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

La evolución de la familia japonesa vista a través del cine: "Cuentos de Tokio" y "Una familia de Tokio"

This article is a comparative study of two films, Tokyo Story (1953) and Tokyo Family (2013). They show the same family story in two different periods. The objective of this analysis is to understand the evolution of Japanese family unit over time.Este artículo es un estudio comparativo de dos películas, Cuentos de Tokio (1953) y Una familia de Tokio (2013), que muestran la historia de una misma familia en dos épocas distintas. El objetivo de este análisis es entender la evolución de la unidad familiar japonesa a lo largo del tiemp

Corrupción política, transparencia y movimientos ciudadanos: una aproximación comparativa entre China y Japón

La corrupción política es uno de los temas que más preocupan al gobierno de Xi Jinping y a la sociedad china en general. En este artículo se analizan los efectos perjudiciales de la corrupción sobre determinadas variables sociales, económicas e institucionales. En primer lugar, se presenta el estado actual de la corrupción política en China y se exploran algunos movimientos sociales surgidos como respuesta a este fenómeno. Como indicadores de corrupción se han utilizado el índice de percepción de la corrupción (elaborado por Transparencia Internacional) y el índice de control de la corrupción (uno de los seis indicadores de gobernabilidad desarrollados por el Banco Mundial). A continuación, se ha extendido el estudio a Japón por tratarse de un país de contexto político y económico distinto al de China. A partir de los datos obtenidos, se ha realizado una aproximación comparativa del estado de la corrupción entre los dos países y se han estudiado las correlaciones de los indicadores anteriores con el grado de libertad (publicado por la Casa de la Libertad) y con el producto interior bruto per cápita (publicado por el Banco Mundial) en los últimos años. Political corruption is one of the most important issues for the Xi Jinping´s government and Chinese society in general. This article analyses the harmful effects of corruption on certain social, economic and institutional variables. First, it presents the current state of political corruption in China and it explores some social movements that have emerged in response to this phenomenon. The corruption perceptions index (prepared by Transparency International) and the control of corruption index (one of the six governance indicators developed by the World Bank) have been used as indicators of corruption. The study was then extended to Japan as a country with a different political and economic context than China. Based on the data obtained, a comparative analysis of the state of corruption between the two countries was carried out. We have studied the correlations of the previous indicators with the degree of freedom (published by Freedom House) and with the Gross Domestic Product per capita (published by the World Bank) in recent years.

Talleres : una metodología par alumnos con necesidades educativas especiales

Este proyecto desarrolla una metodología que permita, a alumnos con necesidades educativas especiales, superar las dificultades psíquicas, sensoriales y motóricas que les impide integrarse en la dinámica de clase, y les capacite para su desenvolvimiento autónomo en la familia, sociedad y mundo laboral. Los objetivos son planificar un curriculum adaptado a las necesidades de estos alumnos; potenciar la funcionalidad en los aprendizajes; lograr que los alumnos desarrollen al máximo su autonomía; incrementar el trabajo en pequeños grupos homogéneos con los que pueda identificar y realizar actitudes conjuntas; crear actividades didácticas motivadoras que faciliten la implementación de este curriculum. Se continúa con las formas de trabajo anteriores y se refuerza con la creación de talleres entre los que destacan el Taller de autonomía y habilidades sociales; el de alimentación, cocina y consumo; el de sociedad y actualidad; el de habilidades y destrezas manipulativas. Se confeccionan disfraces, recetas de cocina, murales y trabajos de artesanía; se realizan salidas a mercadillos y supermercados, juegos cooperativos; se celebran cumpleaños; y solicitan y rellenan documentos. La participación del alumno depende del nivel educativo y sus características. La evaluación es continua y se valora la utilidad de los materiales, la implicación y satisfacción del alumnado y profesorado y se registra en una ficha de actividad para cada alumno y en el informe de evaluación trimestral que se manda a las familias. Existe propuesta de continuidad. Incluye un anexo con las actividades realizadas..Madrid (Comunidad Autónoma). Consejería de EducaciónMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

NolR Regulates Diverse Symbiotic Signals of Sinorhizobium fredii HH103

We have investigated in Sinorhizobium fredii HH103-1 (=HH103 Strr ) the influence of the nolR gene on the production of three different bacterial symbiotic signals: Nod factors, signal responsive (SR) proteins, and exopolysaccharide (EPS). The presence of multiple copies of nolR (in plasmid pMUS675) repressed the transcription of all the flavonoid-inducible genes analyzed: nodA, nodD1, nolO, nolX, noeL, rhcJ, hesB, and y4pF. Inactivation of nolR (mutant SVQ517) or its overexpression (presence of pMUS675) altered the amount of Nod factors detected. Mutant SVQ517 produced Nod factors carrying N-methyl residues at the nonreducing N-acetyl-glucosamine, which never have been detected in S. fredii HH103. Plasmid pMUS675 increased the amounts of EPS produced by HH103-1 and SVQ517. The flavonoid genistein repressed EPS production of HH103-1 and SVQ517 but the presence of pMUS675 reduced this repression. The presence of plasmid pMUS675 clearly decreased the secretion of SR proteins. Inactivation, or overexpression, of nolR decreased the capacity of HH103 to nodulate Glycine max. However, HH103-1 and SVQ517 carrying plasmid pMUS675 showed enhanced nodulation capacity with Vigna unguiculata. The nolR gene was positively identified in all S. fredii strains investigated, S. xinjiangense CCBAU110, and S. saheli USDA4102. Apparently, S. teranga USDA4101 does not contain this gene.Comisión Interministerial de Ciencia y Tecnología (CICYT), Gobierno de España BIO99-0614-C03 y BOS2002-04164-C03-0

Identificación, desarrollo y evaluación de competencias docentes en la aplicación de planes de formación dirigidos a profesorado universitario

Este artículo presenta el proyecto desarrollado durante el año 2011 por las unidades y centros de formación de las universidades públicas catalanas. El proyecto se orienta a la mejora de la calidad del sistema de educación superior y de la actividad del profesorado universitario mediante planes de formación específicamente diseñados con esta finalidad, centrándose primeramente en la identificación de competencias docentes definidas por la comunidad académica. Partiendo del contexto de implementación del Espacio Europeo de Educación Superior se identifican aquellas competencias propias de la función docente, para que posteriormente puedan ser adquiridas, desarrolladas y evaluadas mediante la formación, identificando modelos, estrategias, instrumentos y recursos que lo permitan. El proceso de identificación de las competencias docentes del profesorado universitario se ha desarrollado partiendo de una revisión bibliográfica del estado del arte, para posteriormente ser modificada y validada por grupos de discusión conformados por expertos en competencias y formación docente. Los resultados de identificación de dichas competencias han sido finalmente refrendados mediante una Torra, I. et.al. Identificación de competencias docentes que orienten el desarrollo de planes… 22 encuesta respondida por una muestra representativa de la comunidad académica de las ocho universidades públicas catalanas. El objetivo fundamental del proyecto que aquí presentamos no es otro que el de contribuir a una formación de calidad del profesorado universitario, que permita la adquisición, desarrollo y evaluación de las competencias que, como docente, gran parte de la comunidad académica considera que debe poseer para el ejercicio de su labor profesional, definidas como: interpersonal, metodológica, comunicativa, de planificación y gestión de la docencia, de trabajo en equipo y de innovación.Postprint (published version

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe