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

The Bible and Violence in Africa. Papers presented at the BiAS meeting 2014 in Windhoek (Namibia), with some additional contributions

BiAS 20 contains papers presented at the BiAS meeting 2014 in Windhoek (Namibia), with some additional contributions. Scholars from Nigeria, Cameroon, Botswana, Zimbabwe, South Africa, Namibia and Germany are dealing with the urgent question of how the Bible is involved in the widespread use of violence in political, social, religious, and gender conflicts. One leading question is how to deal with the textual representation of violence in the Bible. It is taken up by more general hermeneutical contributions. The other leading question is how biblical texts and/or concepts are used to cause and justify violence. This is taken up by a greater number of articles which deal with concrete societal and political contexts in Zimbabwe and other African countries. The conference in Namibia was supported as a Humboldt-Kolleg on the Bible and Violence in Africa by the German Alexander von Humboldt Foundation

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

Identification of Surgeon Burnout via a Single-Item Measure

BackgroundBurnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost.AimsTo determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout.MethodsConsultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases.ResultsThe single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain.ConclusionsA single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods

Burnout Among Surgeons in the UK During the COVID-19 Pandemic: A Cohort Study

BackgroundSurgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic.MethodsThis cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).ResultsA total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1–2 and Specialty Trainee 1–2 grades.ConclusionsThese findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons

Funffzehen-ästiger Nieder-Laussitzer Palm-baum/ vermittelst Christ-Schuldigen Lob- und Trauer-Reden

FUNFFZEHEN-ÄSTIGER NIEDER-LAUSSITZER PALM-BAUM/ VERMITTELST CHRIST-SCHULDIGEN LOB- UND TRAUER-REDEN Funffzehen-ästiger Nieder-Laussitzer Palm-baum/ vermittelst Christ-Schuldigen Lob- und Trauer-Reden ([1]) Kupfertitel ([1]) Titelseite ([2]) Psalm. XCII. v. 13 ([2]) Widmung ([3]) An den hochgeneigten Leser. ([7]) Die erste Lob- und Trauer-Rede bey Deß hochgebohrnen Grafen und Herrn/ Hn. Georg Fridrichs ... ([9]) Die andere Lob- und Trauar-Rede/ bey Deß weyland Hoch-Wolgebohrnen Herrn/ Herrn Heinrichs Joachims/ Freyherrn von der Schulenburg ... (25) Die dritte Lob- und Trauer-Rede/ bey Deß weyland Hoch-Wolgebohrnen Herrns/ Herrn Heinrichs Joachims Freyherrns von der Schulenburg ... (49) Die vierdte Lob- und Trauer-Rede/ als Deß weyland Hochwolgebohrnen Grafen und Herrn/ Herrn Johann-Sigismundi ... (75) Die fünffte Lob- und Trauer-Rede/ bey Deß weyland Hoch-Wolgebohrnen Herrn/ Herrn Sigfidi, Freyherrn von Ritlitz ... (93) Die sechste Lob- und Trauer-Rede/ bey Deß weyland Hoch-Wolgebohrnen Herrn/ Herrn Sigfridens/ Freyherrn von Ritlitz ... (111) Die siebende Lob- und Trauer-Rede/ an Deß HochEdlen/ Gestrengen/ Vesten und Mannhafften Hn. Joachim von Schwantes ... (133) Die achte Lob- und Trauer-Rede/ bey Deß weyland HochEdelgebohrnen/ Gestrengen/ Vesten und Hochbenanmten Herrn Sigfrid von der Dahm ... (151) Die neundte Lob- und Trauer-Rede/ als Deß Hoch-Edelgebohrnen/ Gestrengen/ Vesten und Hochbenamten Herrn Sigmund Sigfrides von Dahm ... (169) Die zehende Lob- und Trauer-Rede/ Dem Edlen/ GroßAchtbaren/ Hochgelahrten und Hochbenamten Herrn Christophoro Doeblero, ... (191) Die eilffte Lob- und Trauer-Rede/ bey Deß WolEhrenvesten/ VorAchtbahren/ Wolgelahrten und Wolweisen Herrn Theophili Stephani ... (211) Die zwölffte Lob- und Trauer-Rede/ bey Deß weyland WolEhrwürdigen/ VorAchtbahren und Wolgelahrten Herrn M. Danielis Schindleri, ... (227) Die dreyzehende Lob- und Trauer-Rede/ an Deß WolEhrenvesten/ VorAchtbahren/ Wolgelahrten und Wolweisen Herrn Valentini Exii, ... (239) Die vierzehende Lob- und Trauer-Rede/ bey Deß WolEhrwürdigen/ GroßAchtbahren/ und Wolgelahrten Herrn M. Davidis Grafunderi, ... (253) Stand- und Abdanckungs-Rede/ So Bey Christlich-volckreicher Beerdigung Der WolErbahren/ Viel-Ehr und Tugendbelobten Jungfrau Anna Justina ... (271) Folget vor-erwehntes geistliches Text-Lied/ Mit der Melodi Herrn Johannes Schwarzen/ Cantoris. (319) Register Der Fürnehmsten Sachen. ([1]r) Beiträge ([6]r) Register Der Fürnehmsten Sachen. (Fortsetzung, Bogen Y2-3) ([8]r) Beiträge (Fortsetzung, Bogen b3) ([10]r) Register Der Fürnehmsten Sachen. (Fortsetzung Y[4-5]) ([12]r

