Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians

Plant-based diets may increase the risk of vitamin B12 deficiency due to limited intake of animal-source foods, while dietary folate increases when adhering to plant-based diets. In this cross-sectional study, we evaluated the B12 and folate status of Norwegian vegans and vegetarians using dietary B12 intake, B12- and folic acid supplement use, and biomarkers (serum B12 [B12], plasma total-homocysteine [tHcy], plasma-methylmalonic acid [MMA], and serum-folate). Vegans (n=115) and vegetarians (n=90) completed a 24-hour dietary recall and a food-frequency questionnaire and provided a non-fasting blood sample. cB12, a combined indicator for evaluation of B12 status, was calculated. B12 status were adequate in both vegans and vegetarians according to the cB12 indicator, however 4% had elevated B12. Serum B12, tHcy, MMA concentrations and the cB12 indicator (overall median: 357pmol/L, 9.0µmol/L, 0.18µmol/L, 1.30 (cB12)) did not differ between vegans and vegetarians, unlike for folate (vegans: 25.8nmol/L, vegetarians: 21.6nmol/L, p=0.027). Serum B12 concentration <221pmol/L, was found in 14% of all participants. Vegetarians revealed the highest proportion of participants below the RDI of 2 µg/day including supplements (40 vs. 18%, p<0.001). Predictors of higher serum B12 concentrations were average daily supplement use and older age. Folate deficiency (<10 nmol/L) was uncommon overall (<2.5%). The combined indicator cB12 suggested that none of the participants was B12 depleted, however low serum B12 concentration was found in 14% of the participants. Folate concentrations were adequate, indicating adequate folate intake in Norwegian vegans and vegetarians.publishedVersionPaid open acces

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

Cold atoms in space: community workshop summary and proposed road-map

We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies

Cold atoms in space: community workshop summary and proposed road-map

We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies

Cold atoms in space: community workshop summary and proposed road-map

We summarise the discussions at a virtual Community Workshop on Cold Atoms in Space concerning the status of cold atom technologies, the prospective scientific and societal opportunities offered by their deployment in space, and the developments needed before cold atoms could be operated in space. The cold atom technologies discussed include atomic clocks, quantum gravimeters and accelerometers, and atom interferometers. Prospective applications include metrology, geodesy and measurement of terrestrial mass change due to, e.g., climate change, and fundamental science experiments such as tests of the equivalence principle, searches for dark matter, measurements of gravitational waves and tests of quantum mechanics. We review the current status of cold atom technologies and outline the requirements for their space qualification, including the development paths and the corresponding technical milestones, and identifying possible pathfinder missions to pave the way for missions to exploit the full potential of cold atoms in space. Finally, we present a first draft of a possible road-map for achieving these goals, that we propose for discussion by the interested cold atom, Earth Observation, fundamental physics and other prospective scientific user communities, together with the European Space Agency (ESA) and national space and research funding agencies.publishedVersio

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

Inntak og status av jod og B12 hos en gruppe vegetarianere og veganere i Norge

BAKGRUNN: Personer som velger et plantebasert kosthold har økt de siste årene. Vegetarianere og veganere begrenser eller ekskluderer inntaket av animalske matvarer, noe som kan føre til mangel på flere viktige mikronæringsstoffer. Jod og vitamin B12 er to mikronæringsstoffer det er få kilder til i et vegetarisk og vegansk kosthold. MÅL: Målet med oppgaven er å måle inntak av jod og B12, samt status hos en gruppe vegetarianere og veganere i Norge. Delmål er å vurdere jodkonsentrasjonen i urin, jod og B12- inntak fra 24-timers kostintervju og måle thyroideahormoner i blodprøver. I tillegg, vurdere B12 status ved hjelp av blodmarkører. METODE: Urinprøve, blodprøver (TSH, T3, T4, thyroglobulin, anti-TPO, S-vitamin B12, P- homocystein og P-metylmalonsyre) og kostinformasjon fra 24-timers kostintervju ble samlet inn fra 205 deltakere (90 vegetarianere og 115 veganere) i Oslo og Viken. RESULTAT: Jodstatus og -inntak var utilstrekkelig i begge gruppene i henhold til de epidemiologiske kriteriene til WHO (median u-jod 0.05). Begge gruppene hadde et utilstrekkelig inntak av B12 fra kosten alene (vegetarianere 0.6 μg/dag / veganere 0.01 μg/dag). Ved bruk av tilskudd oppfylte begge gruppene anbefalingene på 2 μg (vegetarianere 2.6 μg/dag / veganere 10 μg/dag). S-vitamin B12 var innenfor referanseområde hos 86% av deltakerne. MMA og homocystein viste at 65% av deltakerne var innenfor referanseområde. Det var liten signifikant forskjell mellom gruppene og S-vitamin B12 (p=0.05), men ingen signifikant forskjell mellom de funksjonelle markørene og vegetarianere og veganere. I multippel regresjonsanalyse var B12 tilskudd den sterkeste prediktoren for serum B12 (β 62.34, 95% KI (12.56, 112.12)). KONKLUSJON: De viktigste funnene tyder på at norske vegetarianere, særlig veganere, er i risiko for suboptimal jod- og B12 inntak fra kosten alene. Ved inkludering av kosttilskudd får begge gruppene oppfylt daglig anbefaling av B12, og veganere oppnådde tilstrekkelig mengde jod. Blodprøver av thyroideahormoner lå innenfor referanseområde for 88% av deltakerne og B12 markører lå innenfor referanseområdet hos 65% av deltakerne

