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

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

Imagining Egypt in postnormal times: The state of war

Accounting for the whole matrix of complex relationships between society and the state in Egypt after the Arab Spring in one go is not easy, nor is offering an analysis of the complexity of civil-military relations in Egyptian history and politics a small task. This chapter will only attempt to highlight in broad brushstrokes the changing nature of the concept of the political in Egypt today in relation to spatiality and to reveal the need for a new paradigm in Middle East studies, as well as an overdue reformation of Egyptian political thought

Palimpsests of civicness: Spontaneity and the Egyptian Uprising/Cairo 2011

More than a decade after the 25th of January 2011 uprising in Egypt most of the research that examined the multifaceted dimension of the uprising focused on the political dynamics of change, addressing issues of contentious politics, constitutional change, local governance, political participation and representation, civil–military relations and counter-revolution. This paper examines the forgotten role of the people who formed the multitude that led to the occupation of Tahrir Square on the 28th of January 2011, and the role of citizens who formed popular committees in their neighbourhood till the 11th of February when Mubarak was ousted. The analysis highlights the significance of spontaneity in the rise of civicness during the 15 days of occupation when the absence of effective sovereignty in spite of the presence of tanks on the streets led to the emergence of forms of collective action that can highlight the complexity of the uprising dynamics. Notions of conviviality and political friendship are introduced to draw a more complex picture of these days, building on previous ethnographic research and political analysis

Rethinking sovereignty beyond the Islamic state rhetoric: Bringing the people back in

The Caliphate of Man is a study of the development of a particular political theology in modern Islamic thought that grounds a doctrinal commitment to a form of popular sovereignty in the Qurʾānic claim that God has created a “caliph” on earth. Andrew March argues that this vision of popular sovereignty is not merely a superficial apologetic move designed to refute claims that “Islam is not compatible with democracy,” but rather reflects a genuine intellectual revolution in modern Islamic thought. That reformulation involved not only reducing rulers to their proper status as agents..

المرأة والاجتهاد: نحو خطاب إسلامي جديد / Women and Ijtihad: Towards a New Islamic Discourse

[This article considers the question of the current struggle in the woman\u27s question as it has become one of the most distinctive issues raised and a source of controversy between Secularists and Islamicists or between the adherents to tradition and the advocates of contemporaneity. The article begins with the spectacle of dominant polarization in the arena which, on the one hand, is the secular discourse that adopts modern sayings and, on the other, is the Islamic discourse that raises the slogans of women\u27s dignity under the protection of Islam. The latter inclines towards narrativity and jurisprudential tradition and drowns in history without attempting to extract a model suitable for reality with its complexities. It lacks revision and self criticism, and focuses on preaching and giving advice on the improvement of woman\u27s state without formulating alternative laws that include its intent, despite its participation in the parliamentary/democratic experience, thus leaving this change of laws wholly to the nation\u27s institutions or the opposing current and under the supervision of Islam\u27s official institutions. On the other hand, this article deals with the features of the Secularists\u27 discourse, finding it lacking in ijtihad (Islamically informed interpretation) and critical revision of its sayings whose major concepts go back to Western schools-Marxist or Liberal-without the crystallization of an independent Arab discourse. Other features are the generality of its statements about Islam\u27s respect for women and its failure to identify the conditions and restraints on Islamic legal and theological judgments as well as its failure in engaging in interpretive studies in the territory of heritage, its failure to point out the dilemmas and problematics of Western feminist discourse (particluarly in the questions of social morals and the family) and the attempt to present views on the ways of avoiding these currents in our reality if feminist theses are adopted. The secularists have also been weak in terms of self criticism and consideration of their own positions, while outspoken when it comes to attacking Islamicists. A final feature is the exaggerated concentration on the legal instrument in instituting change and the neglect of channels of cultural and moral change. This in turn led to focusing on addressing the state to undertake changes rather than address the needs of social units which has suffered, and rather than address the threats of globalism to national culture and traditions. In the second part, this article shifts to tracing new signs in the Islamicists\u27 discourse particularly in the writings of Shaykh Muhammad al-Ghazali and Shaykh Yusuf al-Qaradawy. The article shows the development of the thought of the two shaykhs over the past three decades and charts its twists and turns and features, in opposition to the Secularist discourse that continues to entrench itself behind patriarchal slogans, male hegemony and traditional values without developing its concepts or sayings. In the third part, the article touches on a new discourse that bridges the gap between the two camps in order to undertake a humane and cultural project uniting the forces of the nation, with the purpose of raising women\u27s status, consolidating the family as a social unit, and bringing the modern social sciences and shari\u27a (Islamic canonical law) closer. Such a discourse puts to application the religious text in its social reality and social research to the service of contemporary struggle in the woman\u27s question. Finally, it re-reads history to discover the reason for the deterioration in women\u27s conditions while throwing light on the aspects of women\u27s contribution to culture. The purpose of this is to bring the two camps closer for the re-naissance of the woman and the nation.

