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

A Study on the Ministries of Defence and National Security and Education, Heritage and Arts in Fijian Civil Service

학위논문(석사)--서울대학교 대학원 :행정대학원 글로벌행정전공,2019. 8. Im, ToBin.The way to delivery service to the public is through having a good human resource Department. In the era of new public management, there is a lot of pressure on the employees to remain competitive in the labor force. With changes in the human resource management practices such as from a lifelong employment to a contract based employment leave employee in the edge of being completive. The major objective of the research was to determine the impact of strategic human resource management practices on perceived employee outcomes in the Fijian civil service. The research was conducted on two ministries in the Fijian civil service through questionnaire survey. The questionnaire was developed based on the literature review and past questionnaire was referred to and refined to suit accordingly. To determine the result a statistical analysis was conducted on the data collected. Further, the data was analyzed using descriptive statistics, Cronbachs alpha, linear and multiple regression in order to test the hypothesis and answer the research questions. Following the analysis, the result showed that there is moderate impact of strategic human resource management practices on the job satisfaction and turnover intention in the Fijian civil service. Based on the findings from the analysis, recommendation were made in order to improve the level job satisfaction and reduce the turnover intention of employees in the Fijian civil service. Foremost, it was recommended that the ministries to stop giving wholesale training to employees. In addition, it was suggested that in order to maximum the job satisfaction level and minimum turnover intention of employee the human resource department should develop a checklist of the strategic human resource management policies development and implementation.대중에게서비스를제공하는방법은훌륭한인적자원부를갖는것이다. 신공공관리시대에는노동력에서경쟁력을유지해야한다는압박감이크다. 인적자원관리의 변화와 함께, 고용기반 계약으로 평생 고용과 같은 사례시행들은 직원들을 경쟁의 궁지로 몰게 된다. 본 연구의 주요 목적은 피지 공무원 중 인지된 직원 성과에 대하여 전략적 인적 자원 관리 시행의 영향을 살펴보고는 것이었다. 본 연구는 피지 2개 중앙부처의 공무원에 설문조사를 실시하였다. 설문지는 문헌 연구를 바탕으로 개발되었으며, 과거 설문지를 참고하여 연구에 맞게 수정하였다. 결과를 알아보기 위해 수집된 데이터에 대한 통계 분석을 진행하였다. 또한, 가설을 검증하고 연구 질문에 대답하기 위해 기술 통계, 크론바흐 알파값, 다중 회귀 분석을 사용하여 분석하였다. 분석 결과, 전략적 인적자원관리 시행이 피지 공무원의 업무 만족도와 이직 의도에 미치는 영향은 미미했다. 분석 결과를 바탕으로 피지 공무원의 업무 만족도를 높이고 이직 의도를 낮춰야 한다는 권고가 제시되었다. 무엇보다도, 공무원들에게 대규모로 전체 교육을 하지 말 것을 권고한다. 중앙부처는 공무원들에게 제공되는 교육의 질에 초점을 맞추어야 하며, 이 훈련은 공무원들의 문제 해결과 분석 능력을 향상시키기 위한 구성원 프로세스 구축 과정의 일환이라는 것이 중요하다. 또한, 업무 만족도의 극대화와 이직 의도 최소화를 위하여 인적자원부서는 전략적 인적자원관리 정책 개발 및 실행 지침의 체크리스트를 개발해야 한다. 가장 중요한 것은 인적자원부서는 하급직 공무원이 그들의 걱정을 제기할 수 있으며 그들이 가지고 있는 기술을 업무에 활용할 수 있도록 하는 "문호개방정책"을 실시해야 한다. 그리고 업무를 수행하기 위해 실질적 기대를 가질 수 있도록 구축해야 한다.Table of Contents Abstract ......................................................................................................................... i List of Abbreviations......................................................................................................v Annexation ...................................................................................................................vi List of Tables................................................................................................................vii List of Figures..............................................................................................................viii Chapter 1: Introduction................................................................................................ 1 1.1 Background of Study........................................................................................... 1 1.2 Statement of Problem ........................................................................................ 2 1.3 Significance of the Study .................................................................................... 6 1.4 Research Question and Research Objectives ..................................................... 7 1.5 Scope of the Study.............................................................................................. 8 1.6 Organization of the paper .................................................................................. 9 Chapter 2: Literature Review and Theoretical Background ....................................... 10 2.1 Introduction...................................................................................................... 10 2.2 The Concept of Human Resource Management .............................................. 10 2.3 Definition of Human Resource Management................................................... 11 2.4 Strategic Human Resource Management......................................................... 12 2.5 The Concept of Strategic Human Resource Management ............................... 13 2.6 Current Challenges and Trends in Human Resource Management.................. 16 2.7 Theoretical Background.................................................................................... 21 2.8 Review of Existing Literature on the Impact of Human Resource Management Practices and Employee outcomes:........................................................................ 31 2.9 The Human Resource Management Practices.................................................. 36 Chapter 3: Research Design and Methodology .......................................................... 47 3.1 Introduction...................................................................................................... 47 3.2 Research Design ............................................................................................... 47 3.3 Analytical Framework ....................................................................................... 49 3.4 Procedure for Data Collection .......................................................................... 51 3.5 Data Collection Method ................................................................................... 52 3.6 Data Measurement........................................................................................... 52 3.7 Sampling Method ............................................................................................. 53 3.8 Target Population of Study and Sample Size.................................................... 54 3.9 Data Analysis .................................................................................................... 55 iv 3.10 Validity and Reliability .................................................................................... 55 3.11 Statistical Treatment ...................................................................................... 56 Chapter 4: Data Presentation, Analysis and Interpretations of Data ......................... 58 4.1 Data Analysis .................................................................................................... 58 4.2 Descriptive Analysis.......................................................................................... 59 4.3 Reliability Test .................................................................................................. 73 4.4 Pearson Correlation Analysis............................................................................ 74 4.5 Testing Hypothesis ........................................................................................... 77 4.6 Discussion on the Major Findings..................................................................... 87 Chapter 5: Implications, Recommendation and Conclusion ...................................... 98 5.1 Review of Research Questions ......................................................................... 98 5.2 Recommendations.......................................................................................... 100 5.2.1 Formal structured training systems......................................................... 100 5.3 Implications.................................................................................................... 102 5.4 Limited of the study........................................................................................ 105 5.5 Future Direction.............................................................................................. 106 5.6 Conclusion ...................................................................................................... 107 Bibliography.............................................................................................................. 109 Annexation ............................................................................................................... 121 Questionnaire....................................................................................................... 121 국문초록.................................................................................................................. 126 Acknowledgment......................................................................................................Maste

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

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

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally