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

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries.

BACKGROUND: Escalation in the global rates of labour interventions, particularly cesarean section and oxytocin augmentation, has renewed interest in a better understanding of natural labour progression. Methodological advancements in statistical and computational techniques addressing the limitations of pioneer studies have led to novel findings and triggered a re-evaluation of current labour practices. As part of the World Health Organization's Better Outcomes in Labour Difficulty (BOLD) project, which aimed to develop a new labour monitoring-to-action tool, we examined the patterns of labour progression as depicted by cervical dilatation over time in a cohort of women in Nigeria and Uganda who gave birth vaginally following a spontaneous labour onset. METHODS AND FINDINGS: This was a prospective, multicentre, cohort study of 5,606 women with singleton, vertex, term gestation who presented at ≤ 6 cm of cervical dilatation following a spontaneous labour onset that resulted in a vaginal birth with no adverse birth outcomes in 13 hospitals across Nigeria and Uganda. We independently applied survival analysis and multistate Markov models to estimate the duration of labour centimetre by centimetre until 10 cm and the cumulative duration of labour from the cervical dilatation at admission through 10 cm. Multistate Markov and nonlinear mixed models were separately used to construct average labour curves. All analyses were conducted according to three parity groups: parity = 0 (n = 2,166), parity = 1 (n = 1,488), and parity = 2+ (n = 1,952). We performed sensitivity analyses to assess the impact of oxytocin augmentation on labour progression by re-examining the progression patterns after excluding women with augmented labours. Labour was augmented with oxytocin in 40% of nulliparous and 28% of multiparous women. The median time to advance by 1 cm exceeded 1 hour until 5 cm was reached in both nulliparous and multiparous women. Based on a 95th percentile threshold, nulliparous women may take up to 7 hours to progress from 4 to 5 cm and over 3 hours to progress from 5 to 6 cm. Median cumulative duration of labour indicates that nulliparous women admitted at 4 cm, 5 cm, and 6 cm reached 10 cm within an expected time frame if the dilatation rate was ≥ 1 cm/hour, but their corresponding 95th percentiles show that labour could last up to 14, 11, and 9 hours, respectively. Substantial differences exist between actual plots of labour progression of individual women and the 'average labour curves' derived from study population-level data. Exclusion of women with augmented labours from the study population resulted in slightly faster labour progression patterns. CONCLUSIONS: Cervical dilatation during labour in the slowest-yet-normal women can progress more slowly than the widely accepted benchmark of 1 cm/hour, irrespective of parity. Interventions to expedite labour to conform to a cervical dilatation threshold of 1 cm/hour may be inappropriate, especially when applied before 5 cm in nulliparous and multiparous women. Averaged labour curves may not truly reflect the variability associated with labour progression, and their use for decision-making in labour management should be de-emphasized

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

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Experimental development of predictive models for quantification of total volatile organic compounds (TVOCs) from the points of sales of petroleum products in fueling stations

In many developing nations, heavy reliance on petroleum products for power generation and transportation stems from limited access to sustainable energy sources and inadequate electricity supply. This research aims to experimentally develop predictive models for quantification of total volatile organic compounds (TVOCs) from the dispensing processes of the selected petroleum products: petrol, kerosene, and diesel. A lab-scale fueling station was fabricated with five selected siphon pumps of different flowrates. These with a view to investigating the effect of fuel flowrates on TVOCs emission released near the nozzle gun and the vehicle tanks/portable container openings with varying effective cross-sectional areas (CSAs). The results revealed that petrol emits the highest concentrations of TVOCs emissions among the fuels due to its high volatility. At the highest flowrate of 0.33 L/s and the smallest effective CSA (1.59 × 10−4 m2) of the receiving tank/container openings, the highest concentrations (89, 57, and 45 ppm) of petrol, kerosene, and diesel were released, respectively. When the fuel flowrate was reduced to 0.20 L/s with the same effective CSA, the TVOCs emissions decreased to 53, 37, and 29 ppm for each fuel respectively. Additionally, the lowest TVOCs emission concentration of 5 ppm was observed at the slowest diesel fill rate of 0.05 L/s with the largest effective CSA of the tank/container opening that would make the TVOCs emission concentrations above the standard 0.5 ppm recommended by TECAM. The results also showed that emission fluxes of TVOCs increase when the effective CSA of the tank/container opening is reduced. The highest TVOCs emission flux (5.6 ×105ppm/m2) was recorded from the receiving tank/container opening with the smallest effective CSA of 1.59 × 10−4m2. It was discovered in the study that at high flow rates and smaller effective cross-sectional areas of tank/container openings, there are increase in TVOCs emissions and fluxes. Predictive models. Equations (2)–(4), were developed from the results with the use of Minitab and MATLAB software for predicting, estimating emission inventory and controlling of TVOCs emissions at the points of sales of fueling stations by regulatory bodies

