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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 4. |
- Dreschler, W. A., et al.
(författare)
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D-2-6: Report about the results of the multicentre evaluation of the Auditory Profile. Public report
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Twenty-eight partners participated in the FP6 EU-funded project HearCom, with the goal to improve hearing in our communication society. One of the main achievements has been the provision of advanced hearing screening tests by telephone and Internet. For hearing diagnostics it was aimed at the harmonization of hearing diagnostic tests within Europe. For this the concept of the Auditory Profile has been developed with several tests for various languages. Hearing problems are also a result of adverse acoustical circumstances for which the effects have been studied, modelled and evaluated for hearing impaired. For hearing rehabilitation a large scale comparison study was performed on signal enhancement techniques (algorithms) for hearing devices. Modern technology may assist on hearing and communication by the use of wireless technology and automatic speech transcription. On this it is shown that improvements for auditory communication can be obtained, but that technology should develop further. An overview is given on the HearCom portal with sections for screening diagnostics, hearing information for the public and professionals, and a new service called HearCompanion that provides step-by-step support for the hearing rehabilitation process.
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| 6. |
- Van Loon, Anne, et al.
(författare)
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Drought in the Anthropocene
- 2016
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Ingår i: Nature Geoscience. - : Springer Science and Business Media LLC. - 1752-0894 .- 1752-0908. ; 9:2, s. 89-91
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Drought management is inefficient because feedbacks between drought and people are not fully understood. In this human-influenced era, we need to rethink the concept of drought to include the human role in mitigating and enhancing drought.
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| 7. |
- Van Loon, Anne F., et al.
(författare)
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Drought in a human-modified world : reframing drought definitions, understanding, and analysis approaches
- 2016
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Ingår i: Hydrology and Earth System Sciences. - : Copernicus GmbH. - 1027-5606 .- 1607-7938. ; 20:9, s. 3631-3650
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Tidskriftsartikel (refereegranskat)abstract
- In the current human-modified world, or Anthropocene, the state of water stores and fluxes has become dependent on human as well as natural processes. Water deficits (or droughts) are the result of a complex interaction between meteorological anomalies, land surface processes, and human inflows, outflows, and storage changes. Our current inability to adequately analyse and manage drought in many places points to gaps in our understanding and to inadequate data and tools. The Anthropocene requires a new framework for drought definitions and research. Drought definitions need to be revisited to explicitly include human processes driving and modifying soil moisture drought and hydrological drought development. We give recommendations for robust drought definitions to clarify timescales of drought and prevent confusion with related terms such as water scarcity and overexploitation. Additionally, our understanding and analysis of drought need to move from single driver to multiple drivers and from uni-directional to multi-directional. We identify research gaps and propose analysis approaches on (1) drivers, (2) modifiers, (3) impacts, (4) feedbacks, and (5) changing the baseline of drought in the Anthropocene. The most pressing research questions are related to the attribution of drought to its causes, to linking drought impacts to drought characteristics, and to societal adaptation and responses to drought. Example questions include (i) What are the dominant drivers of drought in different parts of the world? (ii) How do human modifications of drought enhance or alleviate drought severity? (iii) How do impacts of drought depend on the physical characteristics of drought vs. the vulnerability of people or the environment? (iv) To what extent are physical and human drought processes coupled, and can feedback loops be identified and altered to lessen or mitigate drought? (v) How should we adapt our drought analysis to accommodate changes in the normal situation (i.e. what are considered normal or reference conditions) over time? Answering these questions requires exploration of qualitative and quantitative data as well as mixed modelling approaches. The challenges related to drought research and management in the Anthropocene are not unique to drought, but do require urgent attention. We give recommendations drawn from the fields of flood research, ecology, water management, and water resources studies. The framework presented here provides a holistic view on drought in the Anthropocene, which will help improve management strategies for mitigating the severity and reducing the impacts of droughts in future.
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