Psychopharmacology 2003 Conference, 10-13 September 2003

List of abstracts and authors: 1. Comparative benefits of Atypical antipsychotics Diana P Morrison 2. Evidence-based management of depression in Schizophrenia Andre F Joubert 3. Second generation Antipsychotics: An African update Dave Swingler 4. The drug management of patients with HIV/Aids in the Mental Health Care setting: A therapeutic challenge Denise White 5. New developments in the treatment of Bipolar depression Jospeh R Calabrese 6. Dual action antidepressants: Faster onset, more remission, better value? Roger M Pinder 7. Antisocial personality disorder: A review Donald W Black 8. The South African study of stress and health: An overview David R Williams 9. Ugliness is in the eye of the beholder: Psychiatric apsects of body image disturbance David Castle 10. Over diagnosed or under recognized? Treating ADHD Dora Wynchank 11. The contagious effects of trauma and their impact on human service organisations Kerry Gibson 12. Temporal lobe epilepsy in adolescence - 'Understanding the narrative' Helen Clark 13. The effectiveness of treatment programs for Methaqualone (Mandrax) dependence Greg McCarthy, Nandi Siegfried, Bronwyn Myers 14. Community influence on alcohol and marijuana Alan J Flisher, Robyn Mallett, Gary King, Neo Morojele, Martie Muller, Carl Lombard 15. Psychiatric presentations of medical illness Sebastian Akalula 16. Imaging of brain function using Spect James Warwick 17. Selected neuropsychological test performances and SSRI usage Theophilus Lazarus 18. Comparative effectiveness and safety of antipsychotic treatments for outpatient Schizophrenia Frans Korb, Adel Sadak, Aly Akram, Sunar Birsoz, Abderrahmane Belaid 19. Evidence-based mental healthcare - What do you know, think, feel? Nandi Siegfried, George Swingler, Soraya Seedat, Martie Muller, Rachel Churchill, Dan Stein 20. Competitions Act - Anti-competitive health care practices Z Nthakwana 21. Unique approach to mental wellness by medical Schemes Petro Kempen 22. What happens to my medical aid contribution? Eugene Allers 23. Financial issues in a modern private practice Mike Edwards 24. Transcranial magnetic stimulation: Uses in brain function research and medical intervention Alan St Clair Gibson 25. The Neurochemistry of dreams: Implications for Psychiatry Mark Solms 26. Tenascin-R expression in the Central Nervvous system of lower vertebrates Ruth Jarvis, N-. Hsu, P. Pesheva and D.M. Lang 25. Localisation of the Nogo-A receptor in Neronal Lipid rafts Edward Nyatia, D.M. Lang 26. Characterising an animal model for early life trauma using time dependent sensitisation Joachim D.K. Uys, Willie M.U. Daniels, Dan J. Stein 27. Tolmetin affords protection against Quinoclinic acid induced Neurotoxixity in Rat brain Amichand Dairam, S Daya 28. Acetaminophen and aspirin inhibit superoxide anion generation and Lipid Peroxidation, and protect against 1-Methyl-4Phenyl Pyridinim-induced Dopaminergic Neurotoxicity in rats H. Maharaj, D.S. Maharaj, K. S. Saravanan, K.P. Mohanakumar, S. Daya 29. Can exercise provide Neuroprotection in a rat model for Parkinson's disease? M Mabandla, L Kellaway, A St Clair Gibson, M Lambert, V Russell 30. Treatment of rapid cycling Bipolar disorder Joseph R. Calabrese 31. Depression as a Neurodegenerative Disorder: The need for achieving remission Roger M Pinder 32. Side-effects induced by modern antidepressants- Overview and management Franco Colin 33. The Placebo response in antidepressant clinical trials Robin Emsley 34. Impulse control disorders: An overview Donald W. Black 35. Post traumatic stress disorder: The Wits trauma clinic experience Ugash Subramaney 36. Post traumatic stress disorder among recently diagnosed patients with HIV in South Africa Soraya Seedat, Bo Olley, D J Stein 37. Improving outcome in Schizophrenia Diana P Morrison 38. Reviewing post Graduate training Cliff W Allwood 39. Ethics in HIV Research Keimanthro Moodley 40. Improving and maintaining ethical standrads in Psychiatric research Tuviah Zabow ============================================================= Posters: Neurosciences section (Presenting author only) 1. Blunted Acth response correlates with altered Neurotransmitter function in maternally separatedrats W M U Daniels 2. A mechanism for zinc toxicity in Neuroblastoma cells W M U Daniels 3. The effects of Hypericum Perforatum, Quercetin, and Fluoxetine on receptor densities in the Rat Brain L Heiderman 4. Trichotillomania and obsessive-compulsive disorder: Clinical and genetic comparisons within a South African population S M J Hemmings 5. Expression of Nogo-A in the amphibian central nervous system N. J. Hsu 6. Biochemical model for inflammation of the brain: The role of iron, transferring and toxiferring in Lipid Peroxidation S J Van Rensburg 7. Improvement in Alzheimer's disease patients with antioxidant supplementation over 15 months S J Van Rensburg 8. The Placebo effect - Is it all in the mind? S J Van Rensburg 9. Very low serum iron concentrations in elderly patients with active Carcinoma S J van Rensburg 10. Melatonin affords protection against Rotenone-induced Neurotoxicity R John 11. Effect of enriched environment on Ca uptake via NMDA receptors into barrel cortex slices of spontaneously Hypertensiverats M Lehohla 12. Effects of Methylpenidate in a rat model for Attention Deficit Hyperactivity Disorder G. L. S. Lelaka 13. 6-Hydroxymelatonin converts Fe (III) to Fe(II) and reduces iron-induced Lipid Peroxidation D S Maharaj 14. Metrofinate Potentiates Quinolinic Acid and Potassium Cyanide induced Neurotoxicity A Ramsunder 15. The effect of chronic Intra-Amylgdala CRF injections on rat behaviour and HPA-Axis function L Richter 16. Effect of Glutamate in the Prefrontal Cortex of a rat model for Attention-Deficit Hyperactivity Disorder V Russell 17. An investigation into the relationship between Corticosterone and Neuron Cell death P J Van Vuuren ============================================================= 41. Blunted Acth response correlates with altered Neurotransmitter function in maternally separated Rats W M U Daniels, C Y Pietersen, M E Carstens, D J Stein 42. A mechanism for Zinc Toxicity in NeuroBlastoma Cells W M U Daniels, J Hendricks, R Salie, S J Van Rensburg 43. The effects of Hypericum Perforatum, Quercetin and Fluoxetine on receptor densities in the rat brain L Heideman and S Daya 44. Trichotillomania and obsessive-compulsive disorder: Clinical and genetic comparisons withn a South African population S M J Hemmings, C J Kinnear, C Lochner, H Moolman-Smook, D J H Niehaus, V Corfield, D J Stein 45. Expression of Nogo-A in the amphibian central nervous system N. J. Hsu, R Jarvis, D. M. Lang 46. Biochemical model for inflammation of the brain: The role of iron, transferring and Toxiferring in Lipid Peroxidation S J Van Rensburg, R T Erasmus, J M van Zyl, D Hon, W M U Daniels, F C V Potocnik, M J Kotze, N J De Villiers, P R Hurly 47. Improvement in Alzheimer's Disease patients with antioxidant supplementation over 15 months S J van Rensburg, F C V Potocnik, J M Van Zyl, B J Van der Walt, D Hon, A Roos, E Rienhardt, R T Erasmus 48. The Placebo effect - Is it all in the mind? S J van Rensburg, R A  Emsley, C M Smuts, M Kidd, S Van der Merwe, C C Myburgh, P Oosthuizen, H Bleeker 49. Very low serum Iron concentrations in elderly patients with active Carcinoma S J van Rensburg, R Erasmus, D Hon, C Bouwens 50. Melatonin affords protection against Rotenone-induced Neurotoxicity R John, S Daya 51. Effect of enriched environment on Ca uptake via NMDA Receptors into barrel Cortex slices of spontaneously Hypertensive rats M Lehohla, V Russell, L Kellaway 52. Effects of Methylpenidate in a rat model for Attention-Deficit Hyperactivity Disorder G. L. S. Lelaka, V. A. Russel, L. A. Kellaway 53. 6-Hydroxymelatonin converts Fe (III) to Fe (II) and reduces iron-induced Lipid Peroxidation D S Maharaj, S Daya 54. Metrofinate Potentiates Quinolinic Acid and Potassium Cyanide induced Neurotoxicity A Ramsunder, S Daya 55. The effect of chronic Intra-Amygdala CRF injections on rat behaviour and HPA-Axis function L Richter, W Daniels, D J Stein 56. Effect of Glutamate in the Prefrontal Cortex of a rat model for Attention-Deficit Hyperactivity Disorder V Russell, M Lehohla, L Kellaway 57. An investigation into the relationship between Corticosterone and Neuron cell death P J Van Vuuren, J Hendricks, W M U Daniels ============================================================= Posters: Psychiatry Section 1. Descriptive study of Tardive Dyskinesia in a South African Xhosa population S Brink 2. Alcohol drinking problems at three urban High Schools in Umtata O Alonso Betancourt 3. Childhood and adolescent sexual abuse - Demographic, traumatic and clinical signposts P D Carey 4. Inositol in the treatment of Obsessive Compulsive Disorder P D Carey 5. A review of factors associated with Suicidal behaviour in children and adolescents admitted to Tygerberg Hospital T Du Plessis 6. Psychological and physical outcomes fo elective abortion; Local Anaesthesia vs Intravenous Sedation T Ericksen 7. Mental health literacy of Human Resource Practitioners in South Africa C J Hugo 8. The importance of a specialized clinic for the care of patients with first episodes of psychosis N Keyter 9. Self-report vs Urinary drug screening in Schizophrenia: A pilot study L Koen 10. The effect of aggression on the use of Psychotropics in Schizophrenia: A naturalistic study H Lategan 11. Factor analysis of obsessive-compulsive spectrum disorders in patients with obssessive-compulsive disorder: Clinical and Genetic correlates C Lochner 12. Experiences in obsessive-compulsive Disorder and Trichotillomania: Role of childhood trauma C Lochner 13. Delusional systems in Xhosa Schizophrenia Sibpairs J E Muller 14. OCD Heteogeneity reflected by lack of Genealogically determined founder effect D J H Niehaus 15. The efficacy and tolerbaility of low-dose vs standard dose Haloperidol in first episode Psychosis. A randomised, double-blind study P P Oosthuizen 16. Treatment with low-dose Haloperidol does not protect against Tardive Dyskinesia P P Oosthuizen 17. Do healthcare funders discriminate against members on the grounds of mental illness? O Scholtz 18. Treatment strategies in patients with Clozaopine-resistant Schizophrenia at Stikland Hospital: A critical evaluation of one option A Schulte 19. Early coadministration of Clonazepam with Paroxetine for generalized social anxiety disorder S Seedat 20. Trauma exposure and post-traumatic stress symptoms in adolescents: A schools' survey in Cape Town (South Africa) and Nairobi (Kenya) S Seedat 21. The QTC effects of Thioridazine when used as a second line Anti-psychotic ( at Stikland Hospital) C Seller 22. Brain imaging and substance related disorders D J Stein 23. Gender differences in trauma exposure & post traumatic stress disorder in a clinic sample S Suliman 24. Assessing the prevalence of anxiety and depressive symptoms among clinica at Tygerbeg Academic Hospital and controls H Van der Bijl 25. Pharmacological challenge with a serotonin ID Agonist in alcohol dependence B Vythilingum 26. The treatment of ADHD in adults W Verbeeck ============================================================= 58. Descriptive study of Tardive Dyskinesia in a South African Xhosa population S Brink, D J H Niehaus, L Koen, J E Muller 59. Alcohol drinking problems at three Urban High Schools in Umtata O Alonso Betancourt, M Morales Herrera 60. Childhood and adolescent sexual abuse - Demographic, traumatic and clinical signposts P D Carey, J Walker, S Seedat, D J Stein 61. Inositol in the treatment of obsessive compulsive Disorder P D Carey, S Seedat, D J Stein 62. A review of factors associated with suicidal behaviour in children and adolescents admitted to Tygerberg Hospital T Du Plessis, S M Hawkridge, F H Theron, S A Du Plessis 63. Psychological and physical outcomes of elective abortion: Local anaestheisa vs Intravenous sedation T Ericksen, S Seedat, P Labuschagne, D J Stein 64. Mental health literacy of Human resource practitioners in South Africa C J Hugo, H D Vos, D J Stein 65. The importance of a specialized clinic for the care of patients with first episodes of psychosis N Keyter, P P Oosthuizen, R A Emsley, H J Turner 66. Self-reort vs urinary drug screening in Schizophrenia: A pilot study L Koen, D J H Niehaus, J E Muller, C Seller, N Keyter 67. The effect of aggression on the use of Psychotropics in Schizophrenia: A naturalistic study H Lategan, L Koen, D J H Niehaus 68. Factor analysis of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive Disorder: Clinical and genetic correlates C Lochner, D J H Niehaus, S M J Hemmings, C J Kinnear, V A Corfield, J C Moolman-Smook, D J Stein 69. Experiences in obsessive-compulsive disorder and Trichotillomania: Role of childhood trauma C Lochner, S Seedat, P D Carey, D J Stein 70. Delusional systems in Xhosa Schizophrenia Sibpairs J E Muller, D J H Niehaus, L Koen, C Seller, N Keyter, C Laurent, R A Emsley 71. OCD Heteogeneity reflected by lack of Genealogically determined founder effect D J H Niehaus, L Endeman, I Bosman, S Hemmings, C Lochner, L Koen, H Moolman-Smook, V A Corfield, D J Stein 72. The efficacy and tolerability of low-dose vs standard dose Haloperidol in first episode Psychosis. A randomised, double-blind study P P Oosthuizen, R A Emsley, H J Turner, N Keyter 73. Treatment with low-dose Haloperidol does not protect against Tardive Dyskinesia P P Oosthuizen, R A Emsley, H J Turner, N Keyter 74. Do healthcare funders discriminate against members on the grounds of mental illness? O Scholtz, P P Oosthuizen, C Hugo, B Richards 75. Treatment strategies in patients with Clozapine resistant Schizophrenia at Stikland Hospital: A critical evaluation of one option A Schulte, D J H Niehaus, L Koen, J E Muller, P P Oosthuizen, R A Emsley 76. Early coadministration of Clonazepam with Paroxetine for generalised Social Anxiety Disorder S Seedat, M B Stein 77. Trauma exposure and post-traumatic stress symptoms in adolescents: A schools' survey in Cape Town (South Africa) and Nairobi (Kenya) S Seedat, C Nyamap, F Njenga, B Vythilingum, D J Stein 78. The QTC effects of Thioridazine when used as a second line Antipsychotic (at Stikland Hospital) C Seller, P P Oosthuizen 79. Brain imaging and substance related disorders D J Stein 80. Gender differences in trauma exposure & post traumatic stress disorder in a clinic sample S Suliman, S Seedat, F Gxama, J Walker, W Rossouw 81. Assessing the prevalence of anxiety and depressive symptoms among clinicians at Tygerberg Academic Hospital and controls H Van der Bijl, P P Oosthuizen 82. Pharmacological challenge with a Serotonin ID agonist in alcohol dependence B Vythilingum, C Wessels, S Maritz, W P Pienaar, D J Stein 83. The treatment of ADHD in adults W Verbeec

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high‐HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P < 0·001), but the relationship was reversed in low‐HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30‐day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low‐ and middle‐HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low‐HDI countries was half that in high‐HDI countries