Project Lotus: A really cool community-based initiative assisting women post-homelessness

In Canada, recent conservative estimates report upwards of 235,000 individuals are homeless on a given night. Of those experiencing precarious housing situations, women make up approximately 30% and are among the most vulnerable. Their residential insecurity has been further exacerbated with the community and social restrictions of the COVID-19 pandemic. Existing resources that assist women experiencing homelessness or housing insecurity are often stretched to the limit dealing with emergency and crisis housing situations, with less focus on post-shelter supports. To address this issue, a community-based participatory research initiative ‘Project Lotus - Hope Together’ was established in Montreal. Grounded in the World Health Organization’s Commission on Social Determinants of Health Framework, the overarching goal of this research is to co-design a housing supports program for women leaving a shelter stay. We created a cross-sectorial Advisory Committee consisting of women with lived experiences of homelessness, service providers, community leaders, and researchers. To date, we have conducted preliminary research (literature review, interviews with women with lived experience of homelessness, stakeholder meetings) to identity what has assisted women through this transition, and what barriers exist. We have also held virtual community consultation meetings to discuss preliminary findings of recommendations of key components that should be in a post-shelter support program for women. This presentation outlines the current findings and highlights the importance of participatory research. Implementing whole person care in the area of women’s homelessness requires both a comprehensive and individualized approach to help women and children secure home, health, and a sustainable future

Avaliação das queixas auditivas e das otoemissões acústicas em funcionários do Complexo Hospitalar Universitário da Universidade Federal do Pará com COVID-19 / Evaluation of hearing complaints and otoacoustic emissions in employees of the University Hospital Complex of the Universidade Federal do Pará with COVID-19

Objetivo: Avaliação objetiva e subjetiva de queixas auditivas em indivíduos com doença do coronavírus 19 (COVID-19). Métodos: Estudo prospectivo, observacional realizado com 76 funcionários do Complexo Hospitalar Universitário da Universidade Federal do Pará (UFPA) os meses setembro a outubro de 2020, através de protocolo de pesquisa, otoscopia, otoemissões acústicas (OEA) e audiometria. Resultados: A presença de queixas auditivas durante o quadro de COVID-19 não foi corroborada por alterações nos exames de OEA e audiometria. Somente 11% dos pacientes com queixas auditivas apresentaram alteração na OEA. As queixas auditivas apareciam em média de sete a nove dias do início do quadro e 48% dos participantes relataram apresentar sintomas como zumbido e hipoacusia. O comprometimento auditivo relatado possui provavelmente uma característica autolimitada, pois 89% dos entrevistados já relatavam ter notado melhora. Não foi observado correlação com outros sintomas neurológicos e as queixas auditivas. As queixas auditivas não foram maiores no grupo de participantes expostos à ototoxicidade. Conclusão: As queixas auditivas foram relatadas por 48%, porém este achado não significou alterações nos resultados na OEA e na audiometria

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

Enhancing the relevance of Shared Socioeconomic Pathways for climate change impacts, adaptation and vulnerability research

This paper discusses the role and relevance of the shared socioeconomic pathways (SSPs) and the new scenarios that combine SSPs with representative concentration pathways (RCPs) for climate change impacts, adaptation, and vulnerability (IAV) research. It first provides an overview of uses of social–environmental scenarios in IAV studies and identifies the main shortcomings of earlier such scenarios. Second, the paper elaborates on two aspects of the SSPs and new scenarios that would improve their usefulness for IAV studies compared to earlier scenario sets: (i) enhancing their applicability while retaining coherence across spatial scales, and (ii) adding indicators of importance for projecting vulnerability. The paper therefore presents an agenda for future research, recommending that SSPs incorporate not only the standard variables of population and gross domestic product, but also indicators such as income distribution, spatial population, human health and governance

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

Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial

The high intensity diode laser has been studied in periodontics for the reduction of subgingival bacteria in non-surgical treatment. Our study evaluated the bacterial effect as well as changes in periodontal clinical parameters promoted by root scaling and planing associated with this wavelength. Twenty-seven patients randomly assigned in two groups underwent root scaling and planing on the tested sites, and only the experimental group received the diode laser irradiation. Among the clinical parameters studied, the clinical probing depth (CPD) and the clinical attachment level (CAL) resulted in significant enhancement in the control group when compared with the experimental group (P = 0.014 and P = 0.039, respectively). The results were similar for both groups regarding the plaque index (PI) and bleeding on probing (BP). No significant difference in the microbiological parameters was observed between the control and experimental groups. It was possible to conclude that the high power diode laser adjunct to the non-surgical periodontal treatment did not promote additional effects to the conventional periodontal treatment.Fundacao de Amparo a Pesquisa no Estado de Sao Paulo (FAPESP)[2005/56965-8]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

REVIEW SUMMARY ◥ SUSTAINABILITY Systems integration for global sustainability

BACKGROUND: Many key global sustainability challenges are closely intertwined (examples are provided in the figure). These challenges include air pollution, biodiversity loss, climate change, energy and food security, disease spread, species invasion, and water shortages and pollution. They are interconnected across three dimensions (organizational levels, space, and time) but are often separately studied and managed. Systems integration-holistic approaches to integrating various components of couple