The Unequal Pandemic Bambra, Clare; Lynch, Julia; Smith, Katherine E.
06/2021
eBook
Odprti dostop
Rated as a top 10 book about the COVID-19 pandemic by New Statesman: https://www.newstatesman.com/culture/2021/07/best-books-about-covid-19-pandemic
EPDF and EPUB available Open Access under ...CC-BY-NC- ND
It has been claimed that we are ‘all in it together’ and that the COVID-19 virus ‘does not discriminate’.
This accessible, yet authoritative book dispels this myth of COVID-19 as an ‘equal opportunity’ disease, by showing how the pandemic is a syndemic of disease and inequality.
Drawing on international data and accounts, it argues that the pandemic is unequal in three ways: it has killed unequally, been experienced unequally and will impoverish unequally.
These inequalities are a political choice: with governments effectively choosing who lives and who dies, we need to learn from COVID-19 quickly to prevent growing inequality and to reduce health inequalities in the future.
COVID-19 is an unequal pandemic.
This open access edited volume focuses on the scope and benefits of strengthening local industrial-health linkages. The Covid-19 pandemic collapsed international supply chains for health. That ...experience brought home to African policy makers the critical nature of local manufacturing capabilities for sustaining and strengthening health care, and highlighted the pandemic benefits of India’s much stronger industrial base. At that time, a network of researchers in East Africa, India and the UK were investigating how to address the crisis of cancer care in low-resource health systems. Their project, uniquely, focused on the scope and benefits of strengthening local industrial-health linkages. The project researchers were also drawn into the pressing demands of Covid19 response. The result is this very timely book. The authors link their research on cancer to pandemic experience, and they draw sharp lessons for how countries can enhance their populations’ health security. The authors argue that improving cancer care is crucial for human wellbeing and more inclusive health care. They challenge policy makers to bring together health needs, health innovations and improved industrial capabilities to embed better cancer care and broader health system improvement in local industrial innovation and development.
To describe the French program for the prevention of healthcare-associated infections and antibiotic resistance and provide results for some of the indicators available to evaluate the program. In ...addition to structures and process indicators, the 2 outcome indicators selected were the rate of surgical site infection and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the S. aureus isolates recovered.
Descriptive study of the evolution of the national structures for control of healthcare-associated infections since 1992. Through national surveillance networks, process indicators were available from 1993 to 2006, surgical site infection rates were available from 1999 to 2005, and prevalence rates for MRSA infection were available from 2001 to 2007.
A comprehensive national program has gradually been set up in France during the period from 1993 to 2004, which included strengthening of organized infection control activities at the local, regional, and national levels and developing large networks for surveillance of specific infections and antibiotic resistance. These achievements were complemented by instituting mandatory notification for unusual nosocomial events, especially outbreaks. The second phase of the program involved the implementation of 5 national quality indicators with public reporting. Surgical site infection rates decreased by 25% over a 6-year period. In France, the median proportion of MRSA among S. aureus isolates recovered from patients with bacteremia decreased from 33.4% to 25.7% during the period from 2001 to 2007, whereas this proportion increased in many other European countries.
Very few national programs have been evaluated since the Study on the Efficacy of Nosocomial Infection Control. Although continuing efforts are required, the French program appears to have been effective at reducing infection rates.
Staphylococcus aureus is a major cause of bacteremia, and S. aureus bacteremia is associated with higher morbidity and mortality, compared with bacteremia caused by other pathogens. The burden of S. ...aureus bacteremia, particularly methicillin-resistant S. aureus bacteremia, in terms of cost and resource use is high. The risk of infective endocarditis and of seeding to other metastatic foci increases the risk of mortality and raises the stakes for early, appropriate treatment. The incidence of S. aureus bacteremia and its complications has increased sharply in recent years because of the increased frequency of invasive procedures, increased numbers of immunocompromised patients, and increased resistance of S. aureus strains to available antibiotics. This changing epidemiology of S. aureus bacteremia, in combination with the inherent virulence of the pathogen, is driving an urgent need for improved strategies and better antibiotics to prevent and treat S. aureus bacteremia and its complications.
