Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Factores asociados a complicaciones por colocación de catéter venoso central en el Instituto Nacional de Salud del Niño enero – diciembre 2011

Publicación a texto completo no autorizada por el autorEl documento digital no refiere asesorDetermina los factores asociados a complicaciones por la colocación de catéter venoso central en el INSN en el periodo enero 2011 - diciembre 2011. Se realizó un estudio longitudinal retrospectivo de casos y controles. Se analizaron los factores asociados, se determino el riesgo mediante la regresión logística. Se encontró 146 procedimientos realizados en niños del INSN, durante el período de Enero a Diciembre del 2011. Las Complicaciones Tempranas (<24 horas) fueron 17 casos (11.64%) con Hemotórax, 16 casos (10.96%) con Neumotórax, 6 casos (4.11%) con Hematoma y 3 casos de Ruptura de CVC. Los factores con mayor riesgo para Hemotórax fueron: la Edad ≤ 1año (p<0.0001) con un OR=6.446, el genero masculino (p=0.0001) con un OR= 5.815; realizar más de 2 intentos (p=0.0001) con OR=5.657; el calibre de 5 French para CVC (p=0.0001) con un OR=7.287 ; la experiencia de colocar ≤ a 7 CVC/año (p=0.0001) con un OR=8.613 y el acceso subclavio derecho (p=0.0001) con un OR=7.262. Los factores para Neumotórax fueron la edad ≤ 1 año (p=0.0007) tuvo un OR=3.294 veces, el genero masculino (p=0.0005) con un OR=4.552, el tiempo de procedimiento > 30 minutos (p=0.001) con un OR=3.441, la experiencia del cirujano con ≤ de 7 CVC/año (p=0.0004) con un OR=4.386 y acceso subclavio derecho (p=0.0001) con un OR de 3.435. La tercera complicación temprana por colocación de CVC encontrada en el presente estudio fue el Hematoma con un 4.11%, los factores con mayor riesgo fueron el tiempo del procedimiento prolongado a > 30 min (p=0.0008) con un OR=6.848, plaquetas ≤ 150 mil (p=0.004) con un OR=4.385, antecedente subclavio derecho (p=0.006) con un OR= 3.867, experiencia del cirujano con >7 CVC/año (p=0.001) con un OR=4.833 y con número de intentos > 2 (p=0.001) con un OR=5.636. Las complicaciones tardías se vio en 25 casos; 18 de los cuales fueron por Infección en sitio de CVC (12.33%) y 7 casos de Obstrucción ( 4.79%). Para Infección los factores de riesgo fueron el número de intentos > 2 (p=0.0001) con un OR=4.639, el antecedente de CVC subclavio derecho (p=0.0001) con un OR=8.963, el tiempo de procedimiento > 30 min (p=0.0002) con un OR=3.764 y la condición de la superficie del lugar de acceso venoso central (p=0.0001) con un OR=5.836. El 4.79% tuvieron Obstrucción del CVC, sus factores de riesgo fueron: el calibre de 4 French (p=0.00001) con un OR=8.882, el Hematocrito > 30 (p=0.0001) con un OR=7.591 y el antecedente subclavio derecho de CVC (p=0.001) con un OR=5.417. Concluye que la edad de 1 mes a 1 año, el genero masculino, el hematocrito menor de treinta por ciento, el recuento de plaquetas menor a 150 mil, el tiempo de procedimiento > 30 minutos, la experiencia del cirujano con ≤ de 7 CVC/año, el acceso subclavio derecho, fueron los factores con mayor riesgo para las complicaciones tempranas como Neumotórax, Hemotórax. El número de intentos > 2, el antecedente de CVC subclavio derecho , el tiempo de procedimiento > 30 min, la condición de la superficie del lugar de acceso venoso central fueron los factores con mayor riesgo de Infección en sitio de colocación de CVC. Los factores con mayor riesgo para obstrucción fueron calibre de 4 French, el hematocrito > 30 y el antecedente subclavio derecho de CVC.Trabajo académic

Psychometric properties of the Spanish Yale-Brown Obsessive-Compulsive Scale – Second Edition

•The psychometric properties of the Spanish Yale-Brown Obsessive-Compulsive Scale, Second Edition (Spanish-Y-BOCS-II) was evaluated.•The Spanish-Y-BOCS-II internal consistency and inter-rater reliability were high.•Confirmatory factor analyses showed a marginally acceptable fit with the Obsessions and Compulsions two-factor model.•Subsequent exploratory factor analysis revealed a one-factor solution consistent with a Total score including all items.•Satisfactory construct validity was observed with measures of converging and diverging constructs. The Yale-Brown Obsessive-Compulsive Scale, Second Edition (Y-BOCS-II) is an evidence-based clinician-rated measure for assessing the presence and severity of obsessive-compulsive symptoms. The Spanish version of the Y-BOCS-II has not yet been validated. The present study examines the psychometric properties of the Spanish Y-BOCS-II (Spanish-Y-BOCS-II) in adults with obsessive-compulsive disorder (OCD) who are of Hispanic/Latino ancestry. The Spanish-Y-BOCS-II was administered to 1805 adults with OCD. Participants also completed a battery of measures assessing OCD, depression, and anxiety symptoms. The internal consistency for the Symptom Checklist (Kuder-Richardson-20=0.92), Obsession Severity (α=0.87), Compulsion Severity (α=0.86), and Total Severity (α=0.92) were high. The inter-rater reliability for the Severity Scale (intraclass correlations=0.98) was excellent. Confirmatory factor analyses showed a marginally acceptable fit with the Obsessions and Compulsions two-factor model; subsequent exploratory factor analysis revealed a one-factor solution consistent with a Total score including all items. Satisfactory construct validity was observed, supported by the strong correlations with other measures of obsessive-compulsive symptom severity and moderate correlations with measures of depression and anxiety symptoms. Overall, the Spanish-Y-BOCS-II demonstrates acceptable reliability and validity properties

Benchmarking empirical severity for the Yale-Brown Obsessive Compulsive Scale-Second Edition

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is considered the primary instrument for assessing the presence and severity of obsessive-compulsive disorder (OCD). Conceptual and empirical critiques inspired the development of an updated version of the instrument, the Yale-Brown Obsessive Compulsive Scale-Second Edition (Y-BOCS-II), with a higher ceiling of OCD severity to better differentiate between severe and the most debilitating OCD presentations, among other revisions. The Y-BOCS-II has demonstrated sound psychometric properties across diverse samples. Empirically derived severity benchmarks have been proposed for the original Y-BOCS, yielding somewhat different ranges than what has been commonly used in clinical and research settings, yet severity benchmarks for the Y-BOCS-II have yet to be established. Using a diverse, pooled sample of 2982 children and adults with OCD or obsessive-compulsive and related concerns across 13 countries, receiver-operating characteristic (ROC) analyses yielded severity benchmarks that largely mirrored the original Y-BOCS at the lower range of scores and extended the previously established benchmarks at the higher range of scores, owing to the increased ceiling of the instrument. The optimal benchmark ranges were determined as: non−/sub-clinical (0–14), mild (15–21), moderate (22–34), severe (35–50). Similar benchmarks were present across sex and age groups, and their accuracy was adequate in both a holdout sample and an independent sample of OCD patients from China (n = 78). Limitations and implications for the use of the Y-BOCS-II in clinical and research settings are discussed. •This study sought to establish severity benchmarks for the Y-BOCS-II.•Benchmarks largely mirrored the Y-BOCS benchmarks at the lower range of scores.•Benchmarks were sub-clinical (0–14), mild (15–21), moderate (22–34), and severe (35–50).•Similar benchmarks were suggested across sex and age groups.•Findings were affirmed in a holdout sample from China

Transdiagnostic links of reward processing in obsessive-compulsive disorder and depression

Transdiagnostic models aim to uncover shared mechanisms across mental disorders. Reward responsiveness (the ability to experience pleasure from rewarding stimuli) is a plausible, yet underexplored, transdiagnostic mechanism linking obsessive-compulsive disorder (OCD) and depression. This study used network analysis to (1) examine how key reward responsiveness domains are interlinked in individuals with OCD and (2) explore how each domain is uniquely associated with OCD and depression. A total of 1345 individuals with a history of OCD symptoms (ages 18–88, 71 % women) from Latino communities in the United States (including Puerto Rico) and nine Latin American countries completed validated measures of reward responsiveness, OCD, and depression. Network analyses evaluated interrelations among reward responsiveness domains and their links to OCD and depression. Hobbies and social interactions were the most central domains in the reward responsiveness network. Higher OCD severity was uniquely associated with lower responsiveness to social interactions, while higher depression severity was uniquely linked to reduced responsiveness in hobbies and goal-directed behaviors. Reward responsiveness is relevant to both OCD and depression. Interventions that enhance engagement in central domains, such as hobbies and social interactions, may improve outcomes. Future research should explore reward responsiveness in other mental disorders to inform transdiagnostic intervention strategies. •Network analysis explored reward responsiveness as a transdiagnostic link.•Hobbies and social interactions were most central in the reward network.•OCD severity linked to lower responsiveness to social interactions.•Depression severity linked to lower responsiveness to hobbies and goals.•Findings support reward responsiveness as a transdiagnostic treatment target