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

Evaluación de una alternativa de atención nutricional grupal con enfoque de género y técnicas cognitivo-conductuales en los cantones de Alajuela y Goicoechea, en mujeres con exceso de peso con edad entre 18-60 años, en el año 2014

Seminario de graduación (licenciatura en nutrición)UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Nutrició

La opinión del personal docente en educación primaria sobre las actividades de desarrollo profesional que realiza y la influencia que tienen en su práctica pedagógica / The opinion of the teaching staff in primary education about the professional development activities they carry out and the influence they have on their pedagogical practice

El artículo presenta los resultados de un trabajo de investigación cuyo objetivo general fue analizar las actividades de desarrollo profesional en las que participa el personal docente de educación primaria y la influencia en la práctica pedagógica. Se aplicaron dos técnicas de investigación: el cuestionario y la entrevista; el primero dirigido a docentes en ejercicio, mientras que la entrevista se realizó a los encargados de desarrollo profesional de diferentes instituciones en Costa Rica. Los datos obtenidos revelan que existe un interés por parte del personal docente sobre su formación continua, tanto para su crecimiento personal como para el mejoramiento de su desempeño profesional. Por su parte, las instituciones encargadas de promover el desarrollo profesional realizan los esfuerzos necesarios para atender la demanda de los centros educativos y del personal docente en general. Estas instituciones cuentan con algunas limitaciones en cuanto a los recursos humanos y económicos. Finalmente, se concluye que es necesario implementar un programa de desarrollo profesional proveniente de un ente regulador, que coordine las instituciones encargadas de estas actividades, con el fin de que el proceso se realice regularmente y no de forma aislada. The article presents results about a research which general objective was to analyze professional development activities where teachers assist and its influence in their classroom practice, two techniques were applied: survey and interview, the first one was directed to elementary teachers, and the other one was directed to the persons in charge of professional development activities from different institutions of Costa Rica. The information reflects that there is an interest from teachers in their professional development, both for their personal development and also for their professional life. Professional Development institutions declared that they make an effort to attend schools demands and teachers in general. These institutions have limitations with their human and economic resources. Finally, the conclusion was that it is urgent to develop a professional development program that is organized by a regulation institution who coordinates all the institutions involved in this process, in order to unified efforts

LA OPINIÓN DEL PERSONAL DOCENTE EN EDUCACIÓN PRIMARIA SOBRE LAS ACTIVIDADES DE DESARROLLO PROFESIONAL QUE REALIZA Y LA INFLUENCIA QUE TIENEN EN SU PRÁCTICA PEDAGÓGICA

El artículo presenta los resultados de un trabajo de investigación cuyo objetivo general fue analizar las actividades de desarrollo profesional en las que participa el personal docente de educación primaria y la influencia en la práctica pedagógica. Se aplicaron dos técnicas de investigación: el cuestionario y la entrevista; el primero dirigido a docentes en ejercicio, mientras que la entrevista se realizó a los encargados de desarrollo profesional de diferentes instituciones en Costa Rica. Los datos obtenidos revelan que existe un interés por parte del personal docente sobre su formación continua, tanto para su crecimiento personal como para el mejoramiento de su desempeño profesional. Por su parte, las instituciones encargadas de promover el desarrollo profesional realizan los esfuerzos necesarios para atender la demanda de los centros educativos y del personal docente en general. Estas instituciones cuentan con algunas limitaciones en cuanto a los recursos humanos y económicos. Finalmente, se concluye que es necesario implementar un programa de desarrollo profesional proveniente de un ente regulador, que coordine las instituciones encargadas de estas actividades, con el fin de que el proceso se realice regularmente y no de forma aislada

La opinión del personal docente en educación primaria sobre las actividades de desarrollo profesional que realiza y la influencia que tienen en su práctica pedagógica / Elementary teacher`s opinion about professional development activities and its...

El artículo presenta los resultados de un trabajo de investigación cuyo objetivo general fue analizar las actividades de desarrollo profesional en las que participa el personal docente de educación primaria y la influencia en la práctica pedagógica. Se aplicaron dos técnicas de investigación: el cuestionario y la entrevista; el primero dirigido a docentes en ejercicio, mientras que la entrevista se realizó a los encargados de desarrollo profesional de diferentes instituciones en Costa Rica. Los datos obtenidos revelan que existe un interés por parte del personal docente sobre su formación continua, tanto para su crecimiento personal como para el mejoramiento de su desempeño profesional. Por su parte, las instituciones encargadas de promover el desarrollo profesional realizan los esfuerzos necesarios para atender la demanda de los centros educativos y del personal docente en general. Estas instituciones cuentan con algunas limitaciones en cuanto a los recursos humanos y económicos. Finalmente, se concluye que es necesario implementar un programa de desarrollo profesional proveniente de un ente regulador, que coordine las instituciones encargadas de estas actividades, con el fin de que el proceso se realice regularmente y no de forma aislada.   The article presents results about a research which general objective was to analyze professional development activities where teachers assist and its influence in their classroom practice, two techniques were applied: survey and interview, the first one was directed to elementary teachers, and the other one was directed to the persons in charge of professional development activities from different institutions of Costa Rica. The information reflects that there is an interest from teachers in their professional development, both for their personal development and also for their professional life. Professional Development institutions declared that they make an effort to attend schools demands and teachers in general. These institutions have limitations with their human and economic resources. Finally, the conclusion was that it is urgent to develop a professional development program that is organized by a regulation institution who coordinates all the institutions involved in this process, in order to unified efforts