The effect of an educational intervention programme on reproductive health: decision-making among couples in south west Nigeria

Context: Decision making process in reproductive health in Sub-Saharan Africa is a complex activity dictated by the customs, religious beliefs, socio-economic factors, and cultural innovations. The central role played by men in this process gives a strong justification for health education intervention with a primary focus on men. Objective: To find out how educational intervention programme will influence reproductive health decision making among couples. Study Design: This is a quasi-experimental study among couples in 3 towns in Osun State (Ode-Omu, Ejigbo and Otan-Ayegbaju) of Nigeria. Ode-Omu and Ejigbo served as the intervention towns while Otan-Ayegbaju served as the control. The study had 3 phases: baseline survey lasting 3 months, intervention phase of 12 months and postintervention period of 3 months. Interventions: Imparting information and educating members of the community on issues related to reproductive health with emphasis on the role of men using posters, handbills, public lectures, workshops and films. Main Outcome Measures: Decision making on and timing of pregnancy, seeking of post-abortion care, and husbands' support of wives during pregnancy. Results: After the intervention, more couples took joint decisions on timing of pregnancies; more husbands supported their wives during pregnancy and seeking of post-abortion care increased significantly in the intervention towns. Conclusion: Enlightenment of men is a faster and effective short-term measure to improve women's utilization of reproductive health resources. Keywords: men's role, reproductive health, decision-making Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 4-

Economic potentials of pyro bio-oil production from sawdust generated by southwest, Nigeria - A simulation-based approach

In this research, the pyrolysis of wood sawdust to obtain bio-oil was investigated as a viable solution to the waste management of wood sawdust in southwestern Nigeria. This is also with a view to mitigating the erratic state of power supply. Bio-oil, a component that could be obtained from the pyrolysis of biomass, can serve as source of bio-chemicals and fuels to produce electricity. An Aspen plus simulation software, V11 of 2019 involving a four-stage process was developed: pyrolysis, cyclone separation of char, condensation of bio-oil and separation of bio-oil. The material and energy flow across the process were accounted for, all the key process equipment were sized and a detailed economics of the process was estimated. From the results of the simulation, a production rate of 0.124 tons of bio-oil was achieved per ton of wood sawdust. The estimated payback period posed as a major factor in determining the sales price of bio-oil and securing the attention of the would-be investors was determined. The price of the producible bio-oil varied widely between $9.90/kg and$4.65/kg for payback period between 2 and 6 years. This study revealed that proper harnessing of this process of pyrolyzing wood sawdust has the potential of generating $305,595.37 yearly in Southwest, Nigeria alone. Also, an electricity generation capacity of 131,233.75 kWh per year is possible

Structural and properties evolution of copper–nickel (Cu–Ni) alloys: a review of the effects of alloying materials

Copper–nickel alloy has the potential in sustaining the recent demands in advanced marine engineering applications. It has been found advantageous over other copper alloys due to the unique properties and corrosion resistance they possess. However, the structure of Cu–Ni alloy alone is not sufficient to withstand many applications, as the structure cannot perform efficiently in an aggressive environment. The performance of this alloy inherently depends on carefully select alloying compositions, as the alloying elements are associated with the precipitation of intermetallic particles that will enhance mechanical properties and corrosion resistance when designing the component of Cu–Ni alloys. A combination of alloying elements has been conceptualized in the designing of copper–nickel alloy. This review described the role of alloying elements in modifying the microstructural features through phase transformation and how it affects the improvement of the mechanical and physical properties of Cu–Ni based alloys. The effect of alloying elements on the structure and properties of Cu–Ni alloys have been critically summarized based on surveying the works done by authors on this category of structural modification binary Cu–Ni alloy

Squeeze Casting Process: Trends and Opportunities

This chapter introduces the importance of casting process, particularly in ferrous foundries. It opens with a high level functional classification of casting processes, with focus on squeeze casting, and its application in the design of metal matrix composites. To lay a suitable foundation on the subject, detailed discussions on the process parameters, process sequence, cost effectiveness, factors governing the selection of the process, associated casting defects, merits and demerits of the process are included. Special emphasis is given to discussions on the casting defects remedial measures and casting quality, types of squeeze casting processes, differences between them, area of application and components that can be manufactured using squeeze casting. The chapter closes with a brief discussion on the future trends and opportunities for improving the squeeze casting process