The hypotheses of this study are that reduction and rational usage of antibiotics reduces development of antibiotic resistance. In Sweden, the trends do not follow this pattern. Despite a decrease in prescriptions of antibiotics, there is an increase in the number of patients infected with Methicillin-resistant Staphylococcus Aureus (MRSA), Extended Spectrum Beta-Lactamases (ESBL) and ESBL selecting for carbapenem-resistance (ESBLCARBA). This study aims to study factors affecting antibiotic resistance management. An additional aim is to use a multidisciplinary approach for a subject that has mostly been studied with quantitative methods. First, linear regressions investigated any possible significant changes of prescription rates in outpatient care, hospital usage of antibiotic groups and antibiotic resistance. After this, nine interviews were conducted with physicians in outpatient care, hospital care and with representatives from the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (Strama), a network working for Swedish prevention against antibiotics resistance. There was a significant decrease in the number of prescriptions of antibiotics in outpatient care among all Swedish counties and a small, but significant increase of antibiotics used in hospitals. The number of patients infected with multidrug resistant bacteria also show a significant increase. The interviews revealed that health care workers in all counties follow the same guidelines and try to be as specific as possible in choosing antibiotics to hit specific bacteria. The respondents suggested migration and extended travelling as explanations to the growing number of cases of multidrug resistant bacteria. Further, two major factors emerged as important for an efficient antibiotic resistance management; Education/knowledge and Discussion. The results indicate a need for further research on rational usage of antibiotics and the use of broad-spectrum antibiotics in hospital care, rather than the reduction through prescriptions. The results indicate that rational usage has a bigger impact than reduction. Using a multidisciplinary approach gave a broader perspective on the issue and future studies should see the possibilities of mixing quantitative and qualitative studies.

Includes bibliographical references / Introduction: Tuberculosis (TB) notification in South Africa has increased six fold over the last two decades mainly because of the Human Immunodeficiency Virus (HIV) epidemic. Globally, it was estimated that 73% of the TB cases were co-infected with HIV with more than 25% of this global co-infection burden being in South Africa alone. In 2012, globally 1.3 million deaths occurred due to TB; moreover 0.3 million were HIV-associated TB death. In 2010 TB was the leading cause of natural deaths in the population aged 15 to 24 years accounting for 14% of the total deaths in South Africa. In 2013 the proportion of patients with TB who were co-infected with HIV was extremely high at 62%.The outcome of co-infected patients was poorer than the outcome of HIV negative TB patients. However, there is little information available on the risk factors associated with TB treatment outcomes and the influence of co-infection. Method: A cross sectional study analysed Electronic TB Register (ETR.net) data from the Metro East Geographic Service Area (GSA) of the Cape Town Metro district. The dataset included adult patients aged 15 years or more, who initiated TB treatment between 1st July 2011 and 30th June 2012. In the descriptive analysis we analysed death separately but for the regression we merged death with unfavourable treatment outcome. Relative risks were used for measures of association. Univariate and multivariate analyses were performed using a generalized linear regression model. Statistically significant variables in the univariate analysis were included in the multivariate analysis. Findings: TB case notification in Eastern GSA was 922 per 100 000 population. Of the 12672 TB patients registered, 50% were co-infected with HIV. The incidence of death in co-infected was 5% versus 3% in uninfected, treatment success 67% versus 73% and unfavourable treatment outcome 28% versus 24%. The Khayelitsha sub-district had the highest proportion of the TB burden (37%) and of co-infection (65%). Fourteen percent of patients had extra-pulmonary TB (EPTB), 66% of whom were co-infected with HIV. In the multivariate analysis HIV (RR 1.2), retreatment (RR 1.4) and sputum smear microscopy not done (RR 1.4) were significantly associated with unfavourable treatment outcome. The sub districts Eastern (RR 0.9) and Northern (RR 0.7) were less likely to develop unfavourable outcome compared to Khayelitsha. In the stratified analysis, retreatment (RR 1.3) and smear not done (RR 1.3) were significant risk factors for an unfavourable treatment outcome in co-infected patients. Amongst HIV negative patients retreatment (RR 1.6) and smear not done (RR 1.6) were significant risk factors for an unfavourable treatment outcome. Conclusions: The incidence of TB is extremely high in the Eastern GSA of Cape Town however the prevalence of co-infection varies across the sub-districts. Although treatment outcomes have been improving, co-infection, retreatment and smear microscopy not done pre-treatment were factors significantly associated with an unfavourable treatment outcome. Eastern and Northern sub-districts were significantly more likely to have favourable treatment outcomes compared to Khayelitsha, where both TB incidence and HIV co-infection were greatest.

No description available.

BACKGROUND: The needle exchange programme (NEP) started in Sweden in 1986 in Lund and shortly after in Malmo. The first NEP in Stockholm opened in spring 2013. The NEP is a service aimed at intravenous drug users (IDU) from 18 years old, with a goal of preventing the blood borne diseases, such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV). With the on going HIV and Hepatitis epidemics, numerous countries around the world have adopted control strategies, such as the NEP to halt the spread of HIV, HBV, and HCV. The objective of this study was to examine if the needle exchange programme has decreased the incidence of HIV, HBV, and HCV in Sweden over a six-year period.  METHODS: Data for incidence and prevalence was extracted from the yearly reports of the Stockholm’s needle exchange programme from 2013 to 2018 and the yearly reports of the public health agency in Sweden from 2013 to 2018. The data was collected for Stockholm, and compared to Västra Götaland, and the whole of Sweden. RESULTS: The incidence of HIV was zero in 2013 and 2015 in the NEP. The incidence of HBV decreased to zero in 2013 in the NEP. There is an increased incidence of HCV in the NEP. CONCLUSION: The NEP has a protective effect through its combination of needle exchange, opiate substitute therapy, counselling, and vaccinations in reducing and stabilising incidences of the infections, in some instances to zero, as well as providing surveillance and treating infections.

Introduktion: Infektioner är vanligt bland barnen i förskolan. Vissa infektioner är av mer allvarlig karaktär, som antibiotikaresistenta bakterier. Det ger konsekvenser för samhället och folkhälsan, men innebär även en arbetsmiljörisk för personal på förskolan.Syfte: Att undersöka hur väl förskolechefer/rektorer följer arbetsmiljölagstiftningens krav på hygien och förebyggande smittskyddsåtgärder.Metod: Kvantitativ studie där en webbenkät skickades ut till 163 förskolechefer/rektorer i kommunala och fristående förskolor i tre olika regioner (Västra Götaland, Stockholm och Västmanland). Svaren analyserades med hjälp av statistikprogrammet SPSS, version 27.Resultat: Svarsfrekvens på webbenkäten var 39,9% (65 svar utav 163 skickade enkäter). Skillnad (p < 0,001) mellan regionerna kunde påvisas beträffande hygienutbildning av personal. Det var att vanligare att personalen fick hygienutbildning inom kommunalaförskolor jämfört med fristående förskolor (p=0,049) och att kommunala förskolor städas dagligen till skillnad mot fristående (p=0,016). Personal som varit yrkesverksamma en längre tid var bättre på att informera vikarier om hygienrutiner (p=0,005), förskolor med fler än 45 barn hade en högre frekvens av daglig städning (p=0,002) och förskolor med 5 eller fler avdelningar var bättre på att ge personal hygienutbildning (p=0,043). Samtliga förskolor svarade att de använder ytdesinfektionsmedel för rengöring av skötbord.Slutsats: Det finns signifikanta skillnader i hur vanligt det är att personalen fick hygienutbildning mellan regionerna och mellan kommunala och fristående förskolor. Det är vanligare med daglig städning av lokaler på kommunala förskolor. Samtliga förskolor använde ytdesinfektionsmedel och engångshandskar vid behov. Vid framtida studier skulle urvalet behöva vara större, framförallt andelen fristående förskolor och ett större deltagande eftersträvas. / Introduction: Infections are common among preschool children. Some infectious agents, such as antibiotic-resistant bacteria have consequences for society and public health and pose a risk to the occupational health and safety of preschool staff.Aim: To investigate how well preschool principals comply with occupational health and safety legislation's requirements for preventive measures against risks of infections.Methods: A cross-sectional quantitative study was implemented. This study consisted of a web-based survey, sent via an e-mail link to 163 preschool principals in municipal and private preschools in three different regions of Sweden (Västra Götaland, Stockholm and Västmanland). Data were analyzed using the statistical program SPSS, version 27.Results: Of 163 email surveys sent, 65 responses (39.9%) were received. A difference (p < 0.001) between regions was demonstrated in terms of hygiene training of personnel. It was more common with hygiene training of personnel in municipal preschools (p=0.049) and daily cleaning was more common among municipal preschools (p=0.016). Staff who had worked for a longer time were better at informing substitutes about hygiene practices (p=0.005), preschools with more than 45 children had a higher frequency of daily cleaning(p=0.002) and preschools with 5 or more departments were better at hygiene training of personnel (p=0.043). All preschools used surface disinfectants to clean changing tables.Conclusion: There were differences in the level of hygiene training of personnel between regions and between municipal and private preschools. Daily cleaning among municipal preschools was more common. All preschools use surface disinfectants and disposable gloves when needed. Future surveys should include a larger sample size and focus on higher participation.

Objetivo: i) Estudar os casos de tuberculose (TB) por transmissão recente em brasileiros e migrantes sul-americanos, quantificar a transmissão cruzada recente entre ambas as populações e estudar seus fatores associados; ii) Avaliar, isoladamente, os fatores associados à transmissão recente da TB e o impacto da migração e de outras vulnerabilidades nos casos da doença no município. Métodos: Estudo transversal em indivíduos brasileiros e migrantes de origem sul-americana, residentes de distritos centrais do município de São Paulo (MSP) com grande proporção de populações vulneráveis e elevada presença recente de migrantes. Estudaram-se os casos de TB pulmonar por M. tuberculosis (Mtb) notificados entre 2013 e 2014, confirmados por meio de cultura de escarro. Foram utilizados os dados do Sistema Estadual de Notificação (SINAN-TB), de unidades de saúde e do laboratório central do Instituto Adolfo Lutz. Analizaram-se as variáveis sociodemográficas, clínicas e a presença de clusters simples e mistos, obtidos pelo agrupamento dos isolados de Mtb por RFLP-IS6110. i) Descreveu-se a distribuição dos clusters mistos e outras variáveis em brasileiros e migrantes sul-americanos e, investigou-se os fatores independentemente associados à presença de clusters mistos na amostra por meio de regressão logística simples e múltipla; ii) Investigaram-se os fatores independentemente associados à ocorrência de clusters mediante regressão logística simples e múltipla e estimou-se o impacto da transmissão recente da TB por meio da Fração Atribuível Populacional (PAF). Resultados: Foram amostrados 347 indivíduos, 19 por cento dos casos na área estudada. Desses, 76 por cento eram brasileiros e 24 por cento migrantes sul-americanos. O primeiro estudo mostrou que a proporção de clusters foi de 40,5 por cento , sendo 28 por cento desses compartilhados por brasileiros e migrantes sul-americanos (clusters mistos). Clusters mistos foram mais frequentemente encontrados em migrantes sul-americanos do que em brasileiros (OR=6,05), porém sugeriu-se transmissão cruzada em ambas as direções. A análise de sensibilidade, removendo usuários de drogas, HIV positivos e alcóolicos, teve pouco efeito no número de clusters mistos porém reduziu o de clusters simples em vi brasileiros, sugerindo maior transmissão recente do Mtb entre indivíduos brasileiros e migrantes não pertencentes a esses grupos de risco. O segundo estudo sugeriu que o uso de drogas está independentemente e diretamente associados a clusters sugestivos de transmissão recente (ORaj=3,18) e o alcoolismo (ORaj=0,30) está inversamente associado à transmissão recente. Foi encontrada baixa prevalência de comorbidades e outros fatores de risco entre migrantes sul-americanos, tanto em clusters quanto em perfis únicos. A transmissão recente entre usuários de drogas foi atribuída a cerca de 15 por cento dos casos de TB em brasileiros. Conclusões: Verificou-se que a transmissão recente, tanto entre brasileiros quanto entre migrantes sul-americanos, desempenha um papel importante nas regiões centrais do MSP. No entanto, sugere-se que a migração possa desempenhar um papel menos importante na transmissão/reativação da TB do que o uso de drogas e outras condições de vulnerabilidade. Dessa forma, no contexto dos crescentes movimentos migratórios para grandes cidades de países de média e baixa renda, a migração se soma à vulnerabilidade social, reforçando a necessidade de políticas intersetoriais para controle da TB. / Objective: i) to study recent tuberculosis (TB) transmission in Brazilians and South-American migrants, to estimate the proportion of recent cross-transmission occurring between both populations and to study potential associated factors to cross-transmission; ii) to study associated factors to cross-transmission and to estimate the impact of South-American migration and other vulnerabilities on TB cases. Methods: we conducted a cross-sectional study with TB patients in a central area of São Paulo (MSP) with a strong presence of South-American migrants and vulnerable populations. We selected notified pulmonary TB (PTB) cases confirmed by sputum culture between 2013 and 2014 among Brazilians and South-American migrants. We used the Tuberculosis State Notification System (SINAN-TBWEB), health facilities and the State Reference Laboratory (Instituto Adolfo Lutz) as data sources. We typed M. tuberculosis isolates by IS6110-RFLP, which were clustered by similarity. Clusters were considered