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

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.814.4 million) incident T2D cases, representing 70.3% (68.871.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.027.1%)), excess refined rice and wheat intake (24.6% (22.327.2%)) and excess processed meat intake (20.3% (18.323.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.487.7%)) and Latin America and the Caribbean (81.8% (80.183.4%)); and lowest proportional burdens were in South Asia (55.4% (52.160.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally. (c) 2023, The Author(s)

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the worlds child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 1519 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes. (c) 2023, The Author(s)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The global abundance of tree palms

Aim: Palms are an iconic, diverse and often abundant component of tropical ecosystems that provide many ecosystem services. Being monocots, tree palms are evolutionarily, morphologically and physiologically distinct from other trees, and these differences have important consequences for ecosystem services (e.g., carbon sequestration and storage) and in terms of responses to climate change. We quantified global patterns of tree palm relative abundance to help improve understanding of tropical forests and reduce uncertainty about these ecosystems under climate change. Location: Tropical and subtropical moist forests. Time period: Current. Major taxa studied: Palms (Arecaceae). Methods: We assembled a pantropical dataset of 2,548 forest plots (covering 1,191 ha) and quantified tree palm (i.e., ≥10 cm diameter at breast height) abundance relative to co‐occurring non‐palm trees. We compared the relative abundance of tree palms across biogeographical realms and tested for associations with palaeoclimate stability, current climate, edaphic conditions and metrics of forest structure. Results: On average, the relative abundance of tree palms was more than five times larger between Neotropical locations and other biogeographical realms. Tree palms were absent in most locations outside the Neotropics but present in >80% of Neotropical locations. The relative abundance of tree palms was more strongly associated with local conditions (e.g., higher mean annual precipitation, lower soil fertility, shallower water table and lower plot mean wood density) than metrics of long‐term climate stability. Life‐form diversity also influenced the patterns; palm assemblages outside the Neotropics comprise many non‐tree (e.g., climbing) palms. Finally, we show that tree palms can influence estimates of above‐ground biomass, but the magnitude and direction of the effect require additional work. Conclusions: Tree palms are not only quintessentially tropical, but they are also overwhelmingly Neotropical. Future work to understand the contributions of tree palms to biomass estimates and carbon cycling will be particularly crucial in Neotropical forests

Effect of using sugarcane leaf ash and granite dust as partial replacements for cement on characteristics of ultra-high performance concrete

A significant quantity of cement is necessary for the production of ultra-high-performance concrete (UHPC). However, some environmental issues are associated with cement production. The worldwide agricultural growth increases ash from agricultural waste (AW). Furthermore, industrial waste (IW) generated throughout the stone-cutting and processing has increased due to the growing demand for granite stone in construction. This research conducted a unique study that involved comparing the use of sugarcane leaf ash (SLA) as AW and granite dust (GD) as IW as partial substitutes for cement in the production of eco-friendly UHPC. The effect of employing SLA and GD with replacement ratios ranging from 20% to 50% on the mechanical and transport properties of UHPC was studied. In addition, this research investigated the effectiveness of partial replacement of natural fine aggregate (NFA) by recycled fine aggregate (RFA) with ratios ranging from 25% to 100% on the UHPC qualities. Moreover, the effect of elevated temperatures on the UHPC and the microstructural examination were investigated. Results demonstrated that the optimum replacement ratio of SLA or GD from cement was 20%, showing the best mechanical characteristics of the UHPC. For example, after 28 days of casting, the compressive strength increased by 12.16% and 8.44% when SLA and GD were added to the UHPC mix, respectively. Additionally, the 25% replacement ratio of RFA from NFA presented the best mechanical and transport properties of the UHPC. The mixes containing SLA positively affected the UHPC higher than those containing GD

Effects of glass fiber on recycled fly ash and basalt powder based geopolymer concrete

This experimental study encompasses a comprehensive exploration of multiple parameters aiming to enhance the strength, workability, setting time, and environmental attributes of geopolymer concrete (GPC). A pivotal solution lies in substituting fly ash with waste basalt powder, not only reducing binder costs but also ameliorating the overall ecological footprint. A secondary significant factor entails the integration of trimmed glass fibers. Throughout the experimentation process, the predominant GPC binder and fly ash underwent substitution with basalt powder at the proportions of 25%, 50%, and 75%. The mixtures were augmented with glass fibers of 3 mm, 6 mm, and 12 mm lengths, introduced at the ratios of 0.5%, 1%, 2%, and 3%. Then, the acquired samples were subjected to a 24-h curing regimen in an 85 °C oven. Subsequently, after a 7-day period of exposure to external conditions post-incubation, these samples were tested for both the compressive and flexural strengths. Samples incorporating a basalt ratio of 50% exhibited the highest capacities, contrasting with reduced capacities when the basalt ratio was elevated to 75%. Conversely, samples utilizing a sodium hydroxide (NaOH) molarity (M) of 12 demonstrated superior performance. Impressively, the compressive strength exceeding 40 MPa was achieved with the amalgamation of M 12 and 50% basalt additive. However, the workability experienced a notable reduction at the fiber ratios of 2% and 3%. The molarity concentrations did not impede the slump, workability, or setting time. A consistent setting time of 6 h was attained, and the desired workability was obtained without the need for a superplasticizer. For achieving the optimal triad of the workability, setting time, and strength, while maximizing the environmental advantages of GPC, the recommendation is to incorporate a distinct combination comprising 1–2% glass fibers (with 12 mm length), M 12, and 50% basalt powder into the mixture formulation

Using a combination of industrial and agricultural wastes to manufacture sustainable ultra-high-performance concrete

Today, recycling and the use of eco-friendly construction supplies are major concerns for the environment. Concrete is frequently utilized in the engineering and construction sectors. In the past several decades, ultra-high performance concrete (UHPC), characterized by very high mechanical qualities, has emerged as one of the most popular types of concrete. Huge quantities of Ordinary Portland cement (OPC) are often utilized; this increases the price of UHPC, limits its widespread usage in structural applications, produces a substantial quantity of carbon dioxide, and uses a sizable amount of natural resources. It is recommended that other additives be used in lieu of OPC in concrete preparation and that recycled aggregates from a variety of sources be used in place of natural aggregates to make UHPC production more environmentally friendly and economically feasible. This study combines industrial and agricultural waste to create an affordable and sustainable UHPC. For example, glass particles (GP) as a manufacturing byproduct generated by glass waste (GW) are utilized as an alternative for fine aggregate ''sand (S)'' with substitution ratios of 0 %, 50 %, and 100 %, while wheat straw ash (WSA), as an agricultural byproduct, is utilized as an OPC substitute at varying substitution ratios 0 %, 10 %, 20 %, and 30 %. We conducted and analyzed experiments with 12 mixtures divided into three groups. Several factors are studied, including slump flow, mechanical characteristics, drying shrinkage, high temperature, and microstructural features. Based on the obtained outcomes, boosting the percentage of GP utilized to substitute the S made it more workable. In addition, replacing 20 % of the OPC with WSA and 0 % of the S with GP yielded the best results in terms of mechanical characteristics. Increasing the WSA replacement rate while fixing GP to S substitution level significantly reduced drying shrinkage values. Lastly, the compressive strength (fc) findings of UHPC structural components exposed to elevated temperatures up to 200 °C were enhanced using GP as a replacement for S. In brief, the results of this experimental investigation can contribute well to illustrating the effect of utilizing GP and WSA to manufacture sustainable ultra-high-performance concrete

Mechanical performance of geopolymer concrete with micro silica fume and waste steel lathe scraps

Environmental studies for solutions are among the most important agendas of the scientific world. Most of the new studies are taking into account environmental effects. However, it is interesting for the scientific world to find solutions to accumulated environmental problems, reduce harmful production, and turn wastes that cause environmental pollution into useful products. In addition to incorporating fly ash, a recognized environmentally friendly and sustainable material, geopolymer concrete utilizes micro silica fume as a binding agent. Furthermore, waste lathe scraps are introduced to enhance and safeguard the concrete's mechanical properties. During the preparation phase, significant enhancements have been identified in the workability and setting time of the concrete. A total of 16 test samples were prepared for the study. Micro silica of 0%, 5%, 10% and 20% and lathe scraps of 0%, 1%, 2% and 3% were examined. Experimental findings reveal that incorporating 5% micro silica fume resulted in notable improvements in compressive, flexural, and splitting tensile strength, with increases of 14.4%, 7.45%, and 6.18% respectively. However, higher additions of 10% and 20% were found to decrease these strengths. In contrast, the inclusion of 1% lathe scraps led to notable increases in compressive, flexural, and splitting tensile strength by 11.4%, 6.35%, and 8.23% respectively. However, the addition of 2% and 3% lathe scraps resulted in reduced capacity. The findings demonstrated that combining 5% micro silica with 1% lathe scrap provided the highest strength, with improvements of 25.7%, 14.4%, and 12.0% in compressive, flexural, and splitting tensile strength respectively. Considering the enhancements in workability, setting time, and strength observed in all the tests, the recommended optimal geopolymer mixture is 5% micro silica together with 1% lathe scrap

Ultra-high-performance concrete properties containing rice straw ash and nano eggshell powder

Egypt produces more rice straw than any other nation, and this residue is currently discarded in untreated landfills and open fields, causing environmental damage in the country. Furthermore, eggshells, a waste product used in bakeries, restaurants, and poultry farms, were typically disposed of in landfills, posing health hazards. So, grinding eggshells into nanoparticles, known as nano eggshell powder (NEP), increases its activity. In addition, to its high calcium content, NEP may be used with pozzolanic substances like rice straw ash (RSA), which have a lower calcium concentration. This study examined the characteristics of ultra-high-performance concrete (UHPC) produced using RSA and NEP eco-friendly components within partial cement substitution. The ratios of RSA to cement were 0 %, 10 %, 20 %, and 30 %, while the NEP quantities were 2 %, 4 %, and 6 % of the total binder. The results indicate that combining NEP and RSA as pozzolanic materials can improve concrete characteristics while decreasing cement content and reducing environmental contamination. Using RSA and NEP as substitutes for cement has also improved the material's mechanical characteristics, durability, and dry shrinkage