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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

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

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

La lectura en voz alta para el fortalecimiento de la comprensión lectora

127 p.La lectura en voz alta para el fortalecimiento de la comprensión lectora responde a un trabajo de investigación realizado en la Institución Educativa Santa Rosa, sede José Cardona Hoyos, ubicada en la ciudad de Cali (Colombia) debido a las dificultades encontradas en materia de comprensión lectora en este establecimiento educativo, como también en otras del territorio colombiano al ser analizadas las pruebas ICFES y las pruebas PISA donde el rendimiento de los educandos es bajo en materia de lo que esta explícito en el texto, establecer relaciones, hacer suposiciones, inferir, emitir juicios sobre el texto leído, vocabulario escaso entre otras. El objetivo principal se enfatiza en describir el fortalecimiento de la comprensión lectora a partir de la lectura en voz alta en estudiantes del grado 4º-2, donde los objetivos específicos están encaminados a: a) identificar las estrategias desarrolladas por estudiantes y docentes para mejorar la comprensión lectora en el aula; b) identificar los niveles de comprensión que pueden alcanzar los estudiantes; c) puntualizar el aporte de la lectura en voz alta en la mejora de la comprensión lectora de los estudiantes participantes. La metodología empleada responde a una de carácter cuantitativo, con un tipo de investigación experimental, un diseño pre-experimental, y la utilización de la encuesta las pruebas estandarizadas (pre-test y post-test sustraídas del ICFES) como instrumentos de recolección de datos en una muestra de 30 estudiantes y 6 docentes. Teóricamente el trabajo se apoyó en autores como Jean Piaget, Lev Vygotsky y David Ausubel, cuyos postulados aportaron a esta investigación orientaciones esenciales sobre el qué y el cómo se aprende y sobre los factores que inciden en el aprendizaje, y sobre el diseño de estrategias metodológicas que fortalezcan el proceso de enseñanza aprendizaje. Los resultados de la investigación arrojaron una correlación significativa entre las variables comprensión lectora y lectura en voz alta a partir de la prueba de rangos de Wilcoxon que mostró un P-valor de 0,000 menor de alfa (Sig.) <0,05, aprobando la hipótesis: la lectura en voz alta fortalece la comprensión lectora de los estudiantes del grado 4º-2 de la I.E. Santa Rosa - sede José Cardona Hoyos - de Cali (Colombia). Asimismo, se concluye que los estudiantes pueden alcanzar los tres niveles de comprensión lectora a medida que se les proporcionen estrategias que incrementen y potencialicen sus habilidades, y que los aportes de la lectura en voz alta en los procesos de comprensión se ubican desde los componentes semántico, gramático, fonológico y la integralidad de las áreasReading aloud to strengthen reading comprehension responds to a research work carried out at the Santa Rosa Educational Institution, José Cardona Hoyos headquarters, located in the city of Cali (Colombia) due to the difficulties encountered in reading comprehension in this educational establishment, as well as in others of the Colombian territory when the ICFES tests and the PISA tests are analyzed where the performance of the students is low in terms of what is explicit in the text, establish relationships, make assumptions, infer, emit judgments about the text read, little vocabulary among others. The main objective is emphasized in describing the strengthening of reading comprehension from reading aloud in students from grade 4 to 2, where the specific objectives are aimed at: a) identifying the strategies developed by students and teachers to improve reading comprehension in the classroom; b) identify the levels of understanding that students can achieve; c) point out the contribution of reading aloud in improving the reading comprehension of participating students. The methodology used responds to a quantitative one, with a type of experimental research, a pre-experimental design, and the use of the survey, standardized tests (pre-test and post-test subtracted from ICFES) as data collection instruments. in a sample of 30 students and 6 teachers. Theoretically, the work was supported by authors such as Jean Piaget, Lev Vygotsky and David Ausubel, whose postulates contributed to this research essential orientations on what and how is learned and on the factors that influence learning, and on the design of methodological strategies that strengthen the teaching-learning process. The results of the research showed a significant correlation between the variables reading comprehension and reading aloud from the Wilcoxon rank test, which showed a P-value of 0.000 less than alpha (Sig.) <0.05, approving the hypothesis: reading aloud strengthens the reading comprehension of students in grade 4-2 of EI Santa Rosa - José Cardona Hoyos headquarters - from Cali (Colombia). Likewise, it is concluded that students can achieve the three levels of reading comprehension as they are provided with strategies that increase and enhance their abilities, and that the contributions of reading aloud in the comprehension processes are located from the semantic components , grammar, phonological and the integrality of the area