mixed when isolates from at least one Brazilian and one South-American migrant were similar; and were considered simple when the cluster contained isolates from patients of only one nationality. We study demographic and clinical variables from TB patients and the presence of clusters within the sample. i) We described the distribution of simple and mixed clusters and other variables amongst Brazilians and South-American migrants and study associated factors to cross-transmission using logistic regression; ii) we estimated the proportion of recent transmission in the sample and investigated the factors associated with the presence of clusters by multiple logistic regression. Results: We sampled 347 individuals, 19 per cent of cases that occurred in the study area. Nearly 76 per cent were Brazilians and 24 per cent South-Americans. The first study demonstrated that 40.5 per cent of cases were clustered, of which approximately 30 per cent were mixed. South-American migrants were more likely to have mixed clusters than Brazilians (OR=6.05) and the results suggest that TB transmission occurred in both directions. We conducted a sensitivity analysis removing drug users, HIV positive and alcoholics, which suggested higher transmission amongst Brazilian and migrants outside these groups. In the second study we demonstrated that drug users were more likely to viii belong to clusters (ORadj=3.18) while individuals who abuse alcohol were more likely to belong to unique profiles (ORadj=0.30). South American migrants had lower prevalence of comorbidities and other risk factors. Nearly 15 per cent of PTB cases among Brazilians were attributed to recent transmission among drug users. Conclusions: We conclude that general recent transmission of TB and cross-transmission between Brazilian and South American migrants play an important role in the central regions of MSP. Nevertheless, we suggest that social vulnerability and drug use in TB transmission may be more important than migration status itself. In the context of increasing migration to large cities of low- and middle-income countries, our findings add migration to other social vulnerabilities, reaffirming the need for inter-sectoral policies on TB control.

Objetivo: i) Estudar os casos de tuberculose (TB) por transmissão recente em brasileiros e migrantes sul-americanos, quantificar a transmissão cruzada recente entre ambas as populações e estudar seus fatores associados; ii) Avaliar, isoladamente, os fatores associados à transmissão recente da TB e o impacto da migração e de outras vulnerabilidades nos casos da doença no município. Métodos: Estudo transversal em indivíduos brasileiros e migrantes de origem sul-americana, residentes de distritos centrais do município de São Paulo (MSP) com grande proporção de populações vulneráveis e elevada presença recente de migrantes. Estudaram-se os casos de TB pulmonar por M. tuberculosis (Mtb) notificados entre 2013 e 2014, confirmados por meio de cultura de escarro. Foram utilizados os dados do Sistema Estadual de Notificação (SINAN-TB), de unidades de saúde e do laboratório central do Instituto Adolfo Lutz. Analizaram-se as variáveis sociodemográficas, clínicas e a presença de clusters simples e mistos, obtidos pelo agrupamento dos isolados de Mtb por RFLP-IS6110. i) Descreveu-se a distribuição dos clusters mistos e outras variáveis em brasileiros e migrantes sul-americanos e, investigou-se os fatores independentemente associados à presença de clusters mistos na amostra por meio de regressão logística simples e múltipla; ii) Investigaram-se os fatores independentemente associados à ocorrência de clusters mediante regressão logística simples e múltipla e estimou-se o impacto da transmissão recente da TB por meio da Fração Atribuível Populacional (PAF). Resultados: Foram amostrados 347 indivíduos, 19 por cento dos casos na área estudada. Desses, 76 por cento eram brasileiros e 24 por cento migrantes sul-americanos. O primeiro estudo mostrou que a proporção de clusters foi de 40,5 por cento , sendo 28 por cento desses compartilhados por brasileiros e migrantes sul-americanos (clusters mistos). Clusters mistos foram mais frequentemente encontrados em migrantes sul-americanos do que em brasileiros (OR=6,05), porém sugeriu-se transmissão cruzada em ambas as direções. A análise de sensibilidade, removendo usuários de drogas, HIV positivos e alcóolicos, teve pouco efeito no número de clusters mistos porém reduziu o de