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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Estudio de prefactibilidad para la creación de una planta de producción de plaguicidas orgánicos

Los alimentos orgánicos, especialmente frutas y vegetales, no habían tenido gran participación en la canasta familiar durante los últimos años, esto debido a sus altos precios comparados con los productos tradicionales (no orgánicos). Con el boom de lo natural y lo Light que existe actualmente, el consumidor, a nivel mundial, ha adquirido nuevos hábitos de consumo, incidiendo positivamente en la demanda de estos productos. Sumándose a lo anterior, se encuentra que los productores se enfrentan ante unos costos muy superiores a los de la agricultura tradicional debido a que el mantenimiento de los cultivos es altamente tecnificado, demandando algunos insumos que muchas veces no se encuentran en el país. Aprovechando esta oportunidad, se desea conocer que tan factible es la creación de una planta procesadora de plaguicidas orgánicos que fortalezca la gestión de los productores de alimentos orgánicos a través de la minimización de sus costosIncluye bibliografí

Challenges in economic growth, education and gas emission greenhouse effect for sustainable development of Sincelejo

Al analizar a nivel nacional el desarrollo sostenible de las ciudades, se observan progresos al incluir criterios y acciones asociadas a las dimensiones fundamentales del desarrollo económico, social y ambiental, en lo concerniente a la gestión de ciudad. Partiendo de esa idea, la presente investigación se propuso describir el comportamiento de elementos fundamentales para la sostenibilidad como el crecimiento económico, educación y emisión de gases efecto invernadero para el desarrollo sostenible de Sincelejo. Los resultados revelan que en materia de crecimiento económico el departamento de Sucre registró una tasa promedio de 3,2%, los recaudos por concepto de impuesto de industria y comercio, utilizada como variable proxy del PIB de la ciudad de Sincelejo, muestran que se mantuvo un comportamiento promedio creciente del 8.84%. Con respecto a la dimensión social, el promedio de años de escolaridad de la ciudad aumentó de 6.5 años en 2005 a 7.2 años en el 2015. Finalmente, la dimensión ambiental indica una mayor concentración de la población en el área urbana, de 93.64%; con relación a las actividades económicas y productivas se encontró que generan niveles elevados de gases efecto invernadero (GEI), equivalentes a 75% del total de emisiones, mostrando que al transporte, con 33% es el subsector que produce más GEI.When analyzing the current advances or setbacks at the national level in terms of the sustainable development of cities, progress can be observed by including criteria and actions associated with the fundamental dimensions of development: economic, social and environmental in its management of the city. The research proposed to describe the behavior of economic growth, education and greenhouse gas emissions for the sustainable development of Sincelejo as fundamental elements for the sustainability of the city. In terms of economic growth, the department of Sucre registered an average growth rate of 3.2%, the collections for the industry and commerce tax, used as a proxy variable for the GDP of the city of Sincelejo, maintained an increasing average behavior of 8.84%. Regarding the social dimension, the average number of years of schooling in the city increased from 6.5 years in 2005 to 7.2 years in 2015. Finally, the environmental dimension shows a greater concentration of the population in the urban area (93.64%) area in which it is implemented. economic and productive activities that generate higher levels of greenhouse gases (GHG) equivalent to 75% of total emissions, showing transportation as the largest GHG-generating subsector with 33%

La lúdica como estrategia de aprendizaje para fomentar la comprensión lectora de textos narrativos

La presente monografía titulada "La lúdica como estrategia de aprendizaje para fomentar la comprensión lectora de textos narrativos" pretende orientar sobre el uso de la lúdica como una estrategia de aprendizaje con el fin de propiciar la comprensión lectora en los estudiantes. Esto a través de los planteamientos de Piaget sobre la teoría psicogenetica, Daniel Cassany quien habla sobre las metodologías de la comprensión lectora y de Jiménez que muestra la lúdica como estrategia de aprendizaje, todo esto para mejorar el nivel motivacional en los procesos de lectura, a fin de optimizar su proceso de enseñanza y aprendizaje que contribuya a la formación de individuos capaces de transformar su propia realidad.PregradoLicenciado(a) en Educación Básica con Énfasis en Humanidade

Conceptos clave de la gestión cultural. Volumen I

Esta obra tiene como objetivo brindar un primer acercamiento al lenguaje de la gestión cultural en Latinoamérica. Un intento de poner en palabras, de realizar una reflexión de lo que se hace y se piensa desde diversos luga res de nuestras múltiples y extensas realidades que nos caracterizan. Como tal, estos conceptos que presentamos están abiertos y en movimiento, y a partir de ello se pueden armar y desarmar, construir y deconstruir, diversos enfoques y tendencias que buscan dar sentido a una gestión cultural latinoamericana que se encuentra en la búsqueda de sí misma. En gran parte de la historia de nuestra práctica, hemos recibido las influencias externas de las formas de hacer, pensar y nombrar la acción cultural. Por tal motivo, y como resultado de múltiples procesos de formalización o profesionalización, nos vemos en la necesidad de tener claridad de los conceptos y diseñar formas posibles de deslindar campos respecto a las importaciones, en muchos casos mecánicas y fuera de lugar, al mismo tiempo que nos llevan a revisar críticamente la forma en que nos vemos y somos vistos. Los términos aquí expuestos buscan dar sentido a una práctica que se viene realizando desde hace muchos años y que necesita ser pensada. No pretenden ser homogéneos ni hegemónicos, sino contribuir a la reflexión de una gestión cultural que cada vez más se perfila como la posibilidad de constituirse en un referente de la acción cultural en Latinoamérica

Revista Red GRID edición 2

En primer lugar, deseo felicitar a los estudiantes que han desarrollado la iniciativa de hacer esta revista a partir del trabajo en la asignatura Taller de Diseño Editorial en colaboración con los miembros del Club de Diseño Editorial Red Grid. Tanto el proyecto de la revista como el desarrollo del club son iniciativas de formación complementaria en las que los estudiantes tienen la posibilidad de desarrollar competencias y habilidades personales, interpersonales y profesionales. Vale la pena resaltar que hoy en día, un buen profesional no solo es capaz de entender temáticas relacionadas con su profesión mediante un proceso lógico de pensamiento, de resolver problemas profesionales basados en el conocimiento aprendido y de proponer desarrollos innovativos en áreas de aplicación de su conocimiento, lo cual ya es bastante. Adicionalmente, hoy en día se requiere que un profesional haya desarrollado competencias personales e interpersonales muy diversas, como la autonomía, el manejo del tiempo, el trabajo en equipo, la capacidad para atender múltiples frentes simultáneamente, ser capaz de asumir y hacer frente a la presión que el trabajo puede generar, etc. Sin estas competencias al profesional le resultará muy complicado poder aplicar su conocimiento en distintos contextos. Por Alberto De Castro Correa Vicerrector Académico Universidad del Nort

Ciudades sostenibles: Un enfoque diferenciado del desarrollo de las ciudades

La innovación se ha posicionado como el motor que impulsa el desarrollo de las naciones. Desde las grandes economías de las potencias mundiales hasta economías emergentes propias de países en desarrollo, han implementado Innovación en sus procesos productivos, logrando con ello posicionar sus economías regional y mundialmente. La innovación se apoya en la I+D, y esta, a su vez, se fortalece con los recursos destinados por las naciones. En el caso de Colombia, es grande el reto en materia de investigación, es necesario la concientización de que, a mayor inversión, más número de investigadores realizando estudio, más modernizadas las empresas y un mayor crecimiento económico regional