Disorder, transition and women in the Middle East

This contribution was delivered on the occasion of the EUI State of the Union in Florence on 5 May 2016.This intervention was part of the recorded SoU morning sessions that took place on 5 May 2016 available on Youtube; move to the part of the video session of your interest within the video recording.The panel will discuss the difficult political transitions and the state of war in many Middle Eastern countries. The failure of the Arab Spring has opened the way to radicalisation and transnational jihadism, growing violence and civil wars, return to authoritarianism and state repression of dissent. Political transformations and conflicts are often the result of deep societal changes but they also have an important and long lasting impact on women, children and civil societies. Prof. Heba Rauf, a well-known political scientist from Cairo University, will give her perspective on the toll of war and disintegration of states in the Arab world, looking comparatively at a few transitional or conflict countries and addressing critically the role of the EU in defending democratisation in the region

O mundo muçulmano em uma era global: a proteção dos direitos das mulheres The muslim world in a global age: protecting women's ights

As mulheres muçulmanas enfrentam, simultaneamente, três desafios. Em primeiro lugar, elas representam uma identidade islâmica que, com freqüência, está em conflito com regimes políticos modernos e com as elites dos Estados. Em segundo lugar, elas devem lutar contra os fundamentalistas islâmicos, cujas idéias, instituições e objetivos são por elas rejeitados com veemência. Por fim, e tão importante quanto os outros desafios, elas enfrentam no dia-a-dia a cultura patriarcal dominante nos lugares onde vivem. As questões relacionadas aos direitos das mulheres são agravadas pelas dificuldades que as mulheres muçulmanas encontram em uma cultura patriarcal na qual a mulher é geralmente caracterizada por estereótipos. Se, por um lado, a "solidariedade sem fronteiras" possibilitou a promoção de direitos das mulheres dentro e através das culturas, por outro, ela também se depara com questões sociais mais amplas e mais complexas. Embora essa solidariedade global sofra resistência em muitas partes do mundo muçulmano, o empowerment das mulheres é visto como o antídoto mais eficaz contra o extremismo no mundo muçulmano. Este trabalho pretende contextualizar a análise de gênero nos âmbitos cultural, econômico e político, de modo a lidar com três questões: (1) por que as mulheres muçulmanas se tornaram agentes de mudança, reforma e democratização no mundo globalizado? (2) qual o impacto da globalização sobre as mulheres muçulmanas e sobre a ascensão do feminismo islâmico? (3) de que maneira as mulheres muçulmanas podem respeitar a integridade de sua cultura, ao mesmo tempo que se mantêm receptivas a valores, idéias e instituições universais?<br>Muslim women encounter three fronts simultaneously. First, they represent an Islamic identity that more often than not is in conflict with modern political regimes and state elites. Secondly, they must fight against Islamic fundamentalists, whose ideas, institutions, and goals they vehemently reject. And finally, and just as importantly, they face a mundane confrontation with a prevailing patriarchal culture within which they live. Questions of women's rights are exacerbated by difficulties Muslim women encounter in a patriarchal culture in which women are often characterized by stereotypes. The "borderless solidarity" has led to the promotion of women's rights across and within cultures, but it stands in a problematic relationship to broader, more complex social issues. Although this global solidarity is resisted in many parts of the Muslim world, women's empowerment is seen as the most effective antidote to extremism in the Muslim world. This paper attempts to contextualize gender analysis in the cultural, economic, and political domains, while addressing three questions: (1) why have Muslim women become the agents of change, reform, and democratization in a globalizing world? (2) what impact has globalization on Muslim women and the rise of Islamic feminism? (3) how could Muslim women maintain the integrity of their culture while at the same time remain receptive to universal values, ideas, and institutions