Könsdifferentierad idrottsundervisning : För- och nackdelar

Detta arbete handlar om lärare och elevers uppfattningar om könsdifferentierad idrottsundervisning. Denna studie syftar till att lyfta fram lärarnas och elevernas positiva och negativa uppfattningar om könsdifferentierad idrottsundervisning. De frågeställningar som arbetet utgått ifrån är; vilka uppfattningar har lärarna och eleverna på de tre skolor vi besökt angående könsdifferentierad idrottsundervisning? Det innebär att vi även ställt oss frågor som; Vilka elever skulle, enligt de intervjuade lärarna, gynnas av könsdifferentierad undervisning. Vilka skäl anger lärarna och eleverna till varför man ska eller inte ska bedriva könsdifferentierad idrottsundervisning? Den insamlingsmetod som använts för att få svar på våra frågeställningar är intervjuer med strukturerade frågor. Dessa intervjuer och den tidigare forskning som bearbetats har visat ett resultat som tyder på att olika barn gynnas av olika upplägg. Det könsdifferentierade upplägget skulle, enligt vår studie, gynna de starka pojkarna och de svaga flickorna. Samundervisning skulle vara bättre för de svaga pojkarna och de starka flickorna. De fördelar som lyfts fram, av både lärare och elever, är vad den könsdifferentierade undervisningen kan göra för färdighetsträning och vad samundervisning kan göra för det sociala samspelet. Eleverna är, i motsats till lärarna, inte av den uppfattningen att undervisningsformen har någon betydelse för hur man tar till sig undervisningen och dess innehåll

Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians

Plant-based diets may increase the risk of vitamin B12 deficiency due to limited intake of animal-source foods, while dietary folate increases when adhering to plant-based diets. In this cross-sectional study, we evaluated the B12 and folate status of Norwegian vegans and vegetarians using dietary B12 intake, B12 and folic acid supplement use, and biomarkers (serum B12 (B12), plasma total homocysteine (tHcy), plasma methylmalonic acid (MMA) and serum folate). Vegans (n 115) and vegetarians (n 90) completed a 24-h dietary recall and a FFQ and provided a non-fasting blood sample. cB12, a combined indicator for evaluation of B12 status, was calculated. B12 status was adequate in both vegans and vegetarians according to the cB12 indicator; however 4 % had elevated B12. Serum B12, tHcy, MMA concentrations and the cB12 indicator (overall median: 357 pmol/l, 9·0 µmol/l, 0·18 µmol/l, 1·30 (cB12)) did not differ between vegans and vegetarians, unlike for folate (vegans: 25·8 nmol/l, vegetarians: 21·6 nmol/l, P = 0·027). Serum B12 concentration &lt; 221 pmol/l was found in 14 % of all participants. Vegetarians revealed the highest proportion of participants below the recommended daily intake of 2 µg/d including supplements (40 v. 18 %, P &lt; 0·001). Predictors of higher serum B12 concentrations were average daily supplement use and older age. Folate deficiency (&lt; 10 nmol/l) was uncommon overall (&lt; 2·5 %). The combined indicator cB12 suggested that none of the participants was B12-depleted; however, low serum B12 concentration was found in 14 % of the participants. Folate concentrations were adequate, indicating adequate folate intake in Norwegian vegans and vegetarians

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