Cigarette smoking during breastfeeding in Papua New Guinea: Prevalence and demographic and socio-economic predictors

Background Cigarette smoking during breastfeeding is reported to contribute to significant changes in the composition of breast milk not only by reducing its protective features but also affecting infants' response to breastfeeding and breast milk. However, studies on the prevalence of cigarette smoking and associated factors during breastfeeding are limited in Papua New Guinea (PNG). This study estimates the prevalence of cigarette smoking and its association with demographic and economic factors among breastfeeding women in PNG. Methods We used weighted survey data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS). A weighted sample of 3, 822 women who were breastfeeding during the survey were included in the study. The outcome variable in the present study is current cigarette smoking. A multiple logistic regression analysis was used to estimate the association between current cigarette smoking status and socio-demographic and economic variables of breastfeeding women. The regression analysis results were reported using adjusted odds ratios (aOR) with their respective 95% confidence intervals (CIs). Results From the weighted sample, the prevalence of cigarette smoking among breastfeeding women was 21.9%; of which 60.8% smoked daily. The mean number of cigarettes smoked in the last 24 hours preceding the survey was 6.05(SD = 5.99). Multiple logistic regression analysis revealed that breastfeeding women who were from the Momase (aOR: 2.337, CI: 1.786-3.058, p<0.001) and Highlands (AOR: 1.589, CI: 1.213-2.082, p = 0.001), had no religious affiliation (aOR: 3.665, CI: 1.235-10.877, p = 0.019), and households with daughters as household heads (aOR: 1.901, CI: 1.231-2.935, p = 0.004) and being in more than one union (aOR: 2.374, CI: 1.805-3.123, p<0.001) were significantly more likely to smoke cigarette compared to women from southern region, those affiliated to Anglican church, those with husband as household heads, and being in one union respectively. Conclusion Cigarette smoking among breastfeeding women in PNG is relatively high, and region of residence, religion, relationship to household head, and the number of unions remain independent predictors. Interventions should target the individual socio-economic and cultural contexts within which breastfeeding occurs

Use and completion of partograph during labour is associated with a reduced incidence of birth asphyxia: a retrospective study at a peri-urban setting in Ghana

Background: Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony\u2019s Hospital, Dzodze, in the Volta Region of Ghana. Methods: A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered at St Anthony\u2019s Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. Results: The findings revealed that partographs were used by midwives at St Anthony\u2019s Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR (95% CI) 4.29 (1.35\u201314.81)], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR (95% CI) 5.31 (2.011\u201316.04)]. Conclusion: Midwives used partographs during labour at St Anthony\u2019s Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases

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

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Models and frameworks of mental health recovery: a scoping review of the available literature

Background The recovery approach involves providing a holistic and integrated service that is centered on and adapts to the aspirations and needs of consumers, who are seen as the expert on their health and well-being. Evidence is needed to address the current ambiguities related to the concept of recovery and its application. Aim A scoping review was conducted to identify papers describing theories, models, and frameworks of recovery to delineate the central domains of recovery. Methods Three literature search strategies were used: electronic database searching; hand-searching of key journals; and a reference list review of included papers. Inclusion criteria outlined theories, models and frameworks developed to support consumers' recovery and those supporting mental health professionals (MHPs) to deliver recovery-oriented services. Results Twelve studies (eleven articles and one book) were included in the review. The dimensions of recovery were synthesized into a framework named the Consolidated Framework for Recovery-oriented Services (CFRS). There are three domains within the framework: mechanisms/strategies; recovery as an internal process; and recovery as an external process. Each of these domains, as well as their relationships, are discussed. Conclusions The CFRS can be used by practitioners, researchers, funders, and collaborative members to conceptualize, implement, and evaluate recovery-oriented services

Family violence and COVID‐19: Increased vulnerability and reduced options for support

Family violence refers to threatening or other violent behaviours within families that may be physical, sexual, psychological, or economic, and can include child abuse and intimate partner violence (Peterman et al. 2020, van Gelder et al. 2020). Family violence during pandemics is associated with a range of factors including economic stress, disaster-related instability, increased exposure to exploitative relationships, and reduced options for support (Peterman et al. 2020). Due to the social isolation measures implemented across the globe to help reduce the spread of COVID-19, people living in volatile situations of family violence are restricted to their homes. Social isolation exacerbates personal and collective vulnerabilities while limiting accessible and familiar support options (van Gelder et al. 2020). In many countries, including Australia, we have already seen an increase in demand for domestic violence services and reports of increased risk for children not attending schools (Duncan, 2020), a pattern similar to previous episodes of social isolation associated with epidemics and pandemics (Boddy, Young &amp; O'Leary 2020). In Australia, as stay-at-home orders came into force, the police in some parts of the country reported a 40% drop in crime overall, but a 5% increase in domestic abuse call-outs (Kagi 2020). At the same time in Australia, Google reported a 75% increase in Internet searches relating to support for domestic abuse (Poate 2020)

Knowledge and Attitudes of Mental Health Professionals and Students Regarding Recovery in Australia

Introduction Recovery-oriented mental health practice is significant to the lives of people with severe mental illness as it promotes personal transformation and social inclusion. Despite the increasing attention to recovery-oriented practice, studies have identified several environmental and personal factors that affect its implementation. In view of this, research has been undertaken globally regarding the knowledge and attitudes of mental health professionals (MHPs), with focus on elements such as the non-linearity of recovery process and the role of self-definition and peers, to help improve professionals’ capabilities for delivering recovery-based practice. The Recovery Knowledge Inventory (RKI) has been primarily used in previous studies to assess health professionals and students’ knowledge across different developed countries including the United States of America (USA), Ireland, Japan, and Italy. However, previous studies and the RKI tool developers have identified issues with the RKI tool. To date, however, there have been limited empirical studies in Australia about recovery attitudes and knowledge, particularly among MHPs and students. The few existing studies largely address mental health nurses’ views of recovery within an acute setting, promoting recovery oriented practice in mental health services, and the lived experience of recovery from the perspective of consumers, carers and nurses. More so, the few empirical studies that have been undertaken in Australia have focused largely on qualitative or quantitative methods alone, with only a few employing mixed methods designs to achieve complexity and complementarity in data analysis. In addition, a preliminary empirical literature review showed that most of the commonly used instruments used currently to measure knowledge and attitudes regarding recovery were developed purposely for professionals, with no instruments specifically developed to assess students’ knowledge of and attitudes towards recovery. Methods This thesis is the first research study that has undertaken an exploratory sequential mixed methods study to develop greater in-depth understanding of mental health recovery; particularly regarding the measurement of knowledge and attitudes. The thesis was conceptualised in three phases: review of empirical papers, concepts, and theories; fieldwork (recruitment and data collection); and analysis of data. The first phase was used to identify the gap in the literature, especially empirical evidence, and review the available theories on recovery-oriented practices. Three papers were published as part of this phase of the thesis. This phase was also used to identify the common measure/s of mental health recovery knowledge and attitudes, and to identify their limitations. The second phase of the study involved field work. The phase purposively recruited 18 participants (10 MHPs and 8 students) to participate in an interview to explore the key elements related to recovery and recovery-oriented practice. The participants for the qualitative interviews were recruited until saturation occurred and when no new information emerged. These qualitative interviews also produced a publication in the thesis series. Subsequently, the information obtained from these literature reviews and qualitative interviews informed the revision and refinement of the RKI scale (with permission of the original authors). The revised draft items were then reviewed and modified by experts and stakeholders to determine face and content validity, and select the final items for quantitative analysis. The two-stage review panel consisted of eight members, including three practitioners (two who were also caregivers), two consumers, two mental health academics and a PhD student. The third phase recruited 173 (115 MHPs and 58 students) participants with an online survey using Qualtrics. The data were used for the validation of the adapted tool. The quantitative data were analysed using descriptive and inferential statistics, including exploratory factor analysis, reliability analysis, spearman correlation and Mann U Whitney Test. Phase three resulted in the development and psychometric testing of the adapted Recovery Knowledge and Attitudes (R-KAS) measure, and a paper that has also been submitted for publication. Results Findings from the three literature reviews showed increasing evidence regarding mental recovery. However, there were disparities in how MHPs perceive and understood recovery. Also, the final literature review identified several recovery measures in use that do not meet the evaluation criteria for psychometric properties. In addition, consumers were mostly excluded from the development of the measures or the conceptual construction that underpins the measures. The dimensions of recovery that were identified in this review were then synthesized into a conceptual framework named the Consolidated Framework for Recovery-oriented Services (CFRS). In the final phase, the empirical quantitative study produced an adapted scale, the R-KAS, which measures mental health recovery knowledge and attitudes among practitioners and trainees. This measure has three subscales of Competence, Roles and Responsibilities, and Process. The subscales within this adapted measure generally had excellent reliability. The results suggested that the practitioners and trainees mostly had high levels of knowledge and attitudes towards the recovery concept, specifically in areas of competence, roles and responsibilities and process issues. Conclusions and implications for policy and practice The thesis provides information on the global knowledge, attitudes and expectations of MHPs regarding recovery. Also, the various tools available to measure recovery have been organised and discussed. A new conceptual framework known as Consolidated Framework for Recoveryoriented Services (CFRS) has been developed. This framework can be used to implement, monitor and evaluate recovery services. Finally, the thesis has provided an adapted instrument that has utility in assessing practitioners and trainees’ knowledge and attitudes towards recovery. The instrument developed from this thesis is important to facilitate the delivery of appropriate mental health recovery-based training. The thesis concludes with implications for policies, mental health service provision, training of mental health professionals and students, as well as suggestions for future research

Knowledge and Attitudes of Mental Health Professionals and Students Regarding Recovery in Australia - Dataset

The data measures/assesses mental health professionals' and students' perspectives regarding mental health recovery. The data were collected between February 2021 and June 2022 from Australian mental health professionals and students. It consists of both qualitative and quantitative components. Specifically, the data were used to develop and test a tool to assess knowledge and attitudes toward recovery