Acampamento estudantil para a promoção de vocações científicas em STEM: Quimi Camp

[Objetivo] Desde el año 1988 y hasta el año 2018, el estudiantado de secundaria en Costa Rica debía aprobar un examen final para graduarse de la escuela secundaria, y ser elegible para una educación universitaria pública. En ese contexto, cada estudiante debía elegir una prueba nacional de ciencias entre las áreas de física, química y biología. Históricamente, la química fue la menos elegida (4-6 %), entre esas ciencias. Por otro lado, existe la necesidad –a nivel nacional– de aumentar el interés en las carreras relacionadas con STEM (sciences, technology, engineering and mathematics). [Metodología] Desde ambas premisas, en el año 2016 se realizó el primer campamento nacional de promoción de vocaciones científicas en Costa Rica (denominado Quimi Camp) para promover la química entre estudiantes de secundaria. Quimi Camp es un evento amparado en las Olimpiadas Nacionales de Química OLCOQUIM y en las Olimpiadas Nacionales de Ciencias OLCOCI; los cuales son, a su vez, organizados por las 5 universidades estatales costarricenses y el Laboratorio Nacional de Nanotecnología LANOTEC del Centro Nacional de Alta Tecnología CENAT, con la venia de los entes de gobierno. El estudiantado participante realizó la evaluación final de este evento. [Resultados] Los resultados mostraron una excelente percepción del evento en cuanto a su organización y contenido. [Conclusiones] Quimi Camp impulsó la vocación de estudiantes por las ciencias y la ingeniería e influyó positivamente en la selección de una carrera universitaria en STEM.[Objective] From 1988 to 2018, high school students in Costa Rica had to pass a final exam to graduate from high school and be eligible for public university education. In this context, students had to choose a national science test from the areas of physics, chemistry, and biology. Historically, chemistry was the least chosen (4-6 %) of those sciences. On the other hand, there is a need -at the national level- to increase interest in careers related to STEM (Sciences, technology, engineering, and mathematics). [Methodology] Under both premises, in 2016, the first national camp (called Quimi Camp) to promote scientific vocations was held to encourage high school students in Costa Rica to choose chemistry. Quimi Camp is an event supported by the OLCOQUIM National Chemistry Olympiad and the OLCOCI National Science Olympiad, which are in turn organized by the five Costa Rican State universities and the LANOTEC CENAT National Nanotechnology Laboratory at the National Center of High Technology, with the consent of the Ministry of Education (MEP) and the Ministry of Science, Innovation, Technology and Telecommunication (MICITT). The participating students made the final evaluation of this event. [Results] The results showed an excellent perception of the event regarding its organization and content. [Conclusions] Quimi Camp promoted students’ vocation for science and engineering and positively influenced the selection of a University Career in STEM.[Objetivo] De 1988 a 2018, os alunos do ensino médio na Costa Rica deviam passar em uma prova final para se formar no ensino médio e se qualificar para uma educação universitária pública. Nesse contexto, cada aluno tinha de escolher um teste nacional de ciências das áreas da física, química e biologia. Historicamente, a química foi a menos escolhida (4-6%), entre essas ciências. Por outro lado, existe a necessidade - em âmbito nacional - de aumentar o interesse por carreiras relacionadas com STEM (ciências, tecnologia, engenharia e matemática). [Metodologia] Sob ambas as premissas, em 2016 foi realizado o primeiro acampamento nacional de promoção de vocações científicas na Costa Rica (denominado Quimi Camp) para promover a química entre alunos do ensino médio. O Quimi Camp é um evento contemplado pelas Olimpíadas Nacionais de Química da OLCOQUIM e Olimpíadas Nacionais de Ciências da OLCOCI; que por sua vez são organizados pelas 5 universidades estaduais da Costa Rica e pelo Laboratório Nacional de Nanotecnologia LANOTEC do Centro Nacional de Alta Tecnologia CENAT, com a permissão das entidades governamentais. Os alunos participantes fizeram a avaliação final deste evento. [Resultados] Os resultados mostraram uma excelente percepção do evento em termos de organização e conteúdo. [Conclusões] O Quimi Camp impulsionou a vocação dos alunos para ciências e engenharias e influenciou positivamente a escolha de uma Carreira Universitária em STEM.Universidad Nacional, Costa RicaEscuela de Químic

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally