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BACKGROUND:Chronic diseases are the leading cause of mortality and morbidity worldwide. Much of this burden can be prevented by adopting healthy behaviours and reducing chronic disease risk factors. Settings-based approaches to address chronic disease risk factors are recommended globally. Sporting organisations are highly prevalent, and engage many people in many countries. As such, they represent an ideal setting for public health interventions to promote health. However, there is currently limited evidence of their impact on healthy behaviour and health outcomes as previous systematic reviews are either limited in their scope (e.g. restricted to professional sporting organisations), or are out of date. OBJECTIVES:Primary: to assess the benefits and harms of interventions implemented through sporting organisations to promote healthy behaviours (including physical activity, healthy diet) or reduce health risk behaviours (including alcohol consumption, tobacco use). Secondary: to assess the benefits and harms of these interventions to promote health outcomes (e.g. weight), other health-related behaviours (e.g. help-seeking behaviour) or health-related knowledge; to determine whether benefits and harms differ based on the characteristics of the interventions, including target population and intervention duration; to assess unintended adverse consequences of sporting organisation interventions; and to describe their cost or cost-effectiveness. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, one other database and two clinical trial registries, from inception to May 2024, to identify eligible trials. We searched Google Scholar in May 2024. We did not impose language or publication status restrictions. We also searched reference lists of included trials for other potentially eligible trials. SELECTION CRITERIA:We included randomised controlled trials (RCTs), including cluster-RCTs, of any intervention conducted within or using a sporting organisation for access to a target group, that aimed to improve a health behaviour primary outcome or a secondary review outcome, and had a parallel control group (no intervention, alternative intervention). Eligible participants were any individual exposed to an intervention involving a sporting organisation, including players, members, coaches, and supporters. DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane. We conducted random-effects meta-analyses to synthesise results where we could pool data from at least two trials. Where we could not conduct meta-analysis, we followed Cochrane guidance for synthesis using other methods and reported results according to the Synthesis Without Meta-analysis (SWiM) guidance. MAIN RESULTS:We included 20 trials (42 trial arms, 8179 participants) conducted in high-income countries, and identified four ongoing trials and four trials awaiting classification. There was considerable heterogeneity in the type of participants, interventions and outcomes assessed across trials. Included trials primarily targeted sporting organisation members (eight trials) or supporters (eight trials), males only (11 trials) and adults (14 trials). Football clubs (e.g. soccer, American football, Australian football league) were the most common intervention setting (15 trials), and interventions targeted various combinations of health behaviours, knowledge and health outcomes. Fourteen trials (10 RCTs and four cluster-RCTs) assessed the impact of a sporting organisation intervention on a primary outcome: physical activity (nine trials); diet (six trials); alcohol consumption (11 trials); and tobacco use (two trials). For RCTs, we assessed the risk of bias for primary outcomes (physical activity, diet, alcohol consumption) and unintended adverse consequences as being at low risk of bias (four outcomes), some concerns (one outcome) or high risk of bias (32 outcomes), due to outcomes being self-reported. For cluster-RCTs, we assessed the risk of bias for all primary outcomes (alcohol consumption, tobacco use) as high risk (eight outcomes), due to outcomes being self-reported. Sporting organisation interventions versus control probably have a small positive effect on the amount of physical activity per day, equivalent to approximately 7.4 minutes of moderate-to-vigorous physical activity (MVPA) per day (standardised mean difference (SMD) 0.36, 95% confidence interval (CI) 0.22 to 0.49; I2 = 3%; 4 trials, 1213 participants; moderate-certainty evidence) and may not reduce sedentary behaviour (mean difference (MD) -15.18, 95% CI -30.82 to 0.47; I2 = 0%; 2 trials, 1047 participants; low-certainty evidence). Sporting organisation interventions versus control may have a moderate positive effect on fruit and vegetable consumption, equivalent to a score increase of 1.25 points on a 12-point scale for frequency of fruit and vegetable consumption (SMD 0.50, 95% CI 0.35 to 0.65; I2 = 0%; 5 trials, 1402 participants; low-certainty evidence). Sporting organisation interventions versus control may reduce sugary drink consumption (equivalent to a reduction of sugary drink consumption by 0.8 times per day), but the evidence is very uncertain (SMD -0.37, 95% CI -0.64 to -0.10; I2 = 0%; 2 trials, 225 participants; very low-certainty evidence). Sporting organisation interventions versus control may have little to no effect on alcohol consumption (equivalent to a reduction of 0.38 units of alcohol consumed per week), but the evidence is very uncertain (MD -0.38, 95% CI -1.00 to 0.24; I2 = 78%; 7 trials, 2313 participants; very low-certainty evidence). Two trials that could not be synthesised reported equivocal findings on tobacco use (low-certainty evidence). The evidence is very uncertain about the effect of sporting club interventions on unintended adverse consequences. Five trials assessed this outcome, with two reporting that there were no adverse consequences, one reporting only non-serious adverse consequences, and two reporting that there were serious unintended adverse consequences in less than 1% of participants. AUTHORS' CONCLUSIONS:Overall, sporting organisation interventions probably increase MVPA by 7.4 minutes per day, may result in little to no difference in sedentary behaviour, and may increase fruit and vegetable consumption. The evidence is very uncertain about whether sporting organisation interventions decrease sugary drink and alcohol consumption. Findings for tobacco use and unintended adverse consequences were equivocal in the few trials reporting these; thus, the evidence was very uncertain. These findings should be interpreted in the context of the heterogeneity of the interventions, participants and sporting organisations for some outcomes.

INTRODUCTIONData for healthcare-associated infections (HAI) and antibiotic use in long-term care facilities (LTCF) in Switzerland are lacking but are necessary to take actions.AIMWe aimed to estimate HAI prevalence and antibiotic use and to record existing structure and process indicators in the area of infection prevention/antibiotic use in Swiss LTCF.METHODSWe invited all Swiss LTCF for this PPS in September 2024 using the adapted Healthcare-Associated Infections in European Long-Term Care Facilities (HALT)-4 protocol. The proportion of residents with HAI and systemic antibiotic treatment was calculated for a representative sample, stratified by language region and size. We assessed resident-level and institutional risk factors for HAI in all participating institutions, using random-effects logistic regression.RESULTSWe included 94 LTCF (7,244 residents), whereof 49 LTCFs (3,375 residents) belonged to the representative sample. Median age of residents in the representative sample was 87 years (range: 36-107) and 2,334 (69.2%) were female. Prevalence of HAI was 2.2% (95% confidence interval (CI): 1.7-2.7); 2.7% (95% CI: 2.2-3.3) were receiving antibiotic treatment, with highest use in LTCF in French-speaking cantons (5.9%; 95% CI: 4.2-7.5). Urinary tract (46%) and respiratory infections (20%) were most common, aminopenicillins (26%) and nitrofurantoin (19%) the most commonly used antimicrobials. The strongest independent risk factor for HAI was presence of urinary catheters (adjusted odds ratio = 2.65; 95% CI: 1.71-4.11).DISCUSSIONPrevalence of HAI and antibiotic use in Swiss LTCFs were comparable to the European average from 2023/24. There are regional differences in antibiotic consumption. Urinary catheterisation, potentially modifiable, was the most important risk factor for HAI.

Screening patients at risk of multidrug-resistant organism (MDRO) carriage is a cornerstone of infection prevention and control to identify carriers and prevent transmission. In 2021, the Swiss Centre for Infection Prevention Swissnoso published the first national recommendations for the prevention and control of MDROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, carbapenemase-producing Enterobacterales (CPE), and Candida auris. This study evaluated the adherence of institutional guidelines to these recommendations across Swiss acute care hospitals and identified barriers to their implementation. A 28-item online survey was conducted in spring 2023 among Swiss acute care hospitals. The primary outcome was the adherence of institutional guidelines to national recommendations, assessed using a weighted score that accounted for different grades of recommendation for on-admission screening. Secondary outcomes included adherence to recommended body sites for screening, the implementation of universal screening during hospitalization, and perceived barriers to implementation. A total of 68 of 142 invited hospitals (47

Introduction: Extubation in intensive care units (ICUs) is a complex process with a high failure rate and significant impact on clinical outcomes. In a public tertiary hospital in the Federal District, the lack of a standardized protocol results in variations in procedures and risks to patients. The literature highlights the importance of standardization to reduce complications and mortality. Objective: Propose an institutional extubation protocol for critically ill patients in the Intensive Care Units of a public hospital in the Federal District, aiming at standardizing the criteria, conduct and care involved in this procedure. Methodology: This study consisted of a narrative review of literature with a qualitative approach. The bibliographic search was conducted in the PubMed, Scielo and Embase databases. The study was structured in three main stages: survey and analysis of the scientific literature; comparison between the current recommendations found in the literature and the extubation practices adopted in the hospital's ICUs, based on analysis of institutional documents; proposal of an institutional extubation protocol based on the verified results. Results: Evidence suggests that factors such as a positive fluid balance, the presence of abundant secretions, advanced age, and compromised nutritional status increase the risk of extubation failure. Studies show that structured and standardized protocols, including functional testing and multidisciplinary management, increase the extubation success rate, especially in surgical and neurocritical patients. Corticosteroid prophylaxis, primarily dexamethasone and methylprednisolone, has been shown to reduce post-extubation complications. Furthermore, early extubation, when clinically feasible, is associated with better outcomes. These findings supported the proposal of an institutional protocol to standardize criteria, procedures, and care for extubation in ICUs. Conclusion: Based on the study, it is possible to conclude that there are significant variations and gaps in extubation practices across the hospital's ICUs, which reinforces the need for a standardized institutional protocol. The literature review highlighted evidence-based criteria and practices that can be adapted to local circumstances, and the analysis of available resources demonstrated the feasibility of implementing a unified protocol that promotes greater safety, uniformity, and quality in the care of critically ill patients.

Notifications of Salmonella Strathcona infections increased in Europe in 2023 prompting a multi-country outbreak investigation. We aimed to describe the epidemiology of S. Strathcona infections in 17 European countries 2011–2024, investigate the genetic relatedness of S. Strathcona isolates and identify the vehicle. Cases were persons residing in the study area and with a laboratory-confirmed S. Strathcona infection 2011–2024. Confirmed cases had a S. Strathcona isolate clustering with the outbreak reference strain in core genome multilocus sequence typing (cgMLST) within 7 allelic differences (AD) and possible cases within 8–13 AD. Probable cases had an epidemiological link to a confirmed case and non-outbreak cases had an isolate > 13 AD from the outbreak reference strain. Since 2011, 662 S. Strathcona infections have been identified: 469 confirmed, 161 probable, 13 possible and 19 non-outbreak cases. Median age of the cases was 34 years (IQR: 19–58 years) and 306 (47.5%) were notified in 2023–2024. Most sequenced isolates (469/496; 94.5%) were highly genetically related (≤ 7 AD) over time and across countries, compatible with a common source. Epidemiological and traceback investigations identified small tomatoes from Sicily as the suspect food vehicle. Stringent control measures at the source are needed to stop the contamination and prevent future cases.