clusters simples em vi brasileiros, sugerindo maior transmissão recente do Mtb entre indivíduos brasileiros e migrantes não pertencentes a esses grupos de risco. O segundo estudo sugeriu que o uso de drogas está independentemente e diretamente associados a clusters sugestivos de transmissão recente (ORaj=3,18) e o alcoolismo (ORaj=0,30) está inversamente associado à transmissão recente. Foi encontrada baixa prevalência de comorbidades e outros fatores de risco entre migrantes sul-americanos, tanto em clusters quanto em perfis únicos. A transmissão recente entre usuários de drogas foi atribuída a cerca de 15 por cento dos casos de TB em brasileiros. Conclusões: Verificou-se que a transmissão recente, tanto entre brasileiros quanto entre migrantes sul-americanos, desempenha um papel importante nas regiões centrais do MSP. No entanto, sugere-se que a migração possa desempenhar um papel menos importante na transmissão/reativação da TB do que o uso de drogas e outras condições de vulnerabilidade. Dessa forma, no contexto dos crescentes movimentos migratórios para grandes cidades de países de média e baixa renda, a migração se soma à vulnerabilidade social, reforçando a necessidade de políticas intersetoriais para controle da TB. / Objective: i) to study recent tuberculosis (TB) transmission in Brazilians and South-American migrants, to estimate the proportion of recent cross-transmission occurring between both populations and to study potential associated factors to cross-transmission; ii) to study associated factors to cross-transmission and to estimate the impact of South-American migration and other vulnerabilities on TB cases. Methods: we conducted a cross-sectional study with TB patients in a central area of São Paulo (MSP) with a strong presence of South-American migrants and vulnerable populations. We selected notified pulmonary TB (PTB) cases confirmed by sputum culture between 2013 and 2014 among Brazilians and South-American migrants. We used the Tuberculosis State Notification System (SINAN-TBWEB), health facilities and the State Reference Laboratory (Instituto Adolfo Lutz) as data sources. We typed M. tuberculosis isolates by IS6110-RFLP, which were clustered by similarity. Clusters were considered mixed when isolates from at least one Brazilian and one South-American migrant were similar; and were considered simple when the cluster contained isolates from patients of only one nationality. We study demographic and clinical variables from TB patients and the presence of clusters within the sample. i) We described the distribution of simple and mixed clusters and other variables amongst Brazilians and South-American migrants and study associated factors to cross-transmission using logistic regression; ii) we estimated the proportion of recent transmission in the sample and investigated the factors associated with the presence of clusters by multiple logistic regression. Results: We sampled 347 individuals, 19 per cent of cases that occurred in the study area. Nearly 76 per cent were Brazilians and 24 per cent South-Americans. The first study demonstrated that 40.5 per cent of cases were clustered, of which approximately 30 per cent were mixed. South-American migrants were more likely to have mixed clusters than Brazilians (OR=6.05) and the results suggest that TB transmission occurred in both directions. We conducted a sensitivity analysis removing drug users, HIV positive and alcoholics, which suggested higher transmission amongst Brazilian and migrants outside these groups. In the second study we demonstrated that drug users were more likely to viii belong to clusters (ORadj=3.18) while individuals who abuse alcohol were more likely to belong to unique profiles (ORadj=0.30). South American migrants had lower prevalence of comorbidities and other risk factors. Nearly 15 per cent of PTB cases among Brazilians were attributed to recent transmission among drug users. Conclusions: We conclude that general recent transmission of TB and cross-transmission between Brazilian and South American migrants play an important role in the central regions of MSP. Nevertheless, we suggest that social vulnerability and drug use in TB transmission may be more important than migration status itself. In the context of increasing migration to large cities of low- and middle-income countries, our findings add migration to other social vulnerabilities, reaffirming the need for inter-sectoral policies on TB control.