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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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| 3. |
- Hindell, Mark A., et al.
(författare)
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Circumpolar habitat use in the southern elephant seal : implications for foraging success and population trajectories
- 2016
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Ingår i: Ecosphere. - : Wiley. - 2150-8925 .- 2150-8925. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- In the Southern Ocean, wide-ranging predators offer the opportunity to quantify how animals respond to differences in the environment because their behavior and population trends are an integrated signal of prevailing conditions within multiple marine habitats. Southern elephant seals in particular, can provide useful insights due to their circumpolar distribution, their long and distant migrations and their performance of extended bouts of deep diving. Furthermore, across their range, elephant seal populations have very different population trends. In this study, we present a data set from the International Polar Year project; Marine Mammals Exploring the Oceans Pole to Pole for southern elephant seals, in which a large number of instruments (N = 287) deployed on animals, encompassing a broad circum-Antarctic geographic extent, collected in situ ocean data and at-sea foraging metrics that explicitly link foraging behavior and habitat structure in time and space. Broadly speaking, the seals foraged in two habitats, the relatively shallow waters of the Antarctic continental shelf and the Kerguelen Plateau and deep open water regions. Animals of both sexes were more likely to exhibit area-restricted search (ARS) behavior rather than transit in shelf habitats. While Antarctic shelf waters can be regarded as prime habitat for both sexes, female seals tend to move northwards with the advance of sea ice in the late autumn or early winter. The water masses used by the seals also influenced their behavioral mode, with female ARS behavior being most likely in modified Circumpolar Deepwater or northerly Modified Shelf Water, both of which tend to be associated with the outer reaches of the Antarctic Continental Shelf. The combined effects of (1) the differing habitat quality, (2) differing responses to encroaching ice as the winter progresses among colonies, (3) differing distances between breeding and haul-out sites and high quality habitats, and (4) differing long-term -regional trends in sea ice extent can explain the differing population trends observed among elephant seal colonies.
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