Connaître les perceptions et les représentations : quels apports pour la gestion des milieux aquatiques ?

National audienceLa gestion intégrée de l’eau et des milieux aquatiques conduit à porter une attention particulière aux perceptions et aux représentations qu’en ont les différents acteurs (gestionnaires, élus, usagers, public, etc.). Il faut dès lors s’interroger sur l’intérêt et la manière de les mobiliser dans les démarches opérationnelles de gestion.Comment mobiliser les études de perceptions et de représentations pour identifier les acteurs et leurs attentes ?Comment les utiliser pour connaître l’histoire des relations entre les sociétés et les milieux aquatiques ?Comment les solliciter pour évaluer et interroger les pratiques de gestion ?Cet ouvrage de la collection Comprendre pour agir, illustré d’études de cas, d’encarts notionnels et méthodologiques et de retours d’expériences, délivre les résultats d’une réflexion collective, entre scientifiques et gestionnaires, organisée autour des différentes étapes de l’élaboration d’un projet de gestion

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

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Management and outcomes in critically ill nonagenarian versus octogenarian patients.

BACKGROUND: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. METHODS: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. RESULTS: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). CONCLUSION: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. TRIAL REGISTRATION: NCT03134807 and NCT03370692

Approche globale et critique de la restauration des cours d’eau en France et à l’étranger

National audienc

Approche globale et critique de la restauration des cours d’eau en France et à l’étranger

National audienc

La restauration des cours d'eau en France et à l'étranger : de la définition du concept à l'évaluation de l'action. Eléments de recherche applicables

“Restoration” is a key concept in river management. In France and worldwide, “river restoration” has been provided a strong legislative, operational and scientific anchor. This research aims to better understand “river restoration”: that is, how is “river restoration” defined, practiced and evaluated? Research materials stand on various documents (scientific articles, administrative documents of French Water Agencies, technical documents about “restoration” procedures and documents related to specific “restoration projects”). These documents are analysed with textual analysis methods (bibliometrics, content analysis, textual statistics, qualitative analysis).Results are organized into five chapters. Chapter I deals with the position of sciences in the field of “river restoration”. This chapter covers research dynamics, scientific definitions of “restoration” and scientists’ research themes related to “river restoration”. Chapter II draws a timeline of French definitions of “river restoration”. It analyses permanence and change in the definition of “river restoration” from the late 19th Century until today. In Chapter III, a framework which suggests the establishment of three French Water Agencies in order to analyse French “river restoration” public policy and practice is proposed. Chapter IV is dedicated to the analysis of “ecological river restoration” practices. This Chapter’s objective is to better understand French public action. French practices are also compared to German practices. Finally, the monitoring and evaluation of contemporary “ecological river restoration” projects in France and in Germany is described in Chapter V.Operational reflections and recommendations are provided through the results of this research in order to aid public action and evaluation strategies in the field of “river restoration”. Special attention was also paid to scientific perspectives in the context of the implementation of the Water Framework Directive.La « restauration » est un concept majeur de la gestion de cours d’eau. En France, comme à l’étranger, il a aujourd’hui un ancrage législatif, opérationnel et scientifique fort. La démarche de recherche engagée est destinée à mieux comprendre comment est définie, est pratiquée et est évaluée la « restauration de cours d’eau ». Les matériaux utilisés sont documentaires (publications scientifiques, dossiers administratifs des Agences de l’Eau, documents techniques d’appui à l’action, documents relatifs aux projets réalisés). Ils font l’objet d’analyses textuelles (bibliométrie, analyse de contenu, statistique textuelle, analyse qualitative).Les résultats sont organisés en cinq chapitres. Le Chapitre I concerne le positionnement des sciences dans le champ de la « restauration ». Sont abordés successivement les dynamiques scientifiques, les éléments de définitions et les thématiques de travail privilégiées par les chercheurs. Le Chapitre II dessine une chronologie des définitions françaises de la « restauration ». Il présente les permanences et les évolutions observées du XIXème siècle jusqu’à nos jours. Le Chapitre III s’intéresse aux politiques d’intervention de trois Agences de l’Eau. Il offre ainsi une première analyse des pratiques françaises de « restauration de cours d’eau ». Le travail sur les pratiques est ensuite centré, dans le Chapitre IV, sur la « restauration écologique de cours d’eau ». Il prolonge ainsi l’étude de l’action publique française et propose une comparaison avec l’Allemagne. Enfin, le Chapitre V s’intéresse plus particulièrement aux pratiques de suivi et d’évaluation des projets franco-Allemands de « restauration écologique ».Les résultats ont fait l’objet de réflexions opérationnelles et de recommandations afin d’aider l’action publique et les stratégies d’évaluation dans le domaine. Une attention particulière a également été accordée aux perspectives scientifiques dans le cadre d’une thématique stratégique pour la mise en œuvre de la Directive Cadre sur l’Eau

