30 research outputs found
Pediatric Dermatology In Family Medicine: Common Conditions And Management Strategies
- Author
- Abdulaziz Khalid A Alhuthayli
- Abdullah Saad Omar Almalki
- Abdulmajeed Saleh A Alharbi
- Afnan Mohammad Alneami
- Ahmed Abdelsamie Fadl
- Hajar Muhayl Alsahli
- Hamdan Sulaiman Ayed Alshammari
- Hamoud Meshal Farhan Alshammari
- Mohmed Farj Alshmri
- Razan Ahmed F Aljuhani
- Saeed Abdullah Alasmari
- Sahar Abdullah Mansur
- Yousef Ahmed Alduhailan
- Zahraa Ahmed J Alhassan
- Publication venue
- ASSOC ADVANCEMENT ZOOLOGY , AZADANAGAR COLONY RUSTAMPUR, GORAKHPUR, INDIA, 273001
- Publication date
- 29/12/2023
- Field of study
Among the most prevalent disorders are those related to the skin. However, in medical education and training, this class of illnesses is frequently disregarded. The first line of defence for the treatment of common dermatological diseases is a family physician. The purpose of our study was to evaluate the particular identification, management, encountering, and referral practices related to dermatological illnesses in family care. We also looked into the challenges and opportunities that family doctors experience in family medicine and saw a few of the paediatric dermatological diseases that family doctors may encounter. Finding areas of weakness in the clinical therapy of certain dermatological disorders, however, will be aided by assessing how family doctors treat particular ailments. Thus, this needs assessment might serve as a foundation for future research on the efficacy of family medicine in treating common paediatric dermatological problems as well as aid in the development of evidence-based training for family physicians in the area
Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis
- Author
- Aahlin Eirik Kjus
- Aamer Ahmed
- Aaniana Kenneth
- Ababneh Ali
- Abaliksta Tomas
- Abantanga Francis
- Abbas Athar
- Abbasy Jibran
- Abbo Olivier
- Abbott Tom
- Abbouch Meryem
- Abd El-Latif Nadia Khalid
- Abd Elkhalek Esraa
- Abd-Elmawla Manar
- Abdallah Emad
- Abdel-Aty Abdulrahman
- Abdel-Hameed Noran
- Abdel-Kader Sara Mahmoud
- Abdelaal Abdelaziz
- Abdelaty Mohamed
- Abdelazeam Anan Rady
- Abdelazim Galaleldin
- Abdelaziz Mohamed A.
- Abdelbadeai Kholoud
- Abdelfatah Afnan
- Abdelhady Samar
- Abdelhamed Rasha
- Abdelhamid Amina
- Abdelhaq Aram
- Abdelkader Mostafa
- Abdelkader Omar
- Abdelkhalek Mohamed
- Abdelmageed Eman
- Abdelmotaleb Ibrahem
- Abdelraouf Ahmed Mahmoud
- Abdelrouf Doaa Maher
- Abdelshakour Mahmoud
- Abdrabou Abdulshafi Khaled
- Abdul-Latif Saiba
- Abdulaziz Hager
- Abdulaziz Mustafa
- Abdulbagi Omar
- Abdulhakeem Eman Mahmoud
- Abdullah Mohamed Abozed
- Abdullah Nik Azim Nik
- Abdullah Noha
- Abdullahi Lawal
- Abdurrazzaaq Abdussemiu
- Abem Owusu Emmanuel
- Abiola Olajide
- Aboelella Majed
- Aboelmagd Omnia
- Aboelsoud Moustafa R.
- Aboul-Naga Mariam Saad
- Abouzaid Arwa
- Abu Qumbos Amjad
- Abu-toyour Maram
- Abubakr Marwan
- Abuowda Yousef
- Abuqwaider Eman
- Abusalem Lana
- Abushamleh Soha
- Ackom Eric
- Acquah Emmanuel
- Adam Ali
- Adam Nourhan
- Adamu Ahmed
- Adawi Ihdaa
- Adawi Mohammad
- Adebanjo Ademola
- Adebola Oluwaseyi
- Adedeji Adesina
- Adel Badr Eldin
- Adel Israa
- Adella Fidelis Jacklyn
- Adelshone Abdelrahman
- Ademuyiwa Adesoji
- Ademuyiwa Adesoji O.
- Ademuyiwa Adesoji O.
- Adenekan Babajide
- Adeniran James
- Adeniyi Adewale
- Adesanya Opeoluwa
- Adesina Alaba
- Adeyeye Ademola
- Adeyeye Ademola
- Adhitama Novia
- Adil Muhammad
- Adisa Adewale O.
- Adiyaman Can
- Adu-Aryee Niiarmah
- Afana Samah
- Agalianos Christos
- Agarwal Arnav
- Agarwal Arnav
- Agbedinu Kwabena
- Aglan Amro
- Aguado Suarez Nuria
- Aguilera Maria Lorena
- Aguilera Maria Lorena
- Aguilera-Arevalo Maria-Lorena
- Ahlonsou Germain
- Ahlqvist Sandra
- Ahlqvist Sandra
- Ahmed Asdaq
- Ahmed Ataa
- Ahmed Hayam
- Ahmed Hussien
- Ahmed Lopna Ahmed Mohamed
- Ahmed Sara
- Ahmed Saraibrahim
- Ahounou Ernest Yemalin Stephane
- Ajah Jonathan
- Ajai Olalekan
- Ajao Akinlabi
- Ajiboye Anthony
- Akoto Elliot
- Akpenyi Onyinye
- Al Amin Shadid
- Al Attar Samaa Mahmoud
- Al Barraw Fayez Elian
- Al Bastawis Fatema
- Al Meligy Amgad
- Al Rafati Ahmad Abdel Razaq
- Al Raouf Eman Abd
- Al Saied Ghiath
- Al Subaie Norah
- Al-Bahrani Ahmed
- Al-Buhaisi Alaa
- Al-Dakka Emad
- Al-faqawi Maha
- Al-farram Hadeel
- Al-khatib Ahmed
- Al-Marakby Dina
- Al-saqqa Sara
- Al-Saqqa Sara W.
- Al-Slaibi Ibrahim
- Al-taher Taher
- AlaaelDein Shahinaz
- Alada Muslimat
- Alakaloko Felix
- Alaloul Enas
- Alamin Shadid
- Alamoudi Mohammed
- Albiety Adel
- Alcca Ticona Willy
- Alejos Bermudez Ysabel Esthefany
- Alexander Philip
- Alexander Philip
- Alexandre Challine
- Alghamdi Ahmed
- Alghamdi Mohammed Saleh A.
- Alhady Khaled
- Alhammali Tariq
- Alhassan Basmah
- Alhazmi Wedyan
- Alherz Mohammad
- Ali Ahmed
- Ali Citra Dewi Mohd
- Ali Elsayed
- Ali Safia
- Ali Syed Abdul Wahhab Eusoffee Wan
- Ali Tebian Hassanein Ahmed
- Ali Wadah
- Alihonou Thierry
- Alis Halil
- Aliyu Halima
- Aliyu Mohammad
- Aliyu Shamsudeen
- Aljboor Khaled
- Aljiffry Murad
- Alkaaki Aroub
- Alkelani Muhammad
- Allam Meran
- Allam Yomna
- Alnaby Mohamed Hassab
- Alnusairat Aseel
- Alqahtani Saleh
- Alsaggaf Mohammed Ubaid
- Alser Osaid H.
- Alshareef Reham
- Altaf Abdulmalik
- Altamimi Abdullah
- Altamimi Afnan
- Altamini Afnan
- Altarayra Marwa
- Altibi Ahmed
- Altinel Yuksel
- Altinel Yuksel
- Altwijri Abdulaziz
- Alvi Abdul Rehman
- Aly Mohammed Yahia Mohamed
- Alyacoubi Said
- Alyahya Reem
- Alzahrani Ahmed
- Aman Nowrin F.
- Amandito Radhian
- Amandito Radhian
- Ambrona-Zafra David
- Amin Hager Abdul Aziz
- Amjad Mohammadasim
- Amoah Michael
- Amoako Joachim
- Amoako Philip Taah
- Amoako-Boateng Mabel
- Amole Isaac
- Amreia Mahmoud
- Anderson Frank
- Andika Ferry Fitriya Ayu
- Andreotti Dario
- Andress Cedar
- Andriola Valeria
- Ang Yun Lin
- Angelieri Daniele
- Anis Echaieb
- Ansaloni Luca
- Ansaloni Luca
- Ansaloni Luca
- Antezana Diego
- Anthoulakis Christos
- Antoniozzi Angelo
- Anwar Nourhan
- Anyanwu Lofty-John
- Aonzo Paolo
- Appeadu-Mensah William
- Appiah Eric Kofi
- Aquilino Fabrizio
- Arafa Omar
- Arafa Sara
- Arango Maria Clara Mendoza
- Arcudi Claudio
- Armellini Andrea
- Arnaud Alexis
- Arnaud Alexis Pierre
- Arshad Mohammad Mohsin
- Arslan Ekin
- Arsyad Hasbi Maulana
- Arthur Tom
- Aruldas Neerav
- Asar Yomna Hosny
- Asare-Bediako Kwasi
- Ashour Ahmad
- Ashour Ahmad
- Ashour Khlood
- Ashtari Morvarid
- Asi Fatema
- Asilah Siti Mohd Desa
- Assal Abdelrahman
- Asturias Sabrina
- Asumah Hamza
- Ata Ahmed
- Ata Aya Yehia
- Atiyeh Anwar
- Atkins Ebenezer Takyi
- Attia Attia
- Augestad Knut Magne
- Aviles Susan
- Avoka Anthony
- Awad Israa
- Awad Sawsan Adel
- Awadallah Salwa
- Ayandipo Omobolaji
- Aydin Mehmet Can
- Aziz Dayang Nita Abdul
- Aziz Mohamed Rezal Abdul
- Aziz Nora Abdul
- Azizeldine Mohammed G.
- Azzie Georges
- Azzis Olivier
- Baba Suleiman
- Bachri Houda
- Badawy Mahmoud
- Badenjki Mohamed Adel
- Badicel Maria
- Badr Mohamed Fawzy Mahrous
- Badwi Nermin Mohamed
- Bahar Suraya
- Baillie Katie
- Baki Bahadir Emre
- Bakr Ahmad
- Bakry Hesham Mohammed
- Bala Miklosh
- Balalis Dimitrios
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- Baluch Fatima
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- Bani-Sadar Ahmad
- Banipal Gurpreet Singh
- Baquero Suarez Alibeth Andres
- Baraka Heba
- Barendegere Venerand
- Barkolias Christos
- Barmayehvar Behrad
- Barnabas Gandau Naa
- Barrios Emmanuel
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- Bassem Monica
- Bassit Khalil Abdul
- Basso Stefano M. M.
- Bayram Sefa
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- Bedada Alemayehu Ginbo
- BediakoBowan Antoinette
- Bekhet Amira Hassan
- Bekhet Nada Mohamed
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- Bucci Luigi
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- Bustangi Nasir
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- Camilleri-Brennan Julian
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- Celik Saban
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- Cengiz Yucel
- Cengiz Yucel
- Cevik Muazzez
- Chabok Abbas
- Chai Chu-Ann
- Chai Feng Yih
- Chan Luke
- Chan Tsz-Yan Katie
- Chan Xue Wei
- Charles Angeline
- Cheah Alvin Ee Zhiun
- Chen Kar Yan
- Chen Tzu-Ling
- Cheong Yih Jeng
- Chetta Nicola
- Cheung Yuk Hong Eric
- Chibuye Chali
- Chiesa Deborah
- Chilton Gareth
- Chin Pui Xin
- Chin Ye Ru
- Chiu Seehui
- Choi Philip
- Chong Choon Seng
- Chong Hoong-Yin
- Choudhry Asad
- Chow Crystal Yern Nee
- Chowdhury Debkumar
- Chu Kathryn
- Chung Kuet Jun
- Chungui Bravo Jorge Armando
- Ciccioli Eleonora
- Ciubotaru Cezar
- Claire Raquillet
- Clarissa Audrey
- Clegg-Lampety Joe-Nat
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- Clerico Giuseppe
- Coccolini Federico
- Coccolini Federico
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- Coletta Diego
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- Conlon Kevin C.
- Connor Katie
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- Corbellino Mario
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- Corral Moreno Sara
- Correa Juan Camilo
- Corro-Diaz Samantha
- Costa Cecilia
- Costa-Maia Jose
- Costas-Chavarri Ainhoa
- Courboin Etienne
- Cox Daniel
- Cox Michael
- Coyoy-Gaitan Otto
- Craus-Miguel Andrea
- Cullen Fraser
- Curletti Gianluca
- Currow Chelise
- D'Amours Scott
- D'Souza Michelle S.
- Dabboor Majd
- Dabbour Kareem
- Dagoe Enoch
- Dahy Ahmed
- Dainius Edvinas
- Dakubo Jonathan
- Dalli Jeffrey
- Dally Charles
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- Darwish Abdelrhman K. Z.
- Dasari Mohini
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- Dassah Victor
- Datta Uttaran
- Davies Rachel
- Davor Anthony
- Dawood Khaled
- Dayie Makafui
- De Boni Davide
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- Deane Chelsea
- Debrah Sam
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- Dhillon Dharminder
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- Diaz Vico Tamara
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- Diaz-Jover Paula
- Dick Lachlan
- Dijan Emilio
- Dimech Thea
- Din Farhat
- Dindyal Shiva
- Dione Parreno-Sacdalan Marie
- Dissanayake Tharindra
- Djivoh Fernande
- Domini Edgar
- Donnelly Philippa
- Dorani Radin Mohd Nurrahman Radin
- Dorisme Asnel
- Dossou Francis
- Dousset Bertrand
- Dragatas Deividas
- Drake Thomas M.
- Drake Thomas M.
- Drungilas Mantas
- du Plooy Flip
- Du Toit Frederick
- Duane Therese
- Duinhouwer Lucia
- Dulskas Audrius
- Ebidy Mai
- Ebidy Mai Mohamed
- Eid Mostafa Mahmoud
- El Dahab Ali Abo
- El Gendy Noran Halim
- El Halawany Mohamed
- El Jamassi Alaa
- El Kashash Ahmed
- El Sayed Islam Magdy
- El-Dien Khalid Salah
- El-Din Reham Alaa
- El-Din Shahinaz Alaa
- El-Gizawy Esraa
- El-Sagheer Nada
- El-Sawy Aya
- El-Sehily Ahmed
- El-Taher Esraa
- Elashry Rehab
- Elazab Alaa
- Elbanby Esraa Samir
- Elbe Peter
- Elbisomy Khaled Hesham
- Eldafrawy Mahmoud
- Eldeeb Ahmed Zaki
- Eldeen Esraa Alm
- Eldin Mostafa Ahmed Bahaa
- Elebute Olumide
- Elfarargy Arwa
- Elfeki Hossam
- Elfiky Mahmoud
- Elfouly Nesma
- Elfouly Yasmin
- Elgendy Alyaa Halim
- Elgheriany Mohammed
- Elhadad Alaa
- Elhadary Nourhan Medhat
- Elhadry Shady
- Elhalawany Esraa
- Elhamouly Sara
- Elhelbawy Mohamed Salah
- Elhendawy Abdelaziz
- Elhoseny Ghada
- Elhusseiny Ahmed Abd Elmoen
- Elkholy Shimaa Said
- Ellison Quinn
- Elmashala Amjad
- Elmasry Maha
- Elmihy Sohaila
- Elnagar Ahmedglal
- Elnajjar Mahmoud A.
- Elrazek Aly Abd
- Elsabbagh Nourhan
- Elsameea Ahmed Abd
- Elsawy Amira
- Elsayed Nada Ahmed Reda
- Elsemelawy Rofida
- Elshaar Mohammed
- Elshaer Mohamed
- Elshami Mohamedraed
- Elsharkawy Aya Adel
- Elsherbiney Saged
- Elsherif Fawzia Abdellatif
- Elwy Eman
- Elzahed Nada
- Emadeldin Hossam
- Emara Eman
- Emile Sameh
- Eng Calvin
- English William
- Esam Abeer
- Escalante Salas Marilia Del Carmen
- Espin-Basany Eloy
- Espinoza Fernando
- Essam A. A.
- Essam Ahmed
- Essam Mahitab
- Essoun Samuel
- Esteban Enrique
- Estee Mahnuma Mahfuz
- Etchill Eric
- Etienne Sara
- Etwire Victor
- Evajelista Cicilia Viany
- Evans David
- Evans Elizabeth
- Ezzat Eslam
- Ezzat Tarek
- Faboya Omolara
- Fahim Marwan
- Fairfield Cameron
- Falaschi Federica
- Falco Nicolo
- Falzon Malcolm
- Farag Ahmed
- Farag Sameh
- Farahat Mahitab Morsy
- Fares Mohamed
- Farhan-Alanie Muhamed M. H.
- Farhangmehr Neda
- Farouk Sara Amr Mohamed
- Farrugia Alexia
- Farrugia Alexia
- Faruq Amreen
- Fathy Aya Mohamed
- Fatuga Adedeji
- Faturoti Olubukola
- Favero Alessandro
- Feidantsis Thomas
- Fergany Alaa
- Fergusson Stuart J.
- Fergusson Stuart J.
- Fermani Claudio Gabriel
- Fernandes Cristina
- Fernandez Carmen
- Fernandez-Vega Laura
- Ferousis Christoforos
- Ferrero Esther
- Filatau Aliaksandr
- Firdouse Mohammed
- Firdouse Mohammed
- Firwana Aya
- Fitsum Agazi
- Fitzgerald J. Edward
- Fitzgerald J. Edward
- Florez Farfan Erick Samuel
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- Foo Chi Chung
- Forlin Louise
- Fouad Dina
- Fourcade Laurent
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- Frey Daniel
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- Gaafar Shireen
- Gaarder Tina
- Gad Ahmed
- Gad Mariam O.
- Gadelkarim Mohamed
- Gado Ammar
- Gaizauskas Vytautas
- Gala Tanzeela
- Gala Tanzeela
- Galiqi Gezim
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- Gash Katherine
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- Ghaben Ahed
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- Ghanem Sara
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- Haddad Nadeem
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- Hafez Sarah
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- Halhouli Oday
- Halhouli Oday
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- Hall Elisabeth
- Haloho Andreass
- Hamarshi Aseel
- Hamasaki Hamaguchi Jose Luis
- Hamdan Ayah
- Hamdan Marwa
- Hamed Mohamed Fouad
- Hamill Daniel
- Hammad Aya
- Hampton Mark Ian
- Hamsho Ward
- Hanoun Sakhaa
- Hantour Usama
- Hany Ethar
- Haque Muhtarima
- Har Prisca A. L.
- Haraux Elodie
- Harrison Ewen M.
- Harrison Ewen M.
- Harrison Ewen M.
- Hartford Leila
- Harvey Neil
- Hasan Ahmad
- Hasan Doaa
- Hasanah Afifatun
- Hasanain Doaa
- Hascoet Juliette
- Hashad Eman
- Hashim Abdullah
- Haslegrave Aidan
- Hassaan Amr
- Hassaan Ayat
- Hassan Ahmed Tarek Abdelbaset
- Hassan Ihab
- Hassan Osama Mokhtar Mohamed
- Hassanain Mazen
- Hassanein Adel B.
- Heard Rachel
- Hegazy Eman Magdy
- Helene Francois-Coridon
- Helguero-Santin Luis M.
- Hemmila Mark
- Heng Hian Ee
- Henric Nicolas
- Henry Fitjerald
- Henshall David Ewart
- Herebat Azher
- Herikstad Ragnar
- Herrera Cruz Danilo
- Herrera Matta Juan Jaime
- Herrod Philip
- Hervieux Erik
- Hesham Omar
- Hilal Karim
- Hjertberg Maria
- Hmila Sophian
- Ho Adrienne
- Hodonou Fred
- Holte Silje
- Homeida Anmar
- Hossameldin Amr
- Hrora Abdelmalek
- Hunter Kristina
- Husseiny Reem
- Iacono Calogero
- Iannone Immacolata
- Ibraheem Aya AbdelFatah
- Ibrahem Ahmad Aboelkassem
- Ibrahim Ahmed Mohamed
- Ibrahim Amal
- Ibrahim Arij
- Ibrahim Arwa
- Ibrahim Eman
- Ibrahim Eman Mohamed
- Ibrahim Khaled
- Ibrahim Mohamed
- Idress Tasneem
- Idris Faisal
- Iftekhar Farhana
- Iftikhar Zainab
- Ignatavicius Povilas
- Ihediwa George
- Imoro Osman
- Ingabire J. C. Allen
- Ingabire J. C. Allen
- Ioannidis Orestis
- Iqbal Muhammad Rafaih
- Ireland Philip
- Irtan Sabine
- Irwin Gareth
- Irwin Gareth
- Ishak Norzawani
- Iskandar Ferdy
- Isler Vedatcan
- Ismail Ahmed
- Ismail Lawani
- Ismail Lawani
- Ismail Lawani
- Ismail Lawani
- Ismail Mohamed
- Ismail Mohammed Kamal
- Ismail Samar Adel
- Israelsson Leif
- Ivros Nikolaos
- Iyer Dush
- Iyer Dushyant
- Jabal Mohamed Sobhi
- Jaber Sahar
- Jaffry Zahra
- Jaich Robert
- Jama Guled M.
- Jamal Luai
- Janardha K. C.
- Janik Michal
- Jankus Tomas
- Jaradat Dana
- Jasaitis Kristijonas
- Javaid Mahnoor
- Jayathilake A. B.
- Jean-Francois Colombani
- Jeffery Anna
- Jeffery Anna
- Jennings Vicky
- Jensen Elisabeth
- Jeo Wifanto Saditya
- Jeon Hyunjin
- Jeremic Ljiljana
- Jethwani Durvesh Lacthman
- Jeyakumar Jenifa
- Jimenez Carneros Virginia
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- Zeta Solis Ludwing Alexander
- Zielinski Martin
- Zilinskas Justas
- Zilinskas Justas
- Zilinskas Justas
- Zilinskiene Reda
- Ziubryte Greta
- Zohair Ahmed
- Zuber Markus
- Zuk Grzegorz
- Zulkifli Athirah
- Zumbuhl Lucius
- Publication venue
- Elsevier
- Publication date
- 01/06/2003
- Field of study
BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London
Global economic burden of unmet surgical need for appendicitis
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- Publication venue
- Oxford University Press
- Publication date
- 01/01/2022
- Field of study
Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 92492millionusingapproach1and73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 95004millionusingapproach1and75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially
Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy
- Author
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- Bhargava A
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- Chiesa D
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- Chong CL
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- Chong H-Y
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- Chowdhury A
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- Dissanayake T
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- El Halawany M
- El Jamassi A
- El Kashash A
- El Kholy A
- El Magd AA
- El Mesery S
- El Sayed GS
- El Sayed IM
- El Shoura Y
- El-badawy HA
- El-Dien KS
- El-Dien KS
- El-Din RA
- El-Din SA
- El-Gizawy E
- El-Hamouly AS
- El-Kashef H
- El-Latif NK
- El-Ma'doul AS
- El-Rabaa S
- El-Sagheer N
- El-Sawy A
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- El-Shahat NS
- El-Sheemy H
- El-Taher E
- Elabdin HZ
- Elashmawy M
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- Elazoul M
- Elbanby E
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- Elbisomy KH
- Eldafrawy M
- Eldamaty L
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- EldosoukyMohammed A
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- Elena G
- Elfarargy A
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- Elfiky M
- Elfil M
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- Elfouly N
- Elfouly Y
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- Elgendy AH
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- Elgheriany M
- Elhadad A
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- Elhalawany E
- Elhamouly S
- Elhelbawy MS
- Elhendawy A
- Elhendawy AOA
- Elhoseny G
- Elhusseiny AAE
- Elizabeth Lopez C
- Elkadsh I
- Elkady F
- Elkelany A
- Elkelany A
- Elkelany A
- Elkelany A
- Elkhadrawi M
- Elkhalek EA
- Elkholy A
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- Elsemelawy R
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- Elsherbiny AS
- Elsherif FA
- Elshobary M
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- Elzahed N
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- Elzowawi F
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- Emile S
- Eng C
- English W
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- Escalante Salas MDC
- Espin-Basany E
- Espinoza F
- Essam A
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- Farouk SAM
- Farquharson A
- Farrugia A
- Farrugia A
- Faruq A
- Fathy AM
- Fattah AA
- Fