Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

Background: Physicians depend on reliable information on the local epidemiology of infection and antibiotic resistance rates to guide empiric treatment in critically ill patients. As these data are scarce for Central Africa, we performed a retrospective analysis of microbiological findings from a secondary care hospital in Gabon. Methods: Microbiological reports from 2009 to 2012 were used to assess the non-susceptibility rates of the three most common isolates from six major types of infections (bloodstream, ear-eye-nose-throat, surgical site, skin and soft tissue, urinary tract and wound infection). Results: A high diversity of pathogens was found, but Staphylococcus aureus was predominant in the majority of infections. Overall, the three most prevalent pathogens in children were S. aureus (33.7%), Streptococcus pyogenes (8.1%) and Escherichia coli (4.5%) and in adults S. aureus (23.5%), E. coli (15.1%) and Klebsiella pneumoniae (7.4%). In total, 5.8% (n = 19) of all S. aureus isolates were methicillin resistant. The proportion of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae was 15.4% (n = 78), 49.4% of all K. pneumoniae were ESBL-producer (n = 42). Conclusion: The high diversity of potential pathogens and high resistance rates in Gram-negative bacteria challenge a rational empiric use of antibiotics. Countrywide continuous sentinel surveillance is therefore urgently needed.<br

Systematic reviews as a “lens of evidence”: determinants of benefits and harms of breast cancer screening

This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15–25% in trials and 28–56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1–60% in trials and 1–12% in studies with a low risk of bias, and cumulative false‐positive rates were lower with biennial than annual screening (3–17% vs 0.01–41%). There is no consistency in the reviews’ conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen‐film), the number of views, and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54–84% and 47–69%, respectively), and strong evidence of unfavourable benefit‐to‐harm ratio with breast self‐examination. The reviews’ conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high‐income countries, systematically disagree on the interpretation of the benefit‐to‐harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published

How do nurses and teachers perform breast self-examination: are they reliable sources of information?

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the most common cause of cancer-related deaths among women worldwide. The aim of the present study was to determine and compare knowledge, behavior and attitudes among female nurses and teachers concerning breast self-examination (BSE).</p> <p>Methods</p> <p>Two-hundred and eighty nine women working in Aydin, Turkey (125 nurses and 164 teachers) were included in the study. The data were collected using a questionnaire designed to measure the knowledge, attitudes and behavior of the groups. Analysis involved percentiles, χ²tests, <it>t </it>tests and factor analysis.</p> <p>Results</p> <p>The knowledge of nurses about BSE was higher than that of teachers (81.5% versus 45.1%; p < 0.001). BSE practice parameters (i.e. age groups, indications, frequency) were similar (p > 0.05), whereas skills in performing self-examination were higher in nurses (p < 0.001). Fear of having breast cancer is the most frequent reason for performing BSE. Among nurses, the reasons for failure to perform BSE were the absence of prominent breast problems (82%) and forgetting (56.4%). The teachers who did not perform BSE said that the reasons were lack of knowledge on how to perform self-examination (68.9%) and absence of problems (54%). Both groups had unacceptable technical errors in the performance of BSE.</p> <p>Conclusion</p> <p>We conclude that nurses and teachers should be supported with information enabling them to accomplish their roles in the community. To improve BSE practice, it is crucial to coordinate continuous and planned education.</p

Study design of 'FRIENDS for Life': process and effect evaluation of an indicated school-based prevention programme for childhood anxiety and depression

Background: Anxiety disorders and depression are highly prevalent in children and affect their current and future functioning. 'FRIENDS for Life' is a cognitive-behavioural programme teaching children skills to cope more effectively with feelings of anxiety and depression. Although 'FRIENDS for Life' is increasingly being implemented at Dutch schools, its effectiveness as a preventive intervention in Dutch schools has never been investigated. The aim of the study is to evaluate the effectiveness of 'FRIENDS for Life' as an indicated school-based prevention programme for children with early or mild signs of anxiety or depression. Methods/Design. This study is a controlled trial with one pre-intervention and three post-intervention measurements (directly after, and 6 and 12 months after the end of the programme). The study sample consists of children aged 10-12 years (grades 6, 7 and 8 of Dutch primary schools), who show symptoms of anxiety or depressive disorder. Data are collected through self-report, teacher report and peer nomination. A process evaluation is conducted to investigate programme integrity (whether the programme has been executed according to protocol) and to evaluate children's and parents' opinions about 'FRIENDS for Life' using online focus groups and interviews. Discussion. The present study will provide insight into the effectiveness of 'FRIENDS for Life' as an indicated school-based prevention programme for children with early or mild signs of anxiety or depression

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis

Abstract Aims. In the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers. Methods. We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason. Results. We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = −0.71; 95% confidence interval [CI] −1.01 to −0.41; I2 = 83%; 95% CI 78–88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = −1.02; 95% CI −1.52 to −0.51; I2 = 89%; 95% CI 82–93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = −1.05; 95% CI −1.55 to −0.56; I2 = 87%; 95% CI 79–92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life. Conclusions. Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-basedguidelines and implementation packages should be developed accordingly

Patellar tendon properties distinguish elite from non-elite soccer players and are related to peak horizontal but not vertical power

Purpose: The aims of our study were to investigate differences in tendon properties between elite and non-elite soccer players, and to establish whether tendon properties were related to power assessed during unilateral jumps in different directions. Methods: Elite (n=16; age, 18.1 ± 1.0yrs) and non-elite (n=13; age, 22.3 ± 2.7yrs) soccer players performed three repetitions of each type (unilateral vertical, unilateral horizontal-forward and unilateral medial) of countermovement jump (CMJ) on a force plate. Patellar tendon (PT) cross-sectional area (CSA), elongation, stiffness and Young’s modulus (measured at the highest common force interval) were assessed with ultrasonography and isokinetic dynamometry. Results: Elite soccer players demonstrated greater PT elongation (6.83±1.87 vs. 4.92±1.88 mm, P=0.011) and strain (11.73±3.25 vs. 8.38±3.06 %, P=0.009) than non-elite. Projectile range and peak horizontal power during unilateral horizontal-forward CMJ correlated positively with tendon elongation (r=0.657 and 0.693, P<0.001) but inversely with Young’s modulus (r=-0.376 and -0.402, P=0.044 and 0.031). Peak medial power during unilateral medial CMJ correlated positively with tendon elongation (r=0.658, P=<0.001) but inversely with tendon stiffness (r=-0.368, P=0.050). No tendon property correlated with unilateral vertical CMJ performance (r≤0.168; P≥0.204). Conclusions: Patellar tendon strain was greater in elite vs. non-elite soccer players and can therefore be considered an indicator of elite soccer playing status. Moreover, a more compliant patellar tendon appears to facilitate unilateral horizontal-forward and medial, but not vertical CMJ performance in soccer players. These findings should be considered when prescribing the detail of talent selection and development protocols related to direction-specific power in elite soccer players