Mielenterveysvaikutusten ennakkoarviointi : MIVA käyttöön

Hyvä mielenterveys on keskeistä yksilöiden, yhteisöjen ja yhteiskunnan hyvinvoinnille ja menestykselle. Kunnat ja hyvinvointialueet voivat päätöksillään ja toimillaan tukea monin tavoin asukkaidensa mielenterveyttä. Mielenterveyden edistäminen ja mielenterveyshäiriöiden ehkäisy edellyttävät, että mielenterveyskysymykset huomioidaan paitsi sosiaali- ja terveysalan päätöksissä hyvinvointialueilla, myös esimerkiksi kunnan koulutus-, asunto- ja ympäristöpolitiikkaan, yhteisöllisyyteen ja kestävään kehitykseen liittyvissä päätöksissä. Mielenterveysvaikutusten ennakkoarviointi tuottaa tietoa päätöksen mahdollisista ja todennäköisistä vaikutuksista asukkaiden mielenterveydelle. Tietoon perustuvilla päätöksillä voidaan lisätä asukkaiden hyvinvointia, vaikuttaa kunnan ja hyvinvointialueen toimivuuteen, vakauteen ja kustannuksiin. Suomessa on toistaiseksi arvioitu mielenterveysvaikutuksia kuntapäätösten valmistelussa verrattain vähän, eikä yhtenäistä toimintamallia ole olemassa. Arviointeja on tehty esimerkiksi kuraattoripalveluihin, kehitysvammahuollon asuinpalveluihin, mielenterveyspalveluiden resurssointiin ja kouluihin liittyvien päätösten valmistelussa. Tässä raportissa esitellään konkreettinen toimintamalli, jonka tarkoituksena on yhdenmukaistaa, selkeyttää ja helpottaa kuntien ja hyvinvointialueiden mielenterveysvaikutusten ennakkoarviointia.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa.(tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Background Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals. Methods National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis. Findings Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] Kpneurnoniae and 402 (15%) Ecoli). 850 (37%) of 2301 Kpneumoniae samples and 77 (19%) of 402 Ecoli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1.1.3 patients per 10000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics. Interpretation This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Entero-bacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks

Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

Public health interventions to control the current epidemic of carbapenem-resistant Klebsiella pneumoniae rely on a comprehensive understanding of its emergence and spread over a wide range of geographical scales. We analysed the genome sequences and epidemiological data of >1,700 K. pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae. We demonstrate that carbapenemase acquisition is the main cause of carbapenem resistance and that it occurred across diverse phylogenetic backgrounds. However, 477 of 682 (69.9%) carbapenemase-positive isolates are concentrated in four clonal lineages, sequence types 11,15,101, 258/512 and their derivatives. Combined analysis of the genetic and geographic distances between isolates with different beta-lactam resistance determinants suggests that the propensity of K. pneumoniae to spread in hospital environments correlates with the degree of resistance and that carbapenemase-positive isolates have the highest transmissibility. Indeed, we found that over half of the hospitals that contributed carbapenemase-positive isolates probably experienced within-hospital transmission, and interhospital spread is far more frequent within, rather than between, countries. Finally, we propose a value of 21 for the number of single nucleotide polymorphisms that optimizes the discrimination of hospital clusters and detail the international spread of the successful epidemic lineage, ST258/512

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Background Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it difficult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the first structured survey on the occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in European hospitals. Methods National expert laboratories recruited hospitals with diagnostic capacities, who collected the first ten carbapenem non-susceptible clinical isolates of K pneumoniae or E coli and ten susceptible same-species comparator isolates and pertinent patient and hospital information. Isolates and data were relayed back to national expert laboratories, which made laboratory-substantiated information available for central analysis. Findings Between Nov 1, 2013, and April 30, 2014, 455 sentinel hospitals in 36 countries submitted 2703 clinical isolates (2301 [85%] Kpneurnoniae and 402 (15%) Ecoli). 850 (37%) of 2301 Kpneumoniae samples and 77 (19%) of 402 Ecoli samples were carbapenemase (KPC, NDM, OXA-48-like, or VIM) producers. The ratio of K pneumoniae to E coli was 11:1.1.3 patients per 10000 hospital admissions had positive clinical specimens. Prevalence differed greatly, with the highest rates in Mediterranean and Balkan countries. Carbapenemase-producing K pneumoniae isolates showed high resistance to last-line antibiotics. Interpretation This initiative shows an encouraging commitment by all participants, and suggests that challenges in the establishment of a continent-wide enhanced sentinel surveillance for carbapenemase-producing Entero-bacteriaeceae can be overcome. Strengthening infection control efforts in hospitals is crucial for controlling spread through local and national health care networks