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

Tax Planning and its impact on the profitability of the advertising company PDV Latin Group Lima 2021

La empresa PDV Latin Group S.A.C. cuenta con más de 15 años en el mercado de la publicidad de medios en los puntos de venta en la ciudad de Lima. Además, cuenta con contratos de exclusividad con diferentes marcas comerciales de consumo masivo. Asimismo, cuenta con diferentes homologaciones y certificaciones necesarias para poder competir en el mercado de servicios publicitarios. Luego de analizar los estados financieros de la empresa, documentos referidos al cierre del ejercicio, cálculo de impuesto y las comunicaciones generadas por contingencias fiscales, se establece que la empresa carece de planificación tributaria en su gestión empresarial. La empresa refleja una inadecuada estrategia fiscal para poder pagar en justa medida los tributos establecidos por ley; esto último ocasiona pérdidas y falta de previsión en el flujo de efectivo empresarial afectando su rentabilidad. Por lo expuesto anteriormente, se toma como conclusión que PDV Latin Group S.A.C. necesita una adecuada planificación tributaria que pueda proyectar el devengo de impuestos y anticipar los flujos necesarios para el pago de los mismos evitando contingencias con la administración tributaria; asimismo, como consecuencia de lo anterior se podrá ampliar la rentabilidad de la compañía con el ahorro y planificación tributaria.The company PDV Latin Group S.A.C. It has more than 9 years in the advertising market in Peru. In addition, it has contracts with different mass consumption commercial brands. Likewise, it has different approvals and certifications necessary to be able to compete in the advertising services market. After analyzing the company's financial statements, documents referring to the year-end, the tax calculation and the communications generated by tax contingencies, it is established that the company lacks tax planning in its business management. The company reflects an inadequate fiscal strategy to be able to fairly pay the taxes established by law; The latter causes losses and lack of forecast in business cash flow, affecting its profitability. Based on the above, it is concluded that PDV Latin Group S.A.C. needs adequate tax planning that can project the accrual of taxes and anticipate the flows necessary for their payment, avoiding contingencies with the tax administration; Likewise, as a consequence of the above, the company's profitability can be expanded with tax savings and planning.Trabajo de Suficiencia Profesiona

Train your mind

La presente investigación parte de la importancia que cumplen las habilidades blandas en el ámbito personal y laboral, siendo un elemento esencial en el desarrollo social de las personas de hoy en día. Entrena tu mente es una empresa dedicada a prestar servicios de entrenamiento para desarrollar y/o fortalecer habilidades blandas. La empresa está dirigida a hombres y mujeres profesionales y estudiantes con nivel socioeconómicos A y B en Lima metropolitana. Nuestro servicio ofrece entrenamientos para el desarrollo de habilidades blandas. Este está conformado por dos líneas de negocio. La línea individual, exclusiva para profesionales e independientes y la línea corporativa dirigida a empresas que necesiten potenciar las relaciones interpersonales en sus equipos de trabajo. Para ello, se ha desarrollado tres módulos conformados por siete habilidades a trabajar. Nuestra ventaja competitiva es ayudar a los clientes a desarrollar sus habilidades y de esa manera puedan tomar mejores decisiones en diferentes situaciones de su vida. Esto se logrará mediante una metodología innovadora y personalizada a través de ejercicios y juegos lúdicos con un seguimiento constante por nuestros asesores certificados. Contamos con un equipo especializado en Administración de empresas, Marketing y Contabilidad; el cual nos brinda el soporte profesional que nos permite el desarrollo de nuestro proyecto con el objetivo de optimizar recursos y poder maximizar los ingresos.The following research is based on the importance of soft skills and its role in the personal growth and the workplace, which currently performs an essential part in the social development of people. «Entrena tu mente» is an organization dedicated to provide specific and custom training services in order to develop and enhance soft skills. The service is designed for professionals and students of any gender in the A or B socioeconomic scale of Lima. Our service consists of two business lines. In first place, the individual line, which is exclusively aimed to professional employees and for self-employed clients. Second, the executive line which main objective is to reinforce interpersonal relationships in the working place of different enterprises. To accomplish this, the program is designed based on 3 stages of 7 skills to improve. Our competitive advantage is the application of an innovative and customized methodology. This methodology consists in training services and dynamic games with constant monitoring of our certified advisors in order to help the customers to develop their skills, and, in this way, brace them to make better choices in different life circumstances. We have a specialized team in Business Management & Administration, Marketing and Accounting; which gives us the professional support that allows us to fulfill the objectives of resource optimization and profit maximization.Trabajo de investigació

Gestión empresarial: El reto del entorno frente a las nuevas tecnologías, emprendimiento y vida laboral

Human beings perceive and interact in the hospital world through their senses, through sight, hearing, and, to a lesser extent, through smell, touch, and taste, in which labor sensorially shapes the worker’s body. The research aims to show the sensitive interaction of hospital personnel and the labor shaping of the worker's senses. To that end, covert ethnographic method, field diary, and interview were used. Four interviews were carried out to the custodian staff and one to the administrative support staff. All four interviews showed affectation by the hospital world and a sensory configuration of the staff. Moreover, the social setting of the hospital sensorially shaped the body of its personnel, where the interacting bodies adapt to the space, which is influenced by the affective state, becoming larger or smaller depending on this state.El ser humano percibe e interactúa en el mundo hospitalario a través de sus sentidos, mediante la vista, el oído y, en menor medida, por el olfato, el tacto y el gusto, enlos que la labor configura sensorialmente el cuerpo del trabajador. El objetivo de la investigación es mostrar la interacción sensible del personal del mundo hospitalario y la conformación laboral de los sentidos del trabajador. Se empleó la etnografía encubierta, el diario de campo y la entrevista. Se realizaron cuatro entrevistas con personal de intendencia y una con personal administrativo de apoyo. Las cuatro entrevistas mostraron una afectación por el mundo hospitalario y una configuración sensorial del personal. El establecimiento social del hospital delineó sensorialmente el cuerpo de su personal, donde los cuerpos interactuantes se adaptan al espacio, que es influenciado por el estado afectivo, haciéndose más grande o reduciéndose en función de este estad