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

Rural Australian community pharmacists' views on complementary and alternative medicine: a pilot study

<p>Abstract</p> <p>Background</p> <p>Complementary and alternative medicines (CAMs) are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS) in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study.</p> <p>Methods</p> <p>A cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics.</p> <p>Results</p> <p>Eighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books.</p> <p>Conclusions</p> <p>Pharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to address the gaps in attitudes, knowledge and to improve effectiveness of information seeking behaviour.</p

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

Essentials of Job Attitudes and Other Workplace Psychological Constructs

https://digitalcommons.montclair.edu/all_books/1452/thumbnail.jp

Using Careless Responding Indices to Predict In-Role Performance, OCBs, and CWBs

The quality of questionnaire data hinges on participants’ willingness to provide careful responses. Some research participants, unfortunately, respond after only skimming the contents of a given study questionnaire. In more extreme cases, participants may respond without reading the questionnaire content at all. This symposium examines recent advances in careless responding researc

sj-docx-1-orm-10.1177_10944281231223127 - Supplemental material for Building a Bigger Toolbox: The Construct Validity of Existing and Proposed Measures of Careless Responding to Cognitive Ability Tests

Supplemental material, sj-docx-1-orm-10.1177_10944281231223127 for Building a Bigger Toolbox: The Construct Validity of Existing and Proposed Measures of Careless Responding to Cognitive Ability Tests by Mark C. Ramsey and Nathan A. Bowling in Organizational Research Methods</p

The Moderating Effects of Personality on the Relationship Between Change in Work Stressors and Change in Counterproductive Work Behaviors

We examined the relationship between change in work stressors and change in counterproductive work behaviours ( CWBs) over 6 months using three waves of data. Increases in work stressors (i.e., interpersonal conflict and organizational constraints) were positively associated with both increases in CWBs (trend effects) and subsequent levels of CWBs (delayed-reaction effects). Personality characteristics (i.e., agreeableness and conscientiousness) were examined as moderators of the trend effects and delayed-reaction effects. As expected, the trend effect was stronger for low-agreeableness (or low-conscientiousness) workers than for high-agreeableness (or high-conscientiousness) workers. Contrary to expectations, however, the delayed-reaction effect was not consistently moderated by personality. We recommend that organizations recognize the potential for delayed consequences when estimating the effects of changes to the work environment. Organizations may also consider using individually tailored training methods (based on the worker\u27s unique personality) to instruct workers about effective coping strategies. Practitioner points Unfortunately for organizations, the nature of the work stressor- CWB relationship is likely more complex than could be previously understood utilizing cross-sectional data. Organizations should be aware that CWBs could increase concurrently with an increase in work stressors (trend effect) and subsequently after an extended increase in work stressors has occurred (delayed-reaction effect)., The potential presence of both immediate and delayed CWB responses to change in work stressors may indicate that the damage caused by work stressors is often underestimated. Organizations need to be more aware of the potential delayed costs of changes in work stressors for financial forecasting, programme development, and policy change., Organizations should be particularly concerned about an increase in work stressors immediately resulting in CWBs among low-conscientiousness or low-agreeableness workers. Efforts to educate workers about effective coping strategies could be tailored based on the employee\u27s personality. Managers, however, should be aware that low-conscientiousness or low-agreeableness workers may be particularly vulnerable to delayed effects of increasing work stressors

Mean Job Satisfaction Levels Over Time: Are Things Bad and Getting Worse?

The article discusses a study which tested two hypotheses relating to job satisfaction. In the first hypothesis, workers generally report higher job satisfaction levels as compared to the midpoint of the satisfaction scale. In the second hypothesis, the levels of mean job satisfaction will remain consistently higher as compared to the satisfaction scale\u27s mid-point from one year to the next. Several datasets were used to test the hypotheses including the General Social Survey (GSS)