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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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- Barlow, Natasha L. M., et al.
(författare)
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Lack of evidence for a substantial sea-level fluctuation within the Last Interglacial
- 2018
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Ingår i: Nature Geoscience. - : Springer Science and Business Media LLC. - 1752-0894 .- 1752-0908. ; 11:9, s. 627-634
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Forskningsöversikt (refereegranskat)abstract
- During the Last Interglacial, global mean sea level reached approximately 6 to 9 m above the present level. This period of high sea level may have been punctuated by a fall of more than 4 m, but a cause for such a widespread sea-level fall has been elusive. Reconstructions of global mean sea level account for solid Earth processes and so the rapid growth and decay of ice sheets is the most obvious explanation for the sea-level fluctuation. Here, we synthesize published geomorphological and stratigraphic indicators from the Last Interglacial, and find no evidence for ice-sheet regrowth within the warm interglacial climate. We also identify uncertainties in the interpretation of local relative sea-level data that underpin the reconstructions of global mean sea level. Given this uncertainty, and taking into account our inability to identify any plausible processes that would cause global sea level to fall by 4 m during warm climate conditions, we question the occurrence of a rapid sea-level fluctuation within the Last Interglacial. We therefore recommend caution in interpreting the high rates of global mean sea-level rise in excess of 3 to 7 m per 1,000 years that have been proposed for the period following the Last Interglacial sea-level lowstand.
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