Construction and Implementation of First Aid Courses in Rural Populations: A Narrative Review

Colombia has been through five decades of civil war and unrest between the state and guerrilla groups and is currently in the process of healing. Several measures have been taken to aid the peace process, one of them being the Colombian-Norwegian cooperation Rural Health for Peace (RHfP) that aims to strengthen primary health care (PHC) in the areas most afflicted by the war. A previous study done by Søndenå (verbal communication, not yet published) have shown that even though there is no state funded health care in a rural village in Colombia, the inhabitants there make up their own kind of “micro healthcare” with the resources they have. The need for a first aid course was mentioned during the interviews Søndenå carried out. There is a strong local will to act, so there is a potential for targeted training to further enhance learning in regard to health. The purpose of this thesis is thus to perform a literature search to explore what a first aid course in a rural setting could and should contain

Evolutionary Instability of Collateral Susceptibility Networks in Ciprofloxacin-Resistant Clinical Escherichia coli Strains

ABSTRACT Collateral sensitivity and resistance occur when resistance development toward one antimicrobial either potentiates or deteriorates the effect of others. Previous reports on collateral effects on susceptibility focus on newly acquired resistance determinants and propose that novel treatment guidelines informed by collateral networks may reduce the evolution, selection, and spread of antimicrobial resistance. In this study, we investigate the evolutionary stability of collateral networks in five ciprofloxacin-resistant, clinical Escherichia coli strains. After 300 generations of experimental evolution without antimicrobials, we show complete fitness restoration in four of five genetic backgrounds and demonstrate evolutionary instability in collateral networks of newly acquired resistance determinants. We show that compensatory mutations reducing efflux expression are the main drivers destabilizing initial collateral networks and identify rpoS as a putative target for compensatory evolution. Our results add another layer of complexity to future predictions and clinical application of collateral networks. IMPORTANCE Antimicrobial resistance occurs due to genetic alterations that affect different processes in bacteria. Thus, developing resistance toward one antimicrobial drug may also alter the response toward others (collateral effects). Understanding the mechanisms of such collateral effects may provide clinicians with a framework for informed antimicrobial treatment strategies, limiting the emergence of antimicrobial resistance. However, for clinical implementation, it is important that the collateral effects of resistance development are repeatable and temporarily stable. Here, we show that collateral effects caused by resistance development toward ciprofloxacin in clinical Escherichia coli strains are not temporarily stable because of compensatory mutations restoring the fitness burden of the initial resistance mutations. Consequently, this instability is complicating the general applicability and clinical implementation of collateral effects into treatment strategies

Construction and Implementation of First Aid Courses in Rural Populations: A Narrative Review

Colombia has been through five decades of civil war and unrest between the state and guerrilla groups and is currently in the process of healing. Several measures have been taken to aid the peace process, one of them being the Colombian-Norwegian cooperation Rural Health for Peace (RHfP) that aims to strengthen primary health care (PHC) in the areas most afflicted by the war. A previous study done by Søndenå (verbal communication, not yet published) have shown that even though there is no state funded health care in a rural village in Colombia, the inhabitants there make up their own kind of “micro healthcare” with the resources they have. The need for a first aid course was mentioned during the interviews Søndenå carried out. There is a strong local will to act, so there is a potential for targeted training to further enhance learning in regard to health. The purpose of this thesis is thus to perform a literature search to explore what a first aid course in a rural setting could and should contain