Physical activity level and stroke risk in US population: A matched case-control study of 102,578 individuals

Background: Stroke has been linked to a lack of physical activity; however, the extent of the association between inactive lifestyles and stroke risk has yet to be characterized across large populations. Purpose: This study aimed to explore the association between activity-related behaviors and stroke incidence. Methods: Data from 1999 to 2018 waves of the concurrent cross-sectional National Health and Nutrition Examination Survey (NHANES) were extracted. We analyzed participants characteristics and outcomes for all participants with data on whether they had a stroke or not and assessed how different forms of physical activity affect the incidence of disease. Results: Of the 102,578 individuals included, 3851 had a history of stroke. A range of activity-related behaviors was protective against stroke, including engaging in moderate-intensity work over the last 30 days (OR = 0.8, 95% CI = 0.7-0.9; P = 0.001) and vigorous-intensity work activities over the last 30 days (OR = 0.6, 95% CI = 0.5-0.8; P \u3c 0.001), and muscle-strengthening exercises (OR = 0.6, 95% CI = 0.5-0.8; P \u3c 0.001). Conversely, more than 4 h of daily TV, video, or computer use was positively associated with the likelihood of stroke (OR = 11.7, 95% CI = 2.1-219.2; P = 0.022). Conclusion: Different types, frequencies, and intensities of physical activity were associated with reduced stroke incidence, implying that there is an option for everyone. Daily or every other day activities are more critical in reducing stroke than reducing sedentary behavior duration

Effect of Exogenous Fibrolytic Enzymes Supplementation or Functional Feed Additives on In Vitro Ruminal Fermentation of Chemically Pre-Treated Sunflower Heads

peer reviewedThis study aims to provide possible utilization of sunflower head byproduct (SFH) as a feedstuff by implementing chemical pretreatments (4% sodium hydroxide (SFHNaOH) or 4% urea (SFHurea) and supplementation with either exogenous fibrolytic enzymes (EFE) or functional feed additive (FFA). The experimental EFE was a complex (1:1, v/v) of two enzyme products with high activity of β-1,3-1,4-glucanase and endo-1,4-β-D-xylanase and applied at 0 (SFHout), 1, 2, 5, and 10 µL/ gdry matter, while FFA was a fermentation byproduct rich in cellulase and xylanase activities, applied at 0 (SFHout), 0.5, 1, 2, and 4 mg/g DM. SFHurea had the highest (p < 0.05) crude protein (CP) content compared to other SFH substrates. Linear enhancements (p < 0.05) in kinetics of gas production (GP), metabolizable energy (ME), organic matter digestibility (OMD) and total short-chain fatty acids (SCFAs) concentrations were observed for all SFH substrates supplemented with EFE. The SFHout had the highest (p < 0.05) potential GP, maximum rate (Rmax) of GP, ME, OMD and SCFAs. Supplementation of EFE was more pronounced than FFA in affecting the kinetic parameters of in vitro GP for all SFH substrates. SFHout supplemented with EFE seems to be the most promising substrate to enhance microbial fermentation in vitro

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

Efeito da própolis sobre a fermentação ruminal, desempenho reprodutivo e produtivo de ovelhas Santa Inês