La lectura en voz alta para el fortalecimiento de la comprensi?n lectora

127 p.La lectura en voz alta para el fortalecimiento de la comprensi?n lectora responde a un trabajo de investigaci?n realizado en la Instituci?n Educativa Santa Rosa, sede Jos? Cardona Hoyos, ubicada en la ciudad de Cali (Colombia) debido a las dificultades encontradas en materia de comprensi?n lectora en este establecimiento educativo, como tambi?n en otras del territorio colombiano al ser analizadas las pruebas ICFES y las pruebas PISA donde el rendimiento de los educandos es bajo en materia de lo que esta expl?cito en el texto, establecer relaciones, hacer suposiciones, inferir, emitir juicios sobre el texto le?do, vocabulario escaso entre otras. El objetivo principal se enfatiza en describir el fortalecimiento de la comprensi?n lectora a partir de la lectura en voz alta en estudiantes del grado 4?-2, donde los objetivos espec?ficos est?n encaminados a: a) identificar las estrategias desarrolladas por estudiantes y docentes para mejorar la comprensi?n lectora en el aula; b) identificar los niveles de comprensi?n que pueden alcanzar los estudiantes; c) puntualizar el aporte de la lectura en voz alta en la mejora de la comprensi?n lectora de los estudiantes participantes. La metodolog?a empleada responde a una de car?cter cuantitativo, con un tipo de investigaci?n experimental, un dise?o pre-experimental, y la utilizaci?n de la encuesta las pruebas estandarizadas (pre-test y post-test sustra?das del ICFES) como instrumentos de recolecci?n de datos en una muestra de 30 estudiantes y 6 docentes. Te?ricamente el trabajo se apoy? en autores como Jean Piaget, Lev Vygotsky y David Ausubel, cuyos postulados aportaron a esta investigaci?n orientaciones esenciales sobre el qu? y el c?mo se aprende y sobre los factores que inciden en el aprendizaje, y sobre el dise?o de estrategias metodol?gicas que fortalezcan el proceso de ense?anza aprendizaje. Los resultados de la investigaci?n arrojaron una correlaci?n significativa entre las variables comprensi?n lectora y lectura en voz alta a partir de la prueba de rangos de Wilcoxon que mostr? un P-valor de 0,000 menor de alfa (Sig.) <0,05, aprobando la hip?tesis: la lectura en voz alta fortalece la comprensi?n lectora de los estudiantes del grado 4?-2 de la I.E. Santa Rosa - sede Jos? Cardona Hoyos - de Cali (Colombia). Asimismo, se concluye que los estudiantes pueden alcanzar los tres niveles de comprensi?n lectora a medida que se les proporcionen estrategias que incrementen y potencialicen sus habilidades, y que los aportes de la lectura en voz alta en los procesos de comprensi?n se ubican desde los componentes sem?ntico, gram?tico, fonol?gico y la integralidad de las ?reasReading aloud to strengthen reading comprehension responds to a research work carried out at the Santa Rosa Educational Institution, Jos? Cardona Hoyos headquarters, located in the city of Cali (Colombia) due to the difficulties encountered in reading comprehension in this educational establishment, as well as in others of the Colombian territory when the ICFES tests and the PISA tests are analyzed where the performance of the students is low in terms of what is explicit in the text, establish relationships, make assumptions, infer, emit judgments about the text read, little vocabulary among others. The main objective is emphasized in describing the strengthening of reading comprehension from reading aloud in students from grade 4 to 2, where the specific objectives are aimed at: a) identifying the strategies developed by students and teachers to improve reading comprehension in the classroom; b) identify the levels of understanding that students can achieve; c) point out the contribution of reading aloud in improving the reading comprehension of participating students. The methodology used responds to a quantitative one, with a type of experimental research, a pre-experimental design, and the use of the survey, standardized tests (pre-test and post-test subtracted from ICFES) as data collection instruments. in a sample of 30 students and 6 teachers. Theoretically, the work was supported by authors such as Jean Piaget, Lev Vygotsky and David Ausubel, whose postulates contributed to this research essential orientations on what and how is learned and on the factors that influence learning, and on the design of methodological strategies that strengthen the teaching-learning process. The results of the research showed a significant correlation between the variables reading comprehension and reading aloud from the Wilcoxon rank test, which showed a P-value of 0.000 less than alpha (Sig.) <0.05, approving the hypothesis: reading aloud strengthens the reading comprehension of students in grade 4-2 of EI Santa Rosa - Jos? Cardona Hoyos headquarters - from Cali (Colombia). Likewise, it is concluded that students can achieve the three levels of reading comprehension as they are provided with strategies that increase and enhance their abilities, and that the contributions of reading aloud in the comprehension processes are located from the semantic components , grammar, phonological and the integrality of the area

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

The PLATO Mission

International audiencePLATO (PLAnetary Transits and Oscillations of stars) is ESA's M3 mission designed to detect and characterise extrasolar planets and perform asteroseismic monitoring of a large number of stars. PLATO will detect small planets (down to &lt;2 R_(Earth)) around bright stars (&lt;11 mag), including terrestrial planets in the habitable zone of solar-like stars. With the complement of radial velocity observations from the ground, planets will be characterised for their radius, mass, and age with high accuracy (5 %, 10 %, 10 % for an Earth-Sun combination respectively). PLATO will provide us with a large-scale catalogue of well-characterised small planets up to intermediate orbital periods, relevant for a meaningful comparison to planet formation theories and to better understand planet evolution. It will make possible comparative exoplanetology to place our Solar System planets in a broader context. In parallel, PLATO will study (host) stars using asteroseismology, allowing us to determine the stellar properties with high accuracy, substantially enhancing our knowledge of stellar structure and evolution. The payload instrument consists of 26 cameras with 12cm aperture each. For at least four years, the mission will perform high-precision photometric measurements. Here we review the science objectives, present PLATO's target samples and fields, provide an overview of expected core science performance as well as a description of the instrument and the mission profile at the beginning of the serial production of the flight cameras. PLATO is scheduled for a launch date end 2026. This overview therefore provides a summary of the mission to the community in preparation of the upcoming operational phases