Gestion et mise en valeur touristique des sites naturels dans les Bouches-du-Rhône (Schéma départemental du tourisme et des loisirs).

Le contexte : des sites nombreux et riches mais touristiquement mal exploités, mal protégés, mal valorisés. Les orientations préconisées dans le cadre du second Schéma Départemental de Développement du Tourisme et des Loisirs

Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed

Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period

Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017

Antimicrobial agents used to treat infections are life-saving. Overuse may result in more frequent adverse effects and emergence of multidrug-resistant microorganisms. In 2016-17, we performed the second point-prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals. We included 1,209 hospitals and 310,755 patients in 28 of 31 European Union/European Economic Area (EU/EEA) countries. The weighted prevalence of antimicrobial use in the EU/EEA was 30.5% (95% CI: 29.2-31.9%). The most common indication for prescribing antimicrobials was treatment of a community-acquired infection, followed by treatment of HAI and surgical prophylaxis. Over half (54.2%) of antimicrobials for surgical prophylaxis were prescribed for more than 1 day. The most common infections treated by antimicrobials were respiratory tract infections and the most commonly prescribed antimicrobial agents were penicillins with beta-lactamase inhibitors. There was wide variation of patients on antimicrobials, in the selection of antimicrobial agents and in antimicrobial stewardship resources and activities across the participating countries. The results of the PPS provide detailed information on antimicrobial use in European acute care hospitals, enable comparisons between countries and hospitals, and highlight key areas for national and European action that will support efforts towards prudent use of antimicrobials

Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; findings from the New Zealand multicentre stillbirth case-control study

Objective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation). Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n=164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n=569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going to- sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders. Results: Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05). Conclusions: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%

Gender balance and geographical diversity in editorial boards of <i>Geochimica et Cosmochimica Acta</i> and <i>Chemical Geology</i>

Background: Members of editorial boards of academic journals are often considered gatekeepers of knowledge and role models for the academic community. Editorial boards should be sufficiently diverse in the background of their members to facilitate publishing manuscripts representing a wide range of research paradigms, methods, and cultural perspectives. Objectives: To critically evaluate changes in the representation of binary gender and geographic diversity over time on the editorial boards of Chemical Geology and Geochimica et Cosmochimica Acta, flagship geochemistry journals, respectively, from the European Association of Geochemistry and the Geochemical Society – Meteoritical Society partnership. Methods: The composition of editorial boards was ascertained as given in the first issue of each year, over 1965–2021 for Chemical Geology and 1950–2021 for Geochimica et Cosmochimica Acta, and members of the editorial boards were coded for their country of affiliation (the country of origin may have been different) and for their binary gender. Results: Gender parity, limited to men and women, and the number of countries of affiliation increased steadily between the late 1980s and 2021. However, the geographic distribution remained dominated by affiliations from North America and Western Europe. The editor-in-chief or board of editors had a significant impact on the diversity of the editorial boards, and both geographic and gender diversity may evolve with nearly every newly appointed editor. However, the persistently substantial under-representation on editorial boards of affiliations outside North America and Europe is of concern and needs to be the focus of active recruitment and ongoing monitoring. This approach will ensure that traditionally low geographic diversity is increased and maintained in the future. Conclusion: Improving diversity and inclusion of editorial boards of academic journals and strengthening journal and disciplinary reputations are mutually reinforcing. Instituting a rotating editorship with emphasis on embedding broader geographic networks and more equitable international recruitment could ensure sustained and wider geographic representation and gender balance of editorial boards and promote originality and quality of published research, representing our global communities

Variabilité régionale de l’incidence des bactéries multirésistantes aux antibiotiques (BMR) En France : réseau de surveillance BMR-Raisin

National audienc

Gestion et mise en valeur touristique des sites naturels dans les Bouches-du-Rhône (Schéma départemental du tourisme et des loisirs).

International audienceLe contexte : des sites nombreux et riches mais touristiquement mal exploités, mal protégés, mal valorisés. Les orientations préconisées dans le cadre du second Schéma Départemental de Développement du Tourisme et des Loisirs