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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. |
- Holmes, Naomi, et al.
(författare)
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Climatic variability during the last millennium in Western Iceland from lake sediment records
- 2016
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Ingår i: The Holocene. - : SAGE Publications. - 0959-6836 .- 1477-0911. ; 26:5, s. 756-771
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this research was to create a decadal-scale terrestrial quantitative palaeoclimate record for NW Iceland from lake sediments for the last millennium. Geochemical, stable isotope and chironomid reconstructions were obtained from a lake sequence constrained by tephra deposits on the Snaefellsnes peninsula, western Iceland. Obtaining a quantitative record proved problematic, but the qualitative chironomid record showed clear trends associated with past summer temperatures, and the sedimentological records provided evidence for past changes in precipitation, mediated through catchment soil in-wash. When the full range of chronological uncertainty is considered, four clear phases of climatic conditions were identified: (1) a relatively warm phase between AD 1020 and 1310; (2) a relatively stable period between AD 1310 and 1510, cooler than the preceding period but still notably warmer than the second half of the millennium; (3) a consistent reduction of temperatures between AD 1560 and 1810, with the coolest period between AD 1680 and 1810; and (4) AD 1840-2000 has temperatures mainly warmer than in the preceding two centuries, with a rising trend and increased variability from c. AD 1900 onwards. The reconstructions show clearly that the first half of the millennium experienced warmer climatic conditions than the second half, with a return to the warmer climate only occurring in the last c. 100 years. Much of the variability of the chironomid record can be linked to changes in the North Atlantic Oscillation (NAO). The reconstructions presented can track low-frequency and long-term trends effectively and consistently but high-resolution and calibrated quantitative records remain more of a challenge - not just in finding optimal sedimentary deposits but also in finding the most reliable proxy. It is this that presents the real challenge for Holocene climate reconstruction from this key area of the North Atlantic.
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