Overseas Territories Research Articles

Towards a history of parliamentary culture in the early modern world: concept, geopolitical scope, and method

ABSTRACT This article proposes an innovative approach to early modern representative institutions, from the later fifteenth century to the early eighteenth. It argues that only a transnational, interdisciplinary, and comparative study of such bodies can reveal their shared culture and prominence in contemporary political discourse, public memory, and cultural production. Central to this new approach is the concept of ‘parliamentary culture’, which sees representative assemblies as collective constructs and embodiments of a political community, and encompasses the transnational tradition of customs, ideas, and cultural expressions associated with them. The article aims to: (1) sketch out the institutional, geopolitical, and historical scope of our enquiry; (2) define parliamentary culture as a collection of practices of legitimation, negotiation, and debate in political assembly that are central to the life of a community; and (3) demonstrate that the distinctive institutional cultures of representative assemblies were an essential component of the public life and political thought of early modern countries; and that there was a common culture of representative assembly shared and recognized throughout Europe which was variously transplanted to and adapted in the overseas territories of the Iberian, Anglo-British, and Dutch empires, often through interaction with Indigenous traditions of assembly. The underlying argument is that only by looking at early modern representative bodies in this way can we appreciate the vitality and significance of this type of political organization.

‘[A] very improbable and imaginative fiction’: Fictionalising the French invasion of Fishguard

In the years leading up to the centenary of the last invasion of the British mainland, several historical novels in Welsh and English chronicled the events of the French landing near Fishguard in 1797. These fictional explorations throw Welsh national identity into relief at a time when Britain consolidated its domestic and overseas territories against its main rival, France. While ostensibly set in the historical past, the novels under observation share significant traits with the popular genre of the invasion novel that came to the fore in the second half of the nineteenth century as the British Empire neared its largest extent. Published during a time of cultural and political revivals in late-Victorian Wales, these historical invasion novels offer a different, literary way to examine past discourses around Welsh nationhood and national territory as well as coloniality and sovereignty.

Suicide attempts in Martinique and Reunion Island and appointments no-show

ObjectivesStudies on suicidal behaviors in the French overseas territories remain rare. Although mental health resources are limited, some patients identified as being at risk of suicide do not attend the specialist consultations scheduled after identification or screening. Thus, the objective of our study was, firstly to provide a descriptive profile of patients followed up for a suicide attempt in Martinique and Reunion Island, and secondly to explore the risk factors associated with appointments no-show during follow-up. MethodsWe conducted an ancillary retrospective cross-sectional study using data from the APSOM study. Data were collected on 255 patients aged at least 16, admitted to hospital emergency departments after a suicide attempt and followed up in ambulatory care, including 137 in Martinique and 118 in Reunion Island. The characteristics of the sample were described by means [min, max] and proportions [95% confidence intervals]. Differences according to the presence of appointments no-show or not were analyzed using comparison tests of means and percentages (Chi2, Fisher and Wilcoxon). Factors associated with appointments no-show were analyzed using a bootstrapped multivariate logistic regression model. ResultsThe mean age of patients was 35 years [16–84 years]. Women were predominant with a sex ratio of 2.4:1 (71% women). Unemployment affected 37% [28%, 46%] of patients in Martinique and 49% [40%, 59%] in Reunion Island. Psychoactive substances consumption at the time of the suicidal act was observed in 36% [27%, 45%] of patients in Martinique and 34% [26%, 44%] in Reunion Island. The average number of suicide attempts was two per patient [1–20]. Finally, we found no significant association with appointments no-show except for center. Patients from Reunion Island were associated with better compliance than patients from Martinique (OR: 0.20 [0.05–0.65], P<0.012). ConclusionOur study provides a description of suicide attempts admitted to hospital and followed up in ambulatory care in two French overseas territories and suggests interesting approaches for adapting prevention strategies to the socioeconomic context and cultural realities of these territories, particularly outreach interventions for the most vulnerable patients.

National survey to estimate seroprevalence for toxoplasmosis among pregnant women in France, 2021

Abstract Background Toxoplasmosis during pregnancy can result in congenital malformations and fetal death. In France, universal antenatal screening and monthly re-testing of seronegative pregnant women has been established since the 1970s. However, decreasing Toxoplasma gondii seroprevalence among pregnant women and lower incidence of congenital toxoplasmosis may challenge the cost-effectiveness of such programs. The aim of this study was to estimate the current seroprevalence among pregnant women participating in the 2021 national perinatal survey (ENP). Methods All adult women giving birth in France between 15-21 March 2021 were invited to participate in the ENP. Data collected included demographic information, nationality, socio-economic status, education level and Toxoplasma gondii serology. We classified a woman as seropositive if she had IgG antibodies prior to pregnancy or seroconverted during it. Univariable and multivariable regression analyses using Poisson model were conducted to estimate prevalence ratios (PRs) and identify significant factors associated with seropositivity. Results Among the 15,605 participating women, 0.22% seroconverted during pregnancy. The overall seroprevalence was 25.95%. Seropositivity was higher with increasing age (∼5% per 5 years), among residents of French overseas territories Guadeloupe/Saint Martin (PRs:1.07; 95%-CI: 1.03-1.10), La Réunion (PRs:1.10; 95%-CI: 1.08-1.13) and Mayotte (PRs:1.27; 95%-CI: 1.23-1.31), with lower education (PRs:1.22; 95%-CI: 1.04-1.42) and African nationality (PRs:1.11; 95%-CI: 1.02-1.20). Conclusions High seroprevalence for Toxoplasma gondii was found in older women, which may reflect their higher risk of past exposure. The observed geographical differences in seroprevalence may mirror dietary and environmental diversity. Declining seroprevalence among pregnant women in France can affect screening effectiveness and warrants a comprehensive review to determine appropriate future prevention strategies. Key messages • Older women and residents of French overseas territories show higher toxoplasmosis seroprevalence, possibly due to past exposure risks and diverse diets/environments. • Declining toxoplasmosis seroprevalence among pregnant women in France can affect screening effectiveness and warrants a comprehensive review to determine appropriate future prevention strategies.

Prevention and management of infectious and tropical diseases in kidney transplant recipients residing in European outermost and overseas territories.

The European Union encompasses 30 outermost and overseas countries and territories (OCTs). Despite a recent increasing activity of renal transplantation in these territories, many patients still undergo transplantation in continental Europe, with follow-up care coordinated between health professionals from both their transplant center and their home region. Each territory has its unique infectious epidemiology which must be known to ensure appropriate care for kidney transplant recipients (KTRs). This paper proposes a pragmatic approach to optimize pre-transplant check-up and to provide an overview of the specific epidemiological features of each region. It offers practical algorithms to help practitioners in managing infected KTR living in these territories. This work advocates for increased collaborative research among European OCTs.

A global assemblage of tax haven clusters: profit shifting, tax dodging and money laundering

In this paper we explore a selection of tax haven clusters in the US and Europe as diverse but recognisable species of some fifty of the phenomena worldwide that have been seldom studied from an economic geography or spatial planning viewpoint. We treat the objects of study as being almost perfect expressions of the classical, canonical cluster configuration. They are: spatial agglomeration, untraded as well as market dependencies, small and medium-sized enterprise status, associative or agentic relationships, interaction with large firms inside or outside the cluster and knowledge acquisition, advisory, consultancy and knowledge translation services from research and innovation intermediaries - public and/or private. However, we think their characteristics demand further recognition of the interactive and often innovative communication networks by means of which these cluster incumbents interact globally. This is because they are set within a worldwide system that can be conceptualised as an exemplar of the well-known construct known as an ‘assemblage’ (Deleuze and Guattari, 2004a). Unlike more recent treatments from De Landa (2019) and others, we try to concentrate on the motive power of the ‘agentic’ impulses of ‘desire’ that motivate human action (e.g. regarding ‘God, Gold or Glory’ as commonly-rehearsed motivators for colonialism of various kinds). It has been more common to use ‘assemblage theory’ to analyse the interlocking ‘machinic’ elements of complex systems like power networks or laboratory interactions. To unlock the mysteries of system interlocking in our selected tax havens, which comprise Wilmington, Delaware (US), Ireland (EU) and Gibraltar (former EU, now British Overseas Territory) – post-Brexit - occupying a ‘quantum’ space ‘in which both the colonial and post-colonial find expression’ (Perera, 2021). Methodologically, we seek ‘pattern recognition’ to identify the lineaments that explain these clusters and the ‘agentic’ actors that motivate them.

Timing of infant mortality in French Guiana: The persistence of high post neonatal mortality

BackgroundInfant mortality in French Guiana, a French overseas territory, is 2.7 times greater than in mainland France. Given the importance of better understanding infant mortality we aimed to describe the early & late neonatal, and postneonatal mortality in French Guiana between 2007 and 2022. MethodsWe used data from the Institut National de la Statistique et des Etudes Economiques to describe trends and performed survival analysis. ResultsOverall, there were 1 073 deaths before one year of age, of which 297 (27.7 %) occurred on the first day of life. The overall proportion of early neonatal deaths was 47.1 %, late neonatal deaths was 17.3 %, and post-neonatal deaths was 35.6 %. The overall incidences were 4.6 per 1,000 for early neonatal mortality, 1.4 per 1,000 for late neonatal mortality, and 3.1 per 1,000 for post neonatal mortality. The incidence for infant mortality for French Guiana residents was thus 9.1 per 1,000. ConclusionsWe show that post neonatal deaths in French Guiana are proportionally greater than in mainland France and they do not seem to decline, as they did in France. The relative proportions of post-neonatal mortality can thus help to identify important areas for action to correct excess infant mortality. Although poor pregnancy follow-up remains a problem we show that follow-up of infants is also a pressing problem that warrants increased efforts.

Prediabetes in a French overseas territory: Clinical Characteristics, Risk Factors, and Implications for type 2 diabetes prevention

BackgroundPeople with prediabetes are at high risk of developing type 2 diabetes (T2D). This study evaluates clinical, sociodemographic characteristics, and Finnish Diabetes Risk Score (FINDRISC) of individuals with prediabetes recruited in primary care by their general practitioner (GP) for PREDIABRUN study. MethodsPREDIABRUN, a prospective cohort study in primary care on Reunion Island, aimed to identify risk factors for developing T2D in 500 adults with prediabetes (18–70 years) between July 2019 and December 2022. Sociodemographic, anthropometric, health, and lifestyle data were collected. Participants were categorized as having known prediabetes if their GP was aware of glucose abnormalities before the study, otherwise as newly diagnosed. ResultsA total of 469 subjects were included, with a median age of 55 years; 58.4 % were women. Employment was more common among men (53.3 %) than women (36.1 %). Precariousness affected 35.4 % overall, with higher rates in women (41.6 %) than men (26.7 %, p < 0.001). The major associated health issues were obesity (40.1 %), musculoskeletal disorders (50.5 %), hypertension (46.3 %) and cardiovascular diseases (11.5 %). The median FINDRISC score was 16 [IQR: 12–19], higher in women (17 [14–20]) than men (15 [11–17], p < 0.001). For more than half the population (55.0 %), prediabetes status was already known. However, lifestyle habits were similar for those with newly diagnosed prediabetes and those with prediabetes already known. ConclusionScreened population in primary care on Reunion Island is relatively young, with a high FINDRISC score and numerous medical conditions. Tailored intervention to improve dietary habits and increase physical activity could help prevent diabetes in this high-risk group.

The United Nations' General Assembly High-Level Meeting on antimicrobial resistance: a joint statement from the Heads of Government and Chief Medical Officers of the United Kingdom's Overseas Territories.

The UK Overseas Territories (UKOTs) are small, often remote territories with historical and territorial links to the UK. They range from densely populated areas (Cayman, Bermuda, Gibraltar) to land with no permanent inhabitants (British Antarctic Territory, South Georgia). However, they are linked by ecosystem instability (the permacrisis) including antimicrobial resistance (AMR), climate change and biodiversity disruption. The Chief Medical Officers of the UKOTs met in June 2024 and were unanimous in their concerns about the threat of global AMR. They have issued this statement on their hopes and expectations for the United Nations' General Assembly High-Level Meeting, in September 2024. These may be summarized by the hope of achieving united and sustained global political will to reduce the threat of AMR by equitable access to treatments, prevention of AMR by sanitation and accurate diagnostics, and education in health care and the public.

Characterizing environmental contamination by plant protection products along the land-to-sea continuum:a focus on France and French overseas territories.