Propolis as natural dietary additive can be used to manipulate rumen fermentation towards less methane (CH4) and it may affect animal reproductive and productive performance. To study the application of propolis, three studies were conducted. The first study aimed to evaluate the in vitro nutritive value of two types of propolis (Brazilian red propolis (BRP) and Egyptian brown propolis (EBP) for their anti-methanogenic activity, ruminal fermentation and degradability. Propolis extracts were prepared using 70% ethanol and added to a 50:50 Tifton hay to concentrate diet at three levels [0 (negative control, CTL), 25, 50 and 100 micrograma / 0.5 g substrate]. Each propolis were compared with monensin as positive control. Both BRP50 micrograma and EBP25 micrograma showed similar significant effects on CH4 production as monensin; on average 14.2 ml/TDOM g compared with CTL (19.3 ml/TDOM). Monensin supplementation increased (P0.05) any of the observed reproduction traits, but there was promising improvement on the number of services per conceptions and hormones levels: increased (P<0.01) progesterone, decreased cortisol (P<0.05) and thyroxin (T4) (P<0.01) without significant changes in triiodothyronine (T3). Propolis resulted in increasing (P<0.01) of total leukocyte while there were no significant differences observed for other hematological parameters. Propolis increased (P<0.01) total protein and globulin but reduced (P<0.01) triglycerides, glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT) and fecal egg counts (P<0.05) compared with control. The third study was conducted to evaluate the oral administration of BRP extract to Santa Inês ewes from 25±3 day pre-partum through 48 d post-partum on milk yield, milk composition and lamb performance. Twenty Santa Inês ewes (60 ± 2.0 kg BW) were divided into two groups: control (basal diet) and BRP (basal diet plus 3.0g of BRP/ewe/day for 21 days). Milk samples were collected weekly for seven weeks. Propolis fed group showed increasing (P<0.05) milk yield, fat content, fat yield, protein yield, lactose yield and energy corrected milk while somatic cell counts was decreased (P<0.05). Propolis increased (P<0.05) ewes body condition score. Lambs average daily gain and milk conversion ratio were improved (P<0.05) by propolis treatment. The studies highlight the potential of propolis to handle the ruminal fermentation in order to reduce the production of CH4, as well as improved the health of ewes during the breeding season, besides increasing milk production and performance of lambsPrópolis, aditivo natural, pode ser usada para manipular a fermentação ruminal e diminuir a produção de metano (CH4), podendo afetar o desempenho dos animais. Foram conduzidos estudos visando avaliar a aplicação da própolis em ovinos. O primeiro experimento foi realizado com o objetivo de avaliar o valor nutritivo in vitro de dois tipos da própolis (Vermelho Brasileiro (PVB) e Marrom Egípcio (PME)), através da atividade antimetanogênica, fermentação ruminal e degradabilidade. Os extratos da própolis foram preparados usando etanol e adicionados a um substrato base (50:50 feno Tifton x concentrado) em quatro concentrações [0 (controle, CTL), 25, 50 e 100 micrograma / 0,5 g de substrato]; sendo comparadas com a monensina como controle positivo. As própolis PVB50 micrograma e PME25 micrograma apresentaram redução na produção de CH4 similar à monensina, sendo menores que o CTL. A monensina aumentou (P < 0,001) a concentração de proprionato e diminuiu (P < 0,001) a proporção de acetate / propionate, enquanto as própolis aumentaram (P < 0,002) as concentrações dos ácidos graxos voláteis e reduziram (P < 0,001) os protozoários. O segundo estudo objetivou avaliar a administração de extrato de PVB em ovelhas durante o período de \"flushing nutricional\" sobre o desempenho e a saúde dos animais durante a estação de reprodução. Trinta ovelhas (40 ± 2,0 kg PV) foram divididas em dois grupos, controle (dieta basal) e PVB (dieta basal com suplementação de 3,0 g de PVB / ovelha / dia) e suplementadas durante 21 dias. Amostras de sangue e fezes foram coletadas semanalmente durante oito semanas. Administração do PVB não afetou nenhuma característica reprodutiva, mas houve melhora (P < 0.01) no número de serviços por concepção, e aumento (P < 0,01) no teor de progesterona, diminuição (P < 0,01) nas concentrações de cortisol e tiroxina (T4), sem efeito na concentração de tri-iodotironina (T3). Própolis resultou apenas em aumento (P < 0,01) no número de leucócitos dentre os parâmetros hematológicos. A própolis aumentou (P < 0,01) a concentração de proteina total e de globulina, e reduziou (P < 0,05) os teores de triglicerídeos, transaminase oxalacética (TGO), transaminase glutamato piruvato (TGP) e contagem de ovos nas fezes quando comparado com o controle. O terceiro estudo foi conduzido para avaliar a administração do extrato de PVB para as ovelhas desde 25 ± 3 dias pré-parto até 48 dias pós-parto sobre a produção e composição do leite e desempenho dos cordeiros. Vinte ovelhas (56 ± 2,0 kg PV) foram divididas em dois grupos e suplementadas conforme descrito no segundo estudo: controle e PVB durante 21 dias. Amostras de leite foram coletadas semanalmente durante sete semanas. Própolis aumentou (P < 0,05) a produção de leite, conteúdo de gordura, rendimentos de gordura, proteína e lactose e leite corrigido para energia, enquanto diminuiu (P < 0,05) a contagem de células somáticas, mas aumentou (P < 0,05) a condição corporal. O ganho em peso médio diário dos cordeiros e taxa de conversão de leite foram melhoradas (P < 0,05) pelo tratamento com própolis. Os estudos destacam o potencial da própolis para manipular a fermentação ruminal visando redução na produção de CH4, assim como melhorar a saúde de ovelhas durante a estação de reprodução, além de aumentar a produção de leite e desempenho dos cordeiro

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

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this