, explicitamente declarados nos artigos. A análise teve como base as seguintes variáveis: conteúdo científico, autores mais citados e conclusões dos estudos analisados. Observou-se que as vivências de prazer estão ligadas a questões como reconhecimento, flexibilização, desafios e poder. Já as vivências de sofrimento estão atreladas a questões como o contexto organizacional, as relações interpessoais e a rigidez das normas e regras das organizações. Ao final deste trabalho, pôde-se concluir que os sentimentos de prazer e de sofrimento estão relacionados a um conjunto híbrido de fatores que, dependendo da subjetividade dos sujeitos, podem transformar-se em uma patologia

Análise bibliométrica da produção sobre prazer e sofrimento no trabalho nos encontros da Associação Nacional de Pós-Graduação em Administração (2000-2010) Análisis bibliométrica de la producción sobre placer y sufrimiento en el trabajo en los encuentros de la Asociación Nacional De Posgraduación En Administración (2000-2010) Bibliometric analysis of the literature about pleasure and pain at work in the Ennanpad (2000-2010)

Este artigo se propõe identificar e analisar a produção científica no campo da Administração no que diz respeito aos estudos que abordam a temática de prazer e sofrimento. Foram selecionados os artigos encontrados nos CD-ROMS referentes aos Encontros da Associação Nacional de Pós-Graduação em Administração (EnANPAD) no período de 2000 a 2010, o que perfaz um total de 7.962 trabalhos, considerando todas as divisões acadêmicas dos referidos encontros. Desse total de artigos apresentados, apenas 26 artigos se propuseram abordar o tema prazer e sofrimento no trabalho, publicados nos anais das divisões acadêmicas de Gestão de Pessoas e Relações de Trabalho (20), Estudos Organizacionais (4) e Ensino e Pesquisa em Administração e Contabilidade (2), e mostraram uma distribuição esperada quanto à localização temática. A amostra analisada foi escolhida intencionalmente, ao focar os estudos sobre prazer e sofrimento, explicitamente declarados nos artigos. A análise teve como base as seguintes variáveis: conteúdo científico, autores mais citados e conclusões dos estudos analisados. Observou-se que as vivências de prazer estão ligadas a questões como reconhecimento, flexibilização, desafios e poder. Já as vivências de sofrimento estão atreladas a questões como o contexto organizacional, as relações interpessoais e a rigidez das normas e regras das organizações. Ao final deste trabalho, pôde-se concluir que os sentimentos de prazer e de sofrimento estão relacionados a um conjunto híbrido de fatores que, dependendo da subjetividade dos sujeitos, podem transformar-se em uma patologia.Este artículo se propone identificar y analizar la producción científica en el campo de la Administración en lo que respecta a los estudios que abordan la temática del placer y el sufrimiento. Fueron seleccionados los artículos encontrados en los CD-ROMS referentes a los Encuentros de la Asociación Nacional de Posgrado en Administración (EnANPAD) en el período de 2000 a 2010, lo que totaliza 7.962 trabajos, considerando todas las divisiones académicas de los referidos encuentros. De ese total de artículos presentados, solamente 26 artículos se propusieron abordar el tema placer y sufrimiento en el trabajo, publicados en los anales de las divisiones académicas de Gestión de Personas y Relaciones de Trabajo (20), Estudios Organizacionales (4) y Enseñanza e Investigación en Administración y Contabilidad (2), y mostraron una distribución esperada en relación a la localización temática. La muestra analizada fue escogida intencionalmente, al focalizar los estudios sobre placer y sufrimiento, explícitamente declarados en los artículos. El análisis tuvo como base las siguientes variables: contenido científico, autores más citados y conclusiones de los estudios analizados. Se observó que las vivencias de placer están relacionadas a cuestiones como reconocimiento, flexibilización, desafíos y poder. Ya las vivencias de sufrimiento están relacionadas a cuestiones como el contexto organizacional, las relaciones interpersonales y la rigidez de las normas y reglas de las organizaciones. Al final de este trabajo, se pudo concluir que los sentimientos de placer y de sufrimiento están relacionados a un conjunto híbrido de factores que, dependiendo de la subjetividad de los sujetos, pueden transformarse en una patología.This article aims to identify and analyze the scientific production in the field of management with regard to studies that address the theme of pleasure and pain. We selected the items found in CD-ROMs related to the meetings of the National Association of Graduate Business Administration (EnANPAD) in the period 2000 to 2010, a total of 7,962 studies, considering all the academic divisions of that meeting. Out of the total of articles submitted, only 26 set out to address the issue of pleasure and pain at work, published in the annals of the academic divisions Relations Personnel Management and Labor (20), Organizational Studies (4) and the Teaching and Research Administration and Accounting (2) showing an expected distribution of the subject location. The sample was chosen intentionally, for the studies focus on pleasure and pain, what was clearly stated in the articles. The analysis was based on the following variables: science content, most cited authors and the conclusions of the studies analyzed. It was observed that the experiences of pleasure are connected to issues such as recoganition, flexibility, and power challenges. On the other hand, the experiences of suffering are linked to issues such as organizational context, interpersonal relations and rigidity of rules and standards organizations. At the end of this work, it can be concluded that the feeling of pleasure and pain is related to a hybrid combination of factors that depending on the subjectivity of the subject can become a pathology

Evaluation of the effective inactivation of enteric bacteria and viruses from swine effluent and sludge at tropical temperatures.

The safe recycling of organic wastes such as the nutrients obtained from agriculture activities is a relevant aspect of the ?One Health? strategy, a worldwide initiative including all aspects of health care for humans and animals, as well as aspects related to the conservation and development of the environment. It represents an important opportunity to mitigate the potential impact of microbial pathogens likely present in nutrient natural sources, as digestate, when applied to land as fertilizers. The objectives of the current study were to determine the inactivation of enteric microorganisms in swine digestate (effluent and sludge) during storage in anaerobic conditions and at different ambient temperatures of tropical zones (16, 22, and 37 ?C). Human adenovirus 2 (HAdV-2), bacteriophage PhiX-174, and Salmonella enterica serovar typhimurium (S. typhimurium) were used as enteric microbial models to determine the minimum storage time required to reduce at least 3log of enteric microorganisms load in both matrices at the mentioned temperatures. The minimum storage time required for S. typhimurium was shorter than those observed for viruses at 37 ?C, while reduction of at least 3log for S. typhimurium was observed after just 1 day; 20 and 90 days were needed for similar reductions for HAdV-2 and PhiX-174, respectively. Similar results were also observed at lower temperatures: 30 and 45 days were needed for S. typhimurium at 22 and 16 ?C, respectively, but 30 and 90 days were needed at 22 ?C for HAdV-2 PhiX-174, respectively, or 90 and 120 days at 16 ?C for HAdV-2 PhiX-174, respectively. This is a pioneering study on the evaluation of inactivation of enteric viruses in swine digestate in usual tropical ambient temperatures; it demonstrates that the time for a considerable inactivation is longer than that observed for a enteric microorganisms (S. typhimurium), and shows that the storage of swine digestate at the referred temperatures can be used as a low-cost post-treatment to inactivate enteric microorganisms, allowing a further use as safer fertilizer