Methicillin-resistant Staphylococcus aureus (MRSA) isa major cause of healthcare- and community-associated infections worldwide. Within the healthcare setting alone, MRSA infections are estimated to ...affect more than 150,000 patients annually in the European Union (EU), resulting in attributable extra in-hospital costs of EUR 380 million for EU healthcare systems. Pan-European surveillance data on bloodstream infections show marked variability among EU Member States in the proportion of S. aureus that are methicillin-resistant, ranging from less than 1% to more than 50%. In the past five years, the MRSA bacteraemia rates have decreased significantly in 10 EU countries with higher endemic rates of MRSA infections. In addition to healthcare-associated infections, new MRSA strains have recently emerged as community and livestock-associated human pathogens in most EU Member States. The prevention and control of MRSA have therefore been identified as public health priorities in the EU. In this review, we describe the current burden of MRSA infections in healthcare and community settings across Europe and outline the main threats caused by recent changes in the epidemiology of MRSA. Thereby, we aim at identifying unmet needs of surveillance, prevention and control of MRSA in Europe.
This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to ...intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried being
(
= 15), followed by
(
= 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months (
= 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried being
(
= 28) and
(
= 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube (
= 0.008) and administration of third-generation cephalosporins (
= 0.032) and carbapenems (
= 0.045). The most common carbapenemase genes in
and
were
and
, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CR
(2 cases) and
(1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.
Background. Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but ...some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection. Methods. This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003–2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression. Results. Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis. Conclusions. This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.
Health care-associated bacterial pneumonias due to multiple-drug resistant (MDR) pathogens are an important public health problem and are major causes of morbidity and mortality worldwide. In ...addition to antimicrobial resistance, these organisms have adapted to the milieu of the human airway and have acquired resistance to the innate immune clearance mechanisms that normally prevent pneumonia. Given the limited efficacy of antibiotics, bacterial clearance from the airway requires an effective immune response. Understanding how specific airway pathogens initiate and regulate innate immune signaling, and whether this response is excessive, leading to host-induced pathology may guide future immunomodulatory therapy. We will focus on three of the most important causes of health care-associated pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae, and review the mechanisms through which an inappropriate or damaging innate immune response is stimulated, as well as describe how airway pathogens cause persistent infection by evading immune activation.
Sepsis-associated acute kidney injury (SA-AKI) results in significant morbidity and mortality, and ferroptosis may play a role in its pathogenesis. Our aim was to examine the effect of exogenous ...Hsub.2S (GYY4137) on ferroptosis and AKI in in vivo and in vitro models of sepsis and explore the possible mechanism involved. Sepsis was induced by cecal ligation and puncture (CLP) in male C57BL/6 mice, which were randomly divided into the sham, CLP, and CLP + GYY4137 group. The indicators of SA-AKI were most prominent at 24 h after CLP, and analysis of the protein expression of ferroptosis indicators showed that ferroptosis was also exacerbated at 24 h after CLP. Moreover, the level of the endogenous Hsub.2S synthase CSE (Cystathionine-γ-lyase) and endogenous Hsub.2S significantly decreased after CLP. Treatment with GYY4137 reversed or attenuated all these changes. In the in vitro experiments, LPS was used to simulate SA-AKI in mouse renal glomerular endothelial cells (MRGECs). Measurement of ferroptosis-related markers and products of mitochondrial oxidative stress showed that GYY4137 could attenuate ferroptosis and regulate mitochondrial oxidative stress. These findings imply that GYY4137 alleviates SA-AKI by inhibiting ferroptosis triggered by excessive mitochondrial oxidative stress. Thus, GYY4137 may be an effective drug for the clinical treatment of SA-AKI.
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