D5.8-Policy Paper 3-Policy recommendationstopromote mutual understanding between refugees andlocal communities in Europe

This report has been submitted by Greek Forum of Refugees as deliverable D5.8 within the framework of H2020 project "SO-CLOSE: Enhancing Social Cohesion through Sharing the Cultural Heritage of Forced Migrations" Grant No. 870939.Based on the project's activities and the tools implementation and considering the experiences and perceptions of selected stakeholders, this policy paper attempts to assess needs, identify challenges, and draw policy relevant recommendations about the shared experience of forced displacement between refugees and the local communities in Europe. Specifically, the paper draws from the four pilots organised between 2021-2022 and the 15 focus groups and 197 semi-structured individual interviews conducted in 2020 across the following four EU Member States: Italy, Spain, Poland, and Greece. The historical background and the socio-political and cultural context of each country configure a unique local context for each pilot case. Through the development of digital tools and cultural products, SO CLOSE aims at facilitating physical and virtual cultural exchanges between forcefully displaced populations from past and contemporary conflicts as well as local communities and amplifying rich, and emotional co-created narratives

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

Correlation of injury mechanism with the severity of injury in passenger vehicles' crashes

This work correlates the mechanism of injury with its severity and the final prognoses of the vehicle’s occupants. The aim was to arrive to conclusions for the improvement of the secondary and tertiary' prevention of car accidents. Collisions that took place between January 2000 and September 2001 were evaluated. All vehicles whose crash severity using the absorbed energy through the Crash 3 algorithms could not be evaluated were excluded. Also, airbag-carrying vehicles and vehicles whose passengers were ejected were also excluded. 73 vehicles and 127 passengers were studied; 89 of the passengers were involved in head-on collisions, 34 in lateral and 4 in rear ones. 58 passengers involved in small energy collisions, 46 involved in moderate energy and 23 involved in high impact collisions were evaluated. Out of 80 front seat passengers involved in head-on collisions (FSO), 31 used seat- belts whereas 49 were not. The bigger the severity of the impact, the higher was the possibility of having used seat- belts. Not significant difference was noted in small energy crashes between passengers using seat-belts with those who did not. On the other hand, significant difference was noted in moderate energy crashes. The increase of energy from small to moderate increases the possibility of admittance to the hospital of FSO not using seat-belts, while it does not affect FSO using seat-belts. The more severe the deformations of the passenger compartment in vehicles without compartment intrusion, the more severe the injury of FSO and the higher the possibility of hospital admittance. In side-impact crashes, the passengers sitting in the side of the compartment intrusion suffer from more severe injuries than those of the passengers without compartment intrusion and those with compartment intrusion on the adverse side.Η έρευνα συσχετίζει τον μηχανισμό της κάκωσης με την σοβαρότητα της κάκωσης και την τελική πρόγνωση των επιβατών των οχημάτων, με σκοπό την εξαγωγή συμπερασμάτων για την βελτίωση τόσο της δευτερογενούς όσο και της τριτογενούς πρόληψης του τροχαίου ατυχήματος. Μελετήθηκαν οι συγκρούσεις που πραγματοποιήθηκαν από τον Ιανουάριο του 2000 έως τον Σεπτέμβριο του 2001. Αποκλείστηκαν τα οχήματα στα οποία δεν ήταν δυνατός ο υπολογισμός της σοβαρότητας της σύγκρουσης βάσει της ενέργειας που απορροφήθηκε από την σύγκρουση υπολογισμένης με τους αλγόριθμους του Crash 3. Επίσης αποκλείστηκαν οχήματα με άνοιγμα αερόσακου λόγω του μικρού τους αριθμού και οχήματα στα οποία ο επιβάτης εκτινάχθηκε έξω από το όχημα. Μελετήθηκαν 73 οχήματα και 127 επιβάτες, από τους οποίους 89 επέβαιναν σε μετωπικές συγκρούσεις, οι 34 σε πλάγιες και οι τέσσερις σε οπίσθιες. Μελετήθηκαν 58 επιβάτες που συμμετείχαν σε μικρής ενέργειας συγκρούσεις, 46 που συμμετείχαν σε μέτριας και 23 που συμμετείχαν σε μεγάλης σφοδρότητας συγκρούσεις. Από τους 80 επιβάτες μπροστινών θέσεων μετωπικών συγκρούσεων (FSO) οι 31 φορούσαν ζώνη ασφαλείας και οι 49 δεν φορούσαν. Όσο μεγαλύτερη ήταν η σφοδρότητα της σύγκρουσης τόσο μεγαλύτερη ήταν η πιθανότητα χρήσης ζώνης ασφαλείας. Δεν υπήρχε σημαντική διαφορά στην βαρύτητα της κάκωσης FSO που δεν φορούσαν ζώνης ασφαλείας με FSO που φορούσαν ζώνη ασφαλείας σε συγκρούσεις μικρής ενέργειας ενώ υπήρχε σημαντική διαφορά στην βαρύτητα της κάκωσης FSO που δεν φορούσαν ζώνης ασφαλείας με FSO που φορούσαν ζώνη ασφαλείας σε συγκρούσεις μέτριας ενέργειας. Η αύξηση της ενέργειας από μικρή σε μέτρια αυξάνει την πιθανότητα εισαγωγής σε νοσοκομείο FSO που δεν φορούσαν ζώνη ασφαλείας ενώ δεν την αυξάνει σε FSO που φορούσαν ζώνη ασφαλείας. Όσο περισσότερες ήταν οι παραμορφώσεις της καμπίνας των επιβατών, σε οχήματα χωρίς εισχώρηση της καμπίνας, τόσο βαρύτερη ήταν η κάκωση των FSO και τόσο αυξανόταν η πιθανότητα εισαγωγής σε νοσοκομείο. Σε πλάγιες συγκρούσεις οι επιβάτες που κάθονται στην πλευρά όπου υπάρχει εισχώρηση της καμπίνας έχουν βαρύτερες κακώσεις από τους επιβάτες οχημάτων χωρίς εισχώρηση καμπίνας ή με εισχώρηση καμπίνας στην αντίθετη πλευρά

