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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. |
- Batt, Mark E, et al.
(författare)
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Exercise at 65 and beyond.
- 2013
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Ingår i: Sports Medicine. - : Springer Science and Business Media LLC. - 0112-1642 .- 1179-2035. ; 43:7, s. 525-30
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Tidskriftsartikel (refereegranskat)abstract
- Aging is characterized by increasing muscle loss, physical inactivity and frailty. Physical inactivity is known to be associated with increased incidence of obesity and many life-threatening chronic conditions. We know that exercise, through many factors including antiinflammatory effects and enhanced fitness, can help prevent and treat many chronic diseases as well as help maintain independent living. We set out to demonstrate the utility of regular exercise in this potentially vulnerable age group in both the treatment and prevention of chronic diseases. The benefits, risks and recommendations for physical activity are discussed with an emphasis on practical advice for safe exercise in the context of established international guidelines. These guidelines typically state that 150 min per week of moderate aerobic intensity exercise should be achieved with some additional whole-body strength training and balance work. Individual risk assessment should be undertaken in a way to enable safe exercise participation to achieve maximum benefit with minimum risk. The risk assessment, subsequent advice and prescription for exercise should be personalized to reflect individual fitness and functional levels as well as patient safety. Newer and potentially exciting benefits of exercise are discussed in the areas of neuroscience and inflammation where data are suggesting positive effects of exercise in maintaining memory and cognition as well as having beneficial antiinflammatory effects.
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| 3. |
- Humphries, David, et al.
(författare)
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Delphi developed syllabus for the medical specialty of sport and exercise medicine: part 2.
- 2021
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Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 55, s. 81-83
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Tidskriftsartikel (refereegranskat)abstract
- Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.
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