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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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| 2. |
- Chen, Jie, et al.
(författare)
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Long-Term Exposure to Source-Specific Fine Particles and Mortality-A Pooled Analysis of 14 European Cohorts within the ELAPSE Project
- 2022
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Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 56:13, s. 9277-9290
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Tidskriftsartikel (refereegranskat)abstract
- We assessed mortality risks associated with sourcespecific fine particles (PM2.5) in a pooled European cohort of 323,782 participants. Cox proportional hazard models were applied to estimate mortality hazard ratios (HRs) for source-specific PM2.5 identified through a source apportionment analysis. Exposure to 2010 annual average concentrations of source-specific PM2.5 components was assessed at baseline residential addresses. The source apportionment resulted in the identification of five sources: traffic, residual oil combustion, soil, biomass and agriculture, and industry. In single-source analysis, all identified sources were significantly positively associated with increased natural mortality risks. In multisource analysis, associations with all sources attenuated but remained statistically significant with traffic, oil, and biomass and agriculture. The highest association per interquartile increase was observed for the traffic component (HR: 1.06; 95% CI: 1.04 and 1.08 per 2.86 mu g/m(3) increase) across five identified sources. On a 1 mu g/m(3) basis, the residual oil-related PM2.5 had the strongest association (HR: 1.13; 95% CI: 1.05 and 1.22), which was substantially higher than that for generic PM2.5 mass, suggesting that past estimates using the generic PM2.5 exposure response function have underestimated the potential clean air health benefits of reducing fossil-fuel combustion. Source-specific associations with cause-specific mortality were in general consistent with findings of natural mortality.
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| 3. |
- Cole-Hunter, Thomas, et al.
(författare)
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Long-term air pollution exposure and Parkinson's disease mortality in a large pooled European cohort : An ELAPSE study
- 2023
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Ingår i: Environment International. - : Elsevier BV. - 0160-4120 .- 1873-6750. ; 171
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Tidskriftsartikel (refereegranskat)abstract
- Background: The link between exposure to ambient air pollution and mortality from cardiorespiratory diseases is well established, while evidence on neurodegenerative disorders including Parkinson’s Disease (PD) remains limited.Objective: We examined the association between long-term exposure to ambient air pollution and PD mortality in seven European cohorts.Methods: Within the project ‘Effects of Low-Level Air Pollution: A Study in Europe’ (ELAPSE), we pooled data from seven cohorts among six European countries. Annual mean residential concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3), as well as 8 PM2.5 components (copper, iron, potassium, nickel, sulphur, silicon, vanadium, zinc), for 2010 were estimated using Europe-wide hybrid land use regression models. PD mortality was defined as underlying cause of death being either PD, secondary Parkinsonism, or dementia in PD. We applied Cox proportional hazard models to investigate the associations between air pollution and PD mortality, adjusting for potential confounders.Results: Of 271,720 cohort participants, 381 died from PD during 19.7 years of follow-up. In single-pollutant analyses, we observed positive associations between PD mortality and PM2.5 (hazard ratio per 5 µg/m3: 1.25; 95% confidence interval: 1.01–1.55), NO2 (1.13; 0.95–1.34 per 10 µg/m3), and BC (1.12; 0.94–1.34 per 0.5 × 10-5m-1), and a negative association with O3 (0.74; 0.58–0.94 per 10 µg/m3). Associations of PM2.5, NO2, and BC with PD mortality were linear without apparent lower thresholds. In two-pollutant models, associations with PM2.5 remained robust when adjusted for NO2 (1.24; 0.95–1.62) or BC (1.28; 0.96–1.71), whereas associations with NO2 or BC attenuated to null. O3 associations remained negative, but no longer statistically significant in models with PM2.5. We detected suggestive positive associations with the potassium component of PM2.5.Conclusion: Long-term exposure to PM2.5, at levels well below current EU air pollution limit values, may contribute to PD mortality.
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| 4. |
- Marquer, Laurent, et al.
(författare)
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Pollen-based reconstruction of Holocene land-cover in mountain regions : Evaluation of the Landscape Reconstruction Algorithm in the Vicdessos valley, northern Pyrenees, France
- 2020
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Ingår i: Quaternary Science Reviews. - : Elsevier. - 0277-3791 .- 1873-457X. ; 228, s. 1-15
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Forskningsöversikt (refereegranskat)abstract
- Long-term perspectives on climate- and human-induced shifts in plant communities and tree line in mountains are often inferred from fossil pollen records. However, various factors, such as complex patterns of orographic wind fields and abundant insect-pollinated plants in higher altitudes, make pollen-based reconstruction in mountain regions difficult. Over the last decade the Landscape Reconstruction Algorithm (LRA) - a model-based approach in reconstruction of vegetation - has been successfully applied in various parts of the globe. However, evaluation of its effectiveness in mountain ranges is still limited. The present study assesses the extent to which the LRA approach helps quantify the local changes in vegetation cover at Vicdessos valley in northern French Pyrenees as a case study. In the study area well-dated sediment cores are available from eight bogs and ponds, 6-113 m in radius, located above the current tree line. We first use a simple simulation experiment to evaluate the way how pollen records from "landscape islands" (mountain tops and plateaus) would represent local vegetation and to clarify important factors affecting the LRA-based reconstruction in a mountainous region. This study then uses pollen records from these sites and vegetation and land-cover data both within a 50-km radius around the Vicdessos valley and within a 2-km radius from each site for evaluation of the REVEALS- and LOVE-based reconstruction of the regional and local plant cover, respectively, in the LRA approach. The land-cover data are complied for coniferous trees, broadleaved trees and non-forested areas from the CORINE and historical maps in three time windows: 1960-1970, 1990-2000 and 2000-2013. Major findings are as follows. (1) Accuracy of the regional vegetation estimates affects the reliability of the LRA-based reconstruction of vegetation within a 2-km radius; use of the CORINE data as input to the LOVE model improves reliability of the results over the use of the REVEALS-based estimates of regional vegetation. This implies that a systematic selection of pollen data only from sites above the tree line is problematic for estimating regional vegetation, and thus the entire LRA process. (2) Selection of the dispersal models for pollen transport (i.e. the Langrangian Stochastic Model vs. Gaussian Plume Model) does not affect significantly the LRA-based estimates at both the regional and local scales in the study area. (3) The LRA approach improves the pollen-based reconstruction of local vegetation compared to pollen percentage alone in northern Pyrenees. Although further empirical and simulation studies are necessary, our results emphasize the importance of site selection for the LRA-based reconstruction of vegetation in mountain regions. (C) 2019 Elsevier Ltd. All rights reserved.
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