Knowledge is power: studying critical incidents in intensive care

Despite their difficult definition and taxonomy, it is imperative to study critical incidents in intensive care, since they may be followed by adverse events and compromised patient safety. Identifying recurring patterns and factors contributing to critical incidents constitutes a prerequisite for developing effective preventive strategies. Self-reporting methodology, although widely used for studying critical incidents, has been criticized in terms of reliability and may considerably underestimate both overall frequency and specific types of them. Promotion of non-blaming culture, analysis of critical incident reports and development of clinical recommendations are expected to minimize critical incidents in the future

CoCross: An ICT Platform Enabling Monitoring Recording and Fusion of Clinical Information Chest Sounds and Imaging of COVID-19 ICU Patients

Monitoring and treatment of severely ill COVID-19 patients in the ICU poses many challenges. The effort to understand the pathophysiology and progress of the disease requires high-quality annotated multi-parameter databases. We present CoCross, a platform that enables the monitoring and fusion of clinical information from in-ICU COVID-19 patients into an annotated database. CoCross consists of three components: (1) The CoCross4Pros native android application, a modular application, managing the interaction with portable medical devices, (2) the cloud-based data management services built-upon HL7 FHIR and ontologies, (3) the web-based application for intensivists, providing real-time review and analytics of the acquired measurements and auscultations. The platform has been successfully deployed since June 2020 in two ICUs in Greece resulting in a dynamic unified annotated database integrating clinical information with chest sounds and diagnostic imaging. Until today multisource data from 176 ICU patients were acquired and imported in the CoCross database, corresponding to a five-day average monitoring period including a dataset with 3477 distinct auscultations. The platform is well accepted and positively rated by the users regarding the overall experience