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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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- Smith, A.C., et al.
(författare)
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How natural capital delivers ecosystem services: a typology derived from a systematic review
- 2017
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Ingår i: Ecosystem Services. - : Elsevier BV. - 2212-0416 .- 2212-0416. ; 26, s. 111-126
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Forskningsöversikt (refereegranskat)abstract
- There is no unified evidence base to help decision-makers understand how the multiple components of natural capital interact to deliver ecosystem services. We systematically reviewed 780 papers, recording how natural capital attributes (29 biotic attributes and 11 abiotic factors) affect the delivery of 13 ecosystem services. We develop a simple typology based on the observation that five main attribute groups influence the capacity of natural capital to provide ecosystem services, related to: A) the physical amount of vegetation cover; B) presence of suitable habitat to support species or functional groups that provide a service; C) characteristics of particular species or functional groups; D) physical and biological diversity; and E) abiotic factors that interact with the biotic factors in groups A-D. ' Bundles' of services can be identified that are governed by different attribute groups. Management aimed at maximising only one service often has negative impacts on other services and on biological and physical diversity. Sustainable ecosystem management should aim to maintain healthy, diverse and resilient ecosystems that can deliver a wide range of ecosystem services in the long term. This can maximise the synergies and minimise the trade-offs between ecosystem services and is also compatible with the aim of conserving biodiversity.
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