Environmental compartments are contaminated by a broad spectrum of plant protection products (PPPs) that are currently widely used in agriculture or, for some of them, whose use was banned many years ago. The aim of this study is to draw up an overview of the levels of contamination of soils, continental aquatic environments, seawaters and atmosphere by organic PPPs in France and the French overseas territories, based on data from the scientific publications and the grey literature. It is difficult to establish an exhaustive picture of the overall contamination of the environment because the various compartments monitored, the monitoring frequencies, the duration of the studies and the lists of substances are not the same. Of the 33 PPPs most often recorded at high concentration levels in at least one compartment, 5 are insecticides, 9 are fungicides, 15 are herbicides and 4 are transformation products. The PPP contamination of the environment shows generally a seasonal variation according to crop cycles. On a pluriannual scale, the contamination trends are linked to the level of use driven by the pest pressure, and especially to the ban of PPP. Overall, the quality of the data acquired has been improved thanks to new, more integrative sampling strategies and broad-spectrum analysis methods that make it possible to incorporate the search for emerging contaminants such as PPP transformation products. Taking into account additional information (such as the quantities applied, agricultural practices, meteorological conditions, the properties of PPPs and environmental conditions) combined with modelling tools will make it possible to better assess and understand the fate and transport of PPPs in the environment, inter-compartment transfers and to identify their potential impacts. Simultaneous monitoring of all environmental compartments as well as biota in selected and limited relevant areas would also help in this assessment.

Colonial Traces in Contemporary Italian Literature: The Cases of Giulia Caminito’s La Grande A (2016) and Mario Tobino’s Il deserto della Libia (1952)

ABSTRACT This article examines Giulia Caminito’s novel La grande A (2016) to show how descriptions of colonial subjects and spaces rely on stereotypes and exoticisations derived from colonial discourse. By analysing formal aspects and the intertextual relationship with Mario Tobino’s Il deserto della Libia (1952), the article underscores a continuity in terms of modes of representation between La grande A and its main sourcetext, suggesting a lack of interactions or connections with the transnational African/Italian authors who have confronted the legacy of Italy’s colonial past. In a mainly white European figurative framework, the novel marginalises and forecloses Black/African subjects while, at the same time, providing readers with orientalist descriptions of the former colonies. Although the novel addresses a frequently overlooked topic in Italian literature, namely colonialism and women’s experiences in the overseas territories, it also problematically reproduces stereotypes about Africa/Africans rather than effectively exposing and debunking them.

Colonial Project Finance Initiative: to what extent did the UK export its public-private partnership model to Caribbean British Overseas Territories?

ABSTRACT Public–Private Partnerships (PPP) are long-term agreements for procuring public projects that bundle up design, build, finance, operation and management. The UK’s version, Project Finance Initiative, was a policy-based framework, now defunct. Instead, PPPs in Caribbean British Overseas Territories (BOTs) are based on rigid models, with early stopovers focused on ensuring financial sustainability. A comparative analysis among Caribbean BOTs concludes that they show common models, and that those BOTs that need PPPs the most have set up the biggest hurdles to get them started. The analysis comprises four features: legal sources, administrative safeguards, scope restrictions for sector and value, and accountability.

Effect of nirsevimab on hospitalisations for respiratory syncytial virus bronchiolitis in France, 2023–24: a modelling study

Respiratory syncytial virus (RSV) is a major cause of hospitalisations and deaths among infants worldwide. France was one of the first countries to implement a national programme (beginning on Sept 15, 2023) for administration of nirsevimab, a single-dose long-acting monoclonal antibody treatment, to infants born on or after Feb 6, 2023, to prevent lower respiratory tract infection caused by RSV. We aimed to estimate the effectiveness of nirsevimab and the number of hospitalisations averted in children younger than 24 months in real-world settings. In this modelling study, we developed an age-structured deterministic model characterising RSV transmission as well as plausible scenarios for the administration of nirsevimab doses based on maternity ward and community pharmacy supply data. We retrospectively estimated nirsevimab effectiveness in infants younger than 24 months during the 2023-24 RSV season in France (excluding overseas territories) and the number of averted hospitalisations for RSV bronchiolitis occurring after emergency department visits, by calibrating the model to hospital and virological surveillance data from Aug 21, 2017, to Feb 4, 2024, alongside serological data from a previous cross-sectional study. To assess the robustness of our estimates, we conducted sensitivity analyses in which we modified our assumptions about the number of doses administered, the reconstruction of the number of RSV-associated hospitalisations for bronchiolitis, the duration of maternal and post-infection immunity to RSV, and the number of contacts in children aged 0-2 months. We estimated that nirsevimab administration prevented 5800 (95% credible interval 3700-7800) RSV-associated hospitalisations for bronchiolitis after emergency department visits among children younger than 24 months, including 4200 (2900-5600) hospitalisations among those aged 0-2 months, between Sept 15, 2023 (the date nirsevimab was introduced), and Feb 4, 2024-a 23% (16-30) reduction in the total number of hospitalisations and a 35% (25-44) reduction in the 0-2 months age group, compared with the scenario without administration. In our baseline scenario, in which we estimated that 215 000 doses of nirsevimab were administered by Jan 31, 2024, the estimated effectiveness against RSV-associated hospitalisations for bronchiolitis was 73% (61-84), corresponding to one hospitalisation averted for every 39 (26-54) doses administered. In sensitivity analyses, nirsevimab remained effective against RSV-associated hospitalisations for bronchiolitis after emergency department attendance. Our findings show that nirsevimab administration campaigns could effectively reduce the RSV-related hospital burden of bronchiolitis in children younger than 24 months. European Commission, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases programme, and INCEPTION project.

Temperature-related mortality burden and projected change in 1368 European regions: a modelling study

Excessively high and low temperatures substantially affect human health. Climate change is expected to exacerbate heat-related morbidity and mortality, presenting unprecedented challenges to public health systems. Since localised assessments of temperature-related mortality risk are essential to formulate effective public health responses and adaptation strategies, we aimed to estimate the current and future temperature-related mortality risk under four climate change scenarios across all European regions. We modelled current and future mortality due to non-optimal temperatures across 1368 European regions, considering age-specific characteristics and local socioeconomic vulnerabilities. Overseas territories were excluded from the analysis. We applied a three-stage method to estimate temperature-related risk continuously across age and spatial dimensions. Age and city-specific exposure-response functions were obtained for a comprehensive list of 854 European cities from the Urban Audit dataset of Eurostat. Regional aggregates were calculated using an aggregation and extrapolation method that incorporates the risk incidence in neighbouring cities. Mortality was projected for present conditions observed in 1991-2020 and for four different levels of global warming (1·5°C, 2°C, 3°C, and 4°C increase) by regions, and subregions using an ensemble of 11 climate models produced by the Coordinated Regional Climate Downscaling Experiment-CMIP5 over Europe, and population projection data from EUROPOP2019. Our results highlight regional disparities in temperature-related mortality across Europe. Between 1991 and 2020, the number of cold-related deaths was 2·5 times higher in eastern Europe than western Europe, and heat-related deaths were 6 times higher in southern Europe than in northern Europe. During the same time period, there were a median of 363 809 cold-related deaths (empirical 95% CI 362 493-365 310) and 43 729 heat-related deaths (39 880-45 921), with a cold-to-heat-related death ratio of 8·3:1. Under current climate policies, aligned with 3°C increase in global warming, it is estimated that temperature-related deaths could increase by 54 974 additional deaths (24 112-80 676) by 2100, driven by rising heat-related deaths and an ageing population, resulting in a cold-to-heat-related death ratio of 2·6:1. Climate change is also expected to widen disparities in regional mortality, particularly impacting southern regions of Europe as a result of a marked increase in heat-related deaths. This study shows that regional disparities in temperature-related mortality risk in Europe are substantial and will continue to increase due to the effects of climate change and an ageing population. The data presented can assist policy makers and health authorities in mitigating increasing health inequalities by prioritising the protection of more susceptible areas and older population groups. We identify the projected areas of heightened risk (southern Europe), where policy intervention aimed at building adaptation and enhancing resilience should be prioritised. European Commission.

Overcoming the Patronage System: Propaganda Fide and Its Portuguese Patronage Documents on China in the Early Modern Period

From its foundation in 1622, the Congregation de Propaganda Fide held supreme jurisdiction over all missionary activities of the Catholic Church at the global level, with authority coming directly from the pope. Its main goals were the expansion of the Catholic faith, the reaffirmation of papal spiritual primacy, and the promotion of Indigenous clergy throughout the world, which put Propaganda Fide in direct competition with secular rulers who also wanted to control missionary activities in their overseas territories. This article will examine one such conflict, namely that regarding Portugal and its royal patronage system in China. The Historical Archive of Propaganda Fide in the Vatican City holds extensive material concerning Portuguese patronage and China, which has remained relatively unknown and understudied. Through an examination of several of the most significant documents, such as the formal terms sent by the Portuguese court to the Holy See, the response of Propaganda Fide, and the final declaration of the Holy See, which would become the cornerstone for all future decisions over the patronage system, it is suggested that these negotiations about China are in fact central to a wider shift in global Catholic policy and politics in the field of missionary activity.

