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

Interface among Motivation, Strategy Application, Comprehension, and Attribution: An Examination of Taiwanese Adolescent Readers of English-as-a-Foreign-Language

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[[alternative]]動機、策略運用、理解力和歸因關係之研究: 以台灣青少年英語讀者為例

[[abstract]]Adopting a social-cognitive perspective, this study aims to explore the relationships among reading motivations, strategy use, literacy performance, and causal attributions in a second/foreign language (L2/FL) context. These relationships, especially as they concern L2/FL readers in secondary education, remain infrequently examined. Three hundred and ninety-six Taiwanese high-school students, including 208 boys and 188 girls, participated in the study. The instruments used included three questionnaires presented in Mandarin Chinese (the participants’ first language), as well as an English-as-a-Foreign-Language (EFL) literacy test. The questionnaires measured L2 learners’ intrinsic and extrinsic motivations, rates of strategy use, and causal attributions, respectively. The EFL test assessed the participants’ knowledge of words, phrases, and sentence structures, as well as their ability to understand English passages. The structural equation modeling (SEM) was performed to examine the relations between those factors. The results showed positive and significant relationships among the factors examined. Reading motivations had a direct effect on strategy use, as did strategy use on L2 performance. Equally important, L2 performance also had a significant direct effect on causal attributions, which, in turn, had a significant effect on reading motivations. The findings support the contention that reading comprehension involves a coordination of motivational processes with cognitive and metacognitive operations [1, 2].[[notice]]補正完

[[alternative]]高成就和低成就的中、英文成人讀者之意義建構以及策略使用的特性

[[abstract]]This study examined the ways in which Taiwanese adolescent readers approached texts written in two varieties of their first language i.e., classical and contemporary literary styles of Chinese, along with a foreign language i.e., English. The construction-integration model of text comprehension (Kintsch, 1998, 2004) and reader response theory (Beach, 1993; Galda & Beach, 2001) served as the theoretical frameworks for this study. Data included semi-structured interviews and think-aloud protocols. The constant comparative method proposed by Glaser and Strauss (1967) was employed for data analyses. Overall, the data show that the text processing mechanism utilized by the bilingual readers of Chinese and English appeared to follow the procedure of the construction-integration model of reading. Lower-level processes became substantially salient as students read the texts written in classical literary styles of Chinese and contemporary English, respectively. In contrast, relatively higher-level comprehension processes were evident in students’ reading of texts written in contemporary Chinese. The degree of language transfer, particularly in the employment of mental translation, indicates a ‘linguistic interdependent relationship’ between one’s two languages, as posited by Cummins (1979).[[booktype]]電子

[[alternative]]探究中文閱讀能力、英語字彙知識及後設認知策略對英語閱讀理解之影響

[[abstract]]This study examines the functions of linguistic and non-linguistic knowledge in learning to read English as a foreign language among Taiwanese students in secondary education. Data consisted of two vocabulary tests, two reading comprehension tests, and two questionnaires concerning strategy use for reading Chinese as a first (L1) and English as a second/foreign (L2; FL) language. The results show that knowledge of L2 lexicons acts as a key player while metacognitive knowledge plays a secondary one in promoting L2 reading comprehension. With the increase of vocabulary knowledge, the effect of L1 reading proficiency emerges as a salient factor influencing L2 reading comprehension.[[journaltype]]國內[[incitationindex]]TSSCI[[ispeerreviewed]]Y[[booktype]]電子版[[countrycodes]]TW

Improving Asian Students’ Text Comprehension and Interpretation through Reader Response

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The Representation of Teachers in Taiwanese Children’s Literature, 1960–2012

[[abstract]]This study investigates the images of teachers presented in Taiwanese children’s books published between 1960 and 2012 using the narrative theory outlined by Nikolajeva (Child Lit Assoc Q, 28(1):5–16, 2003). A purposive sample based upon the portrayal of school life is applied. One hundred and one books were identified as texts in which cultural messages about teachers were embedded. With respect to the depiction of teachers, three salient characteristics emerged from these texts: most images are positive; the teacher is often portrayed as a powerful animal; and the teacher is typically Han Chinese. Additionally, the modes of discourse that these writers used show their preference for realism, the first-person male perspective, and humor. As these findings attest, writing children’s books portraying teachers and school lives is a practice regulated by pedagogical and didactic intent. These findings provide insight into the ways that teachers see themselves and their profession, in addition to how they are seen by others.[[notice]]補正完畢[[incitationindex]]A&HCI[[cooperationtype]]國