Évaluation du risque sulfites dans la filière «Crustacés»

The main objective of this work is to evaluate the use of sulphites in crustacean sector. Sulphites are additives used by professionals to prevent melanosis in crustaceans. The study was based on data analysis of the notifications of the Rapid Alert System for Food and Feed (RASFF), surveys with shipowners (n=27) and two packing companies as well as the determination of residual SO2 content in 22 samples by the two methods, the Monier Williams (official method) and the strips technique. The analysis of RASFF data between 1981 and 2015 revealed that crustaceans accounted for 8.7 % of notifications concerning fishery products and that sulphites were the main reason. The results of surveys showed that the use of sulfiting agents is a common practice in the crustacean sector. Professionals use sulphite preparations at a rate of 2 % and its use is strictly controlled by veterinary services. The sulphite content found by the official method ranged from 7 to 280 ppm with an average of 64.3 ppm. The strips technique yielded accurate values for low levels (<50 ppm) and mixed results for high levels. A risk assessment showed that the daily amount of sulphite, of all origins, a 60 kg adult consumer can safely ingest is 42 mg. The amount of SO2 obtained in a 200 g portion, based on the average, was 12.9 mg, which constitutes 30.7% of the Acceptable Daily Intake (ADI). Crustaceans analyzed are thus free of any risk to the consumer. The conformity of almost all the samples confirmed the relevance of co-regulation in controlling the health risk of sulphites. Keywords: Crustacean, sulphites, analysis, risk, sulphite, use of sulfiting agents, co-regulation, Morocco.L’objectif de ce travail est de statuer sur l’utilisation des sulfites dans la filière des crustacés. Les sulfites sont des additifs utilisés par les professionnels pour prévenir la mélanose des crustacés. L’étude a été conduite par l’analyse des notifications du RASFF, des enquêtes auprès des armateurs (n=27) et deux établissements de conditionnement, ainsi que la détermination des teneurs résiduelles en SO2 dans 22 échantillons par la méthode officielle de Monier Williams et celle des bandelettes. L’analyse des données du RASFF entre 1981 et 2015 a montré qu’au sein des produits de la pêche, les crustacés ont fait l’objet de 8,7 % des notifications, et que les sulfites en sont le principal motif. Les enquêtes montrent que la sulfitation est une pratique courante. Les professionnels utilisent des préparations de sulfites à raison de 2 %. L’addition des sulfites fait l’objet d’un contrôle strict par les services vétérinaires. Les teneurs de sulfites trouvées par la méthode officielle varient entre 7 et 280 ppm avec une moyenne de 64,3 ppm. La technique des bandelettes a donné des valeurs sures pour les teneurs faibles (<50 ppm) et des résultats mitigés pour les teneurs élevées. Une évaluation du risque a permis de montrer que la quantité journalière de sulfites, toutes origines confondues, qu’un consommateur adulte de 60 kg peut ingérer sans danger est de 42 mg. La quantité de SO2 présente dans une ration de 200 g selon la moyenne obtenue est de 12,9 mg, ce qui constitue 30,7% de la Dose journalière admissible (DJA). Les crustacés analysés sont donc dénués de tout risque pour le consommateur. La conformité de la quasi-totalité des échantillons confirme la pertinence de l’approche corégulation dans la maîtrise du risque sanitaire des sulfites. Mots-clés: Crustacés, sulfites, analyse, risque, sulfitation, corégulation, Maroc

Sulphites risk assessment in the crustacean sector

The main objective of this work is to evaluate the use of sulphites in crustacean sector. Sulphites are additives used by professionals to prevent melanosis in crustaceans. The study was based on data analysis of the notifications of the Rapid Alert System for Food and Feed (RASFF), surveys with shipowners (n=27) and two packing companies as well as the determination of residual SO2 content in 22 samples by the two methods, the Monier Williams (official method) and the strips technique. The analysis of RASFF data between 1981 and 2015 revealed that crustaceans accounted for 8.7 % of notifications concerning fishery products and that sulphites were the main reason. The results of surveys showed that the use of sulfiting agents is a common practice in the crustacean sector. Professionals use sulphite preparations at a rate of 2 % and its use is strictly controlled by veterinary services. The sulphite content found by the official method ranged from 7 to 280 ppm with an average of 64.3 ppm. The strips technique yielded accurate values for low levels (<50 ppm) and mixed results for high levels. A risk assessment showed that the daily amount of sulphite, of all origins, a 60 kg adult consumer can safely ingest is 42 mg. The amount of SO2 obtained in a 200 g portion, based on the average, was 12.9 mg, which constitutes 30.7% of the Acceptable Daily Intake (ADI). Crustaceans analyzed are thus free of any risk to the consumer. The conformity of almost all the samples confirmed the relevance of co-regulation in controlling the health risk of sulphites

