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

The Journey Experience of Visually Impaired People on Public Transport in London

The use of public transport is critical for Visually Impaired People (VIP) to be independent and have access to out-of-home activities. Despite government policies promoting accessible transport for everyone, the needs of VIP are not well addressed, and journeys can be very difficult to negotiate. Journey requirements can often differ from those of other categories of people on the disability spectrum. Therefore, the aim of this research is to evaluate the journey experience of VIP using public transport. Semi-structured interviews conducted in London are used. The results show that limited access to information, inconsistencies in infrastructure and poor availability of staff assistance are the major concerns. Concessionary travel, on the other hand, encourages VIP to make more trips and hence has a positive effect on well-being. The findings suggest that more specific policies should be introduced to cater to the special needs of particular disabilities rather than generalising the types of aids available. It is also concluded that the journey experience of VIP is closely related to an individual’s independence and hence inclusion in society

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

The journey experience of visually impaired people on public transport in London

The use of public transport is critical for Visually Impaired People (VIP) to be independent and have access to out-of-home activities. Despite government policies promoting accessible transport for everyone, the needs of VIP are not well addressed, and journeys can be very difficult to negotiate. Journey requirements can often differ from those of other categories of people on the disability spectrum. Therefore, the aim of this research is to evaluate the journey experience of VIP using public transport. Semi-structured interviews conducted in London are used. The results show that limited access to information, inconsistencies in infrastructure and poor availability of staff assistance are the major concerns. Concessionary travel, on the other hand, encourages VIP to make more trips and hence has a positive effect on well-being. The findings suggest that more specific policies should be introduced to cater to the special needs of particular disabilities rather than generalising the types of aids available. It is also concluded that the journey experience of VIP is closely related to an individual\u27s independence and hence inclusion in society

Enablers and Barriers of a Cross-Cultural Geriatric Education Distance Training Programme: The Singapore-Uganda Experience

Background: By 2050, 80% of the world&rsquo;s older population will reside in developing countries. There is a need for culturally appropriate training programs to increase awareness of eldercare issues, promote knowledge of how to better allocate resources to geriatric services, and promulgate elder-friendly policies. A monthly distance geriatric education programme between a public hospital in Singapore and health institute in Uganda was implemented. This study explored the enablers and barriers to the delivery of culturally appropriate geriatric education programmes via a videoconferencing platform. Methods: We conducted 12 in-depth interviews with six teachers from Singapore and six learners from Uganda. The interviews were audio-recorded, transcribed and analyzed using an inductive thematic approach to analysis with the aid of the NVivo software. Results: Enablers included inter-personal real-time interactions between teachers and learners whereas misaligned perceptions of cross-cultural differences between Singaporean teachers and Ugandan learners were a barrier. Rapport building, teacher motivation and institutional support were perceived to contribute to the programme&rsquo;s sustainability. Overall, Ugandan learners perceived that the training improved knowledge, skills, attitude and practice of geriatric care. Participants suggested that future initiatives consider aligning cross-cultural perceptions between partners, conducting a training needs analysis, exploring complementary modes of information dissemination, and allotting time for more interaction, thereby reinforcing mutual sharing. Adequate publicity and appropriate incentivisation may also better sustain the programme. Conclusions: Our findings suggest that cross-cultural training via a videoconferencing platform was feasible. Our results inform planners of future distance educational programmes of how to improve standards of cross-cultural competency and forge promising international partnerships

Structurally robust phosphorescent [Pt(O^N^C^N)] emitters for high performance organic light-emitting devices with power efficiency up to 126 lm W-1 and external quantum efficiency over 20%

© the Partner Organisations 2014. A series of robust, bulky and strongly emissive platinum(ii) complexes supported by tetradentate O^N^C^N ligands with tert-butyl groups (1-4), a bridging tertiary amine (5) or a biphenyl group with a spiro linkage (6) at the periphery of the [O^N^C^N] ligand scaffold have been prepared. Their photophysical properties were examined by absorption and emission spectroscopy, density functional theory calculations, and ultra-fast time-resolved emission measurements. These complexes display emission quantum yields of up to 95%, with emission maxima λmax in the range of 522 to 570 nm, and have a good thermal stability of up to Td > 423 °C. Notably, the kq values of 4-6 are in the range of 8.5 × 106 to 2.0 × 107 mol-1 dm3 s-1, smaller than those (∼108 to 109 mol-1 dm3 s-1) of other reported Pt(ii) complexes. The bulky groups at the periphery of the [O^N^C^N] ligand disfavour intermolecular interactions and hence excimer formation in solutions. These complexes are good light-emitting materials (dopants) for OLEDs, since the triplet-triplet annihilation (TTA) and concentration quenching effect arising from intermolecular interactions can be minimized even at a high dopant concentration. The efficiency of the devices fabricated with 4-6 increased with dopant concentration up to a high level of 10% with no extra emitting component or significant shift in the CIE observed. The maximum power efficiency (PE) values achieved for the 5 (yellow-emitting) and 6 (green-emitting) based devices were 118 and 126 lm W-1, respectively. These PE values are the highest among the reported Pt(ii)-OLEDs and comparable to those of the best reported Ir(iii)-OLEDs without the out-coupling technique. Complex 7 is structurally analogous to, but less bulky than 3-6 and is prone to giving excimer emission in the solid state. A high PE of up to 55.5 lm W-1 and external quantum efficiency of up to 25.1% have been realized in the white OLEDs fabricated with 7 as a single emitting material. These values are comparable with those of the best reported WOLEDs based on a single emitting material. This journal isLink_to_subscribed_fulltex