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

Parler de sexualité à l'école : Controverses et luttes de pouvoir autour des frontières de la vie privée

How to talk about sexuality at school ? This controversial question was first officially answered in 1973 in a circular from the Ministry of National Education entitled « Information and sexual education ». This was the beginning of the public policy of sex education in the French school environment. Since then, the answers to this same question have evolved and have been the subject of clashes betweendifferent actors. If the battle line has been shifting, there has been a core stake : the definition of public and private in terms of sexuality. This Ph.D proposes to focus on this boundary that structures sex education policy from the 1970s to the present day, through the lens of three stories that unfold from the ministry's offices to the classroom. The first plot is that of a "war story", where troops of volunteers have been taking turns since the 1970s to define what the School is allowed to say or not to say to children. The second is an incursion into the heart of the strategies developed by state institutions to legitimize the role of the school in sex education. In the end, the third story appears to be a theatreplay, sometimes comic, sometimes tragic. Yet it does not take place on a stage but in front of the blackboard.Comment parler de sexualité à l’École ? Cette question controversée trouve une première réponse officielle en 1973, dans une circulaire du ministère de l’Éducation nationale intitulée « information et éducation sexuelles » : c'est le début de la politique d'éducation à la sexualité en milieu scolaire en France. Depuis, les réponses apportées à cette même question ont évolué et ont fait l'objet d'affrontements entre différents acteurs. Et si la ligne de front est mouvante, celle-ci se structure toujours autour d'un même enjeu : la définition du public et du privé en matière de sexualité. Cette thèse propose de s'intéresser à cette frontière qui structure la politique d’éducation à la sexualité des années 1970 à nos jours, au prisme de trois histoires qui se déroulent des bureaux du ministère jusque dans la salle de classe. La première intrigue est celle d'un « récit de guerre », où des troupes de volontaires se relaient depuis les années 1970 pour définir ce que l’École a le droit de dire ou non aux enfants. La seconde est une incursion au cœur des stratégies élaborées par les institutions étatiques pour rendre légitime le rôle de l’École dans l'éducation à la sexualité. Enfin, le troisième récit s'apparente à une pièce de théâtre parfois comique, parfois tragique, sans rideau rouge et devant le tableau noir de la salle de classe

Émile Durkheim, Sur l’éducation sexuelle, Paris, Payot et Rivages, 2011, 144 p.

Avec la publication de cette contribution méconnue de Durkheim sur l’éducation sexuelle, les éditions Payot & Rivages font revivre un siècle plus tard une controverse qui agitait (déjà) la Société française de philosophie en février 1911 : faut-il instituer un programme d’éducation sexuelle à l’école ? Quelle forme doit prendre cet enseignement ? Sur quel type de morale doit-il trouver son fondement ? Doit-on instruire pareillement les filles et les garçons en la matière ? Ce livre, publié ..

L’homosexualité, une « question difficile ». Distinction et hiérarchisation des sexualités dans l’éducation sexuelle en milieu scolaire

Sex education has been compulsory in the French school system since 2001. What kind of content is proposed to the pupils and to the sex educators ? This paper analyzes the processes of classification and hierarchical organization of homosexuality and heterosexuality in sex education curricula. There are different kinds of “invisible barriers” (Varikas, 2007) that relegate homosexuals to the status of sexual outcast. At least three points are made to keep homosexuality in this particular place : it is a personal question, it is a matter of specific practices, it is a matter of age (and does not concern children or teenagers). The distinctions between public and private, between the universal and the specific, and between adolescence and adulthood are three kinds of “invisible barriers” that set up an implicit hierarchy of heterosexuality over homosexuality. A fourth kind of barrier appears among the very few representations of homosexuality in the French educational material: lesbians are invisible and remain the ultimate sexual outcast

Talking about sexuality at school : Controversies and power struggles about the boundaries of privacy

Comment parler de sexualité à l’École ? Cette question controversée trouve une première réponse officielle en 1973, dans une circulaire du ministère de l’Éducation nationale intitulée « information et éducation sexuelles » : c'est le début de la politique d'éducation à la sexualité en milieu scolaire en France. Depuis, les réponses apportées à cette même question ont évolué et ont fait l'objet d'affrontements entre différents acteurs. Et si la ligne de front est mouvante, celle-ci se structure toujours autour d'un même enjeu : la définition du public et du privé en matière de sexualité. Cette thèse propose de s'intéresser à cette frontière qui structure la politique d’éducation à la sexualité des années 1970 à nos jours, au prisme de trois histoires qui se déroulent des bureaux du ministère jusque dans la salle de classe. La première intrigue est celle d'un « récit de guerre », où des troupes de volontaires se relaient depuis les années 1970 pour définir ce que l’École a le droit de dire ou non aux enfants. La seconde est une incursion au cœur des stratégies élaborées par les institutions étatiques pour rendre légitime le rôle de l’École dans l'éducation à la sexualité. Enfin, le troisième récit s'apparente à une pièce de théâtre parfois comique, parfois tragique, sans rideau rouge et devant le tableau noir de la salle de classe.How to talk about sexuality at school ? This controversial question was first officially answered in 1973 in a circular from the Ministry of National Education entitled « Information and sexual education ». This was the beginning of the public policy of sex education in the French school environment. Since then, the answers to this same question have evolved and have been the subject of clashes betweendifferent actors. If the battle line has been shifting, there has been a core stake : the definition of public and private in terms of sexuality. This Ph.D proposes to focus on this boundary that structures sex education policy from the 1970s to the present day, through the lens of three stories that unfold from the ministry's offices to the classroom. The first plot is that of a "war story", where troops of volunteers have been taking turns since the 1970s to define what the School is allowed to say or not to say to children. The second is an incursion into the heart of the strategies developed by state institutions to legitimize the role of the school in sex education. In the end, the third story appears to be a theatreplay, sometimes comic, sometimes tragic. Yet it does not take place on a stage but in front of the blackboard

Émile Durkheim, Sur l’éducation sexuelle, Paris, Payot et Rivages, 2011, 144 p.

Avec la publication de cette contribution méconnue de Durkheim sur l’éducation sexuelle, les éditions Payot & Rivages font revivre un siècle plus tard une controverse qui agitait (déjà) la Société française de philosophie en février 1911 : faut-il instituer un programme d’éducation sexuelle à l’école ? Quelle forme doit prendre cet enseignement ? Sur quel type de morale doit-il trouver son fondement ? Doit-on instruire pareillement les filles et les garçons en la matière ? Ce livre, publié ..

Gardey Delphine (dir.), Le féminisme change-t-il nos vies ?

Le féminisme change-t-il nos vies ? La question que pose le titre de l’ouvrage collectif dirigé par Delphine Gardey pourrait sonner comme une invitation au récit de vie. Mais les auteur-e-s ont préféré se situer à « un niveau moins intime » pour écrire en tant que « professionnel-le-s de l’analyse des rapports historiques, politiques et sociaux entre les sexes » (p. 10). C’est donc en tant que chercheuses (et chercheur) de l’équipe des Études genre de l’Université de Genève que les auteur-e-s..