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Evaluation of Connecting Classrooms in Nigeria, Ethiopia, Bangladesh and Lebanon. Wave 2

This report presents the overseas findings from the impact evaluation of the Connecting Classrooms programme, the British Council's international education programme. The programme aims to build the capacity of teachers and school leaders to integrate a range of core skills (critical thinking and problem-solving, collaboration and communication, creativity and imagination, digital literacy, global citizenship and student leadership) into the curriculum. This report was part of a broader 20-month evaluation carried out between 2016-2018 that also included the UK. The evaluation was commissioned by The British Council principal office in London and conducted through a partnership between the research consultancy Ecorys and the Robert Owen Centre at the University of Glasgow. Findings in this overseas report are based on fieldwork in Nigeria, Lebanon, Bangladesh and Ethiopia. The first round of fieldwork took place in 2017 and comprised a counterfactual analysis of five Connecting Classrooms (CC) schools and five comparison schools per country. The second round of fieldwork occurred in the first quarter of 2018. These follow-up visits took place at CC schools only, and focused on assessing retention of knowledge, how much further core skills had become embedded in the curriculum, and the sustainability of changes in teaching practices. An additional element of the follow-up visits was the impact of the programme on policy and education stakeholders

Evaluation of Connecting Classrooms in Nigeria, Ethiopia, Bangladesh and Lebanon. Wave 2

This report presents the overseas findings from the impact evaluation of the Connecting Classrooms programme, the British Council's international education programme. The programme aims to build the capacity of teachers and school leaders to integrate a range of core skills (critical thinking and problem-solving, collaboration and communication, creativity and imagination, digital literacy, global citizenship and student leadership) into the curriculum. This report was part of a broader 20-month evaluation carried out between 2016-2018 that also included the UK. The evaluation was commissioned by The British Council principal office in London and conducted through a partnership between the research consultancy Ecorys and the Robert Owen Centre at the University of Glasgow. Findings in this overseas report are based on fieldwork in Nigeria, Lebanon, Bangladesh and Ethiopia. The first round of fieldwork took place in 2017 and comprised a counterfactual analysis of five Connecting Classrooms (CC) schools and five comparison schools per country. The second round of fieldwork occurred in the first quarter of 2018. These follow-up visits took place at CC schools only, and focused on assessing retention of knowledge, how much further core skills had become embedded in the curriculum, and the sustainability of changes in teaching practices. An additional element of the follow-up visits was the impact of the programme on policy and education stakeholders

Impact Evaluation of Connecting Classrooms Programme. Interim Report to British Council.

This report presents the interim findings from the impact evaluation of the Connecting Classrooms programme, the British Council's international education programme. The programme aims to build the capacity of teachers and school leaders to integrate a range of core skills (critical thinking and problem-solving, collaboration and communication, creativity and imagination, digital literacy, global citizenship and student leadership) into the curriculum. The evaluation was conducted through a partnership between the research consultancy, Ecorys and the Robert Owen Centre at the University of Glasgow. Findings are based on fieldwork across five countries (Nigeria, Lebanon, Bangladesh, UK and Ethiopia), chosen to capture the geographic diversity of the programme. In each country, five Connecting Classrooms schools were randomly selected to be included in the evaluation. Schools who agreed to participate were then matched with five non-Connecting Classrooms schools that were broadly similar in terms of key characteristics. Each school was then visited for one day by the research team. The visits included teacher and school leader interviews, classroom observations and student focus groups. The analysis of the data used a counterfactual approach, where outcomes in programme schools were compared against outcomes in control schools, to better understand the changes that may be attributed to the programme and to assess the ‘distance travelled’ within treatment schools. The small sample means that differences cannot be generalised to the whole population of treatment and non-treatment schools. To offset this, a theory-based and realist framework underpinned the analysis, where outcomes were compared against log-frame assumptions, and moderated through an understanding of local context. Throughout the study, a contribution analysis approach was used to understand wider drivers of change, particularly where it became evident that other factors were impacting on core skills teaching within schools