Large‐Scale Drivers of Tropical Extreme Precipitation Events: The Example of French Overseas Territories

AbstractDue to their severity and lack of predictability, understanding and forecasting extreme precipitation events (EPEs) is critical for disaster risk reduction. The present work documents the large‐scale environment of tropical EPEs based on a 42‐year data set combining dense rain‐gauge networks that cover several tropical small islands and coastal regions. Approximately 10%–30% of EPEs are associated with a tropical storm or cyclone (TC), except for Reunion, for which its high topography makes it reach 55%. TCs multiply the EPE probability by a factor of 4–15, especially during TCs of category 1 or higher. A composite analysis demonstrates that the remaining large part of EPEs occurs within large‐scale and strong moist, convective, and cyclonic wind anomalies resulting from the superimposition of intraseasonal, seasonal‐to‐annual, and interannual timescales. These intense anomalies come essentially from intraseasonal variability, and lower frequencies improve the effect of intraseasonal events in creating a favorable environment for EPEs.

Ethnic disparities in mental health problems in New Caledonia and French Polynesia.

Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.

An energy transition for all: Investigating determinants of citizen support for energy community initiatives on the island of Mayotte

For an equitable transition towards a decentralized and clean energy future, the involvement and active participation of citizens is needed, exemplified by new organizational forms such as Energy Communities (ECs). While determinants of citizen engagement in renewable energy projects have received some attention in the literature, research mostly focuses on continental Europe, with limited understanding of the perceptions and motivations of citizens living in the Global South or in contexts of poverty and marginalization. Using novel survey data (n = 392) and insights from 16 key informant interviews from the French overseas territory Mayotte, we investigate citizens' perception of renewable energies and ECs and their willingness to participate in such initiatives, confirming high support of the local population for a community-based energy transition. Through exploratory factor analysis and subsequent multivariate regressions, we identify the factors Environmental Awareness, Access to Services and Social Inclusion as important determinants of citizen engagement, with Environmental Awareness exhibiting particularly strong and robust effects on both general support and the willingness to actively participate in an EC. Establishing the housing situation of respondents as a proxy for socio-economic status (SES), we find positive effects of SES on EC support, which is mediated by the identified factors and thereby represents a fourth, underlying determinant of support. Our research underscores the vital importance of considering the multifaceted, diverse perceptions and motivations of the local population to achieve the vision of an equitable transition. Inclusion of needs and priorities of various socio-economic groups, particularly the most vulnerable community members, is essential.

Bone and Joint Infections in Children With Sickle Cell Disease in French Guiana: A 13-Year Retrospective Multicenter Review.

Sickle cell disease (SCD) is a genetic disorder with a high infectious morbidity and mortality and a heterogeneous distribution in France. One of the challenges is to differentiate a bone and joint infection (BJI) from a vaso-occlusive crisis. This challenge is particularly prevalent in French Guiana, an overseas territory with the highest incidence of SCD in France. The aim of this study was to describe the epidemiology of BJI in children with SCD in French Guiana. This was a retrospective multicentric descriptive study of SCD patients living in French Guiana aged under 18 and diagnosed with a BJI between 2010 and 2022. These BJI were divided into 2 groups: those with microbiological documentation (d-BJI) and those without microbiological identification (ud-BJI). A total of 53 episodes of BJI in 42 patients (mean age 7.2 years) were reported. Clinical symptoms on arrival were comparable between the d-BJI and ud-BJI groups. Patients in the d-BJI group had longer average hospital stays (40.4 days vs. 16.8 days, P = 0.01) and Salmonella spp. were the most identified bacteria (n = 8/13). White blood cell count was greater in the d-BJI group (30.3 G/L vs. 18.G/L, P = 0.01) and a collection was more frequently identified on imaging (11/13 vs. 16/40, P = 0.01) in this group. Initial in-hospital antibiotic therapy was longer in the d-BJI group (17.2 days vs. 12.8, P = 0.02), as were infection-related complications (9/13 vs. 12/40 P = 0.01). BJI in children with SCD is not sufficiently microbiologically documented. Progress must be made to improve the documentation of BJI.

Identifying suicidal risk factors in the French Overseas Territories with multimethod psychological autopsy (AUTOPSOM): a mixed-methods study protocol

IntroductionUnderstanding suicide in more isolated territories is a challenge because of the entanglement of cultural identity with historical, geographical and sociocultural specificities. This knowledge is a necessary precondition for the...