River restoration in France and worldwide : from the definition of a concept to practical evaluation of projects. Applicable research elements

La « restauration » est un concept majeur de la gestion de cours d’eau. En France, comme à l’étranger, il a aujourd’hui un ancrage législatif, opérationnel et scientifique fort. La démarche de recherche engagée est destinée à mieux comprendre comment est définie, est pratiquée et est évaluée la « restauration de cours d’eau ». Les matériaux utilisés sont documentaires (publications scientifiques, dossiers administratifs des Agences de l’Eau, documents techniques d’appui à l’action, documents relatifs aux projets réalisés). Ils font l’objet d’analyses textuelles (bibliométrie, analyse de contenu, statistique textuelle, analyse qualitative).Les résultats sont organisés en cinq chapitres. Le Chapitre I concerne le positionnement des sciences dans le champ de la « restauration ». Sont abordés successivement les dynamiques scientifiques, les éléments de définitions et les thématiques de travail privilégiées par les chercheurs. Le Chapitre II dessine une chronologie des définitions françaises de la « restauration ». Il présente les permanences et les évolutions observées du XIXème siècle jusqu’à nos jours. Le Chapitre III s’intéresse aux politiques d’intervention de trois Agences de l’Eau. Il offre ainsi une première analyse des pratiques françaises de « restauration de cours d’eau ». Le travail sur les pratiques est ensuite centré, dans le Chapitre IV, sur la « restauration écologique de cours d’eau ». Il prolonge ainsi l’étude de l’action publique française et propose une comparaison avec l’Allemagne. Enfin, le Chapitre V s’intéresse plus particulièrement aux pratiques de suivi et d’évaluation des projets franco-Allemands de « restauration écologique ».Les résultats ont fait l’objet de réflexions opérationnelles et de recommandations afin d’aider l’action publique et les stratégies d’évaluation dans le domaine. Une attention particulière a également été accordée aux perspectives scientifiques dans le cadre d’une thématique stratégique pour la mise en œuvre de la Directive Cadre sur l’Eau.“Restoration” is a key concept in river management. In France and worldwide, “river restoration” has been provided a strong legislative, operational and scientific anchor. This research aims to better understand “river restoration”: that is, how is “river restoration” defined, practiced and evaluated? Research materials stand on various documents (scientific articles, administrative documents of French Water Agencies, technical documents about “restoration” procedures and documents related to specific “restoration projects”). These documents are analysed with textual analysis methods (bibliometrics, content analysis, textual statistics, qualitative analysis).Results are organized into five chapters. Chapter I deals with the position of sciences in the field of “river restoration”. This chapter covers research dynamics, scientific definitions of “restoration” and scientists’ research themes related to “river restoration”. Chapter II draws a timeline of French definitions of “river restoration”. It analyses permanence and change in the definition of “river restoration” from the late 19th Century until today. In Chapter III, a framework which suggests the establishment of three French Water Agencies in order to analyse French “river restoration” public policy and practice is proposed. Chapter IV is dedicated to the analysis of “ecological river restoration” practices. This Chapter’s objective is to better understand French public action. French practices are also compared to German practices. Finally, the monitoring and evaluation of contemporary “ecological river restoration” projects in France and in Germany is described in Chapter V.Operational reflections and recommendations are provided through the results of this research in order to aid public action and evaluation strategies in the field of “river restoration”. Special attention was also paid to scientific perspectives in the context of the implementation of the Water Framework Directive