Fusobacterium Is Associated with Colorectal Adenomas

The human gut microbiota is increasingly recognized as a player in colorectal cancer (CRC). While particular imbalances in the gut microbiota have been linked to colorectal adenomas and cancer, no specific bacterium has been identified as a risk factor. Recent studies have reported a high abundance of Fusobacterium in CRC subjects compared to normal subjects, but this observation has not been reported for adenomas, CRC precursors. We assessed the abundance of Fusobacterium species in the normal rectal mucosa of subjects with (n = 48) and without adenomas (n = 67). We also confirmed previous reports on Fusobacterium and CRC in 10 CRC tumor tissues and 9 matching normal tissues by pyrosequencing. We extracted DNA from rectal mucosal biopsies and measured bacterial levels by quantitative PCR of the 16S ribosomal RNA gene. Local cytokine gene expression was also determined in mucosal biopsies from adenoma cases and controls by quantitative PCR. The mean log abundance of Fusobacterium or cytokine gene expression between cases and controls was compared by t-test. Logistic regression was used to compare tertiles of Fusobacterium abundance. Adenoma subjects had a significantly higher abundance of Fusobacterium species compared to controls (p = 0.01). Compared to the lowest tertile, subjects with high abundance of Fusobacterium were significantly more likely to have adenomas (OR 3.66, 95% CI 1.37–9.74, p-trend 0.005). Cases but not controls had a significant positive correlation between local cytokine gene expression and Fusobacterium abundance. Among cases, the correlation for local TNF-α and Fusobacterium was r = 0.33, p = 0.06 while it was 0.44, p = 0.01 for Fusobacterium and IL-10. These results support a link between the abundance of Fusobacterium in colonic mucosa and adenomas and suggest a possible role for mucosal inflammation in this process

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 social ecological, relationship-based strategy for parent involvement: Families And Schools Together (FAST)

Purpose – Most schools struggle to get busy and stressed parents to come repeatedly to the school building for events. At primary schools, especially those with pupils living in low-income communities or with many immigrants, involving parents to come at all is seen as a challenge. The purpose of this paper is to present a social ecological strategy of using the school building as a site for families to gather and for community networks to grow by building relationships between parents who have same-aged children attending that school. When families know other families, they feel more comfortable coming into the school building, and probably will return frequently. Design/methodology/approach – A large randomised controlled trial of 52 urban schools with an average of 73 per cent Latino students situated in disadvantaged neighbourhoods in the USA has data to examine the impact of this strategy on parent involvement. Parents of all first-grade students (age 6 or 7) at schools assigned either to Families and Schools Together (FAST) or services-as-usual were invited to participate. At schools with the social ecological strategy universal invites were made to those in the study to attend any one of eight weekly multi-family group sessions offered after-school at the building. Trained teams were culturally representative of the families (language, ethnicity) and made up of local parents and professionals; each team hosted up to ten families in a hub for two and a half hours (83 families attended at one session). Parents were socially included, treated with respect, coached by the team to lead a family meal, singing, family crafts and games at a family table. Parent time (respite) was provided with chat-time in pairs, followed by parent-led discussion groups. Parents were coached in one to one time, “child-led” responsive play for 15 minutes. Findings – Parent involvement data showed that on average, 43.6 per cent of all first-grader’s families (an average of 44 families per school) attended at least one session; of those, who attended at least one session, 69 per cent returned for another. On average, of those families who attended at least once, the average family went four times; an average of 22 families per school attended six or more sessions. Parent graduates led monthly booster sessions open to all families. In half of the families, both fathers and mothers attended; immigrant parents attended statistically significantly more than native-born ones. In surveys, more parents in schools with FAST vs control reported attending three or more events at school. Practical implications – The FAST programme encourages the involvement of reluctant parents in school events. This benefits both children’s general well-being and academic attainment and so contributes to preventative public health strategies. Originality/value – This paper brings new perspectives to the challenges faced by educators in involving parents at school by a sociologist-led research team introducing a social worker-developed social ecological, systemic strategy to schools in low-income communities using a randomised controlled design. This novel social ecological approach has consistently and effectively engaged whole families into increased involvement in schools in 20 countries, especially in low-income communities. Headteachers consistently report increased school engagement of FAST parent graduates for years, suggesting that the early intensity builds ongoing relationships of trust and reciprocity across home, school and community. Policy makers should note that building social capital in disadvantaged communities through partnerships with parents and schools can result in decreased disparities in health, social care and education

Cultural adaptation of an evidence-based parenting programme with elders from South East Asia in the US: co-producing Families and Schools Together – FAST

Purpose – Without some flexibility, replications of manualised evidence-based programmes (EBP) may not achieve predictable outcomes due to differences in cultural priorities. In this case study, Families and Schools Together (FAST) was co-produced with elders from a community of Hmong political refugees in the US Mid-West. The paper aims to describe and evaluate the process of culturally adapting and implementing this universal parenting programme. Design/methodology/approach – Observations of FAST groups to monitor programme integrity and notes on adaptation discussions were undertaken. Quantitative evaluations of parents in the first cohort (2 FAST groups) used a wait-list control, randomised strategy, using three standardised instruments completed by the parents three different times. Data from five matched pairs of parent graduates (10) randomly assigned to “FAST now” or “FAST later” were analysed using one-tailed, paired t-tests. Findings – Hmong parents and elders reported satisfaction on the cultural fit of FAST across the four groups, which graduated on average seven families each. Of 38 low-income families who attended FAST once, 78 percent attended six or more sessions, in other words 22 percent dropped out. Parents reported statistically significant improvements in child anxiety (CBCL internalizing), child social skills (SSRS) and family adaptability (FACES II), with no changes in CBCL externalizing or family cohesion. Originality/value – The paper provides a detailed study and evaluation of how an EBP can be successfully implemented with a highly socially marginalized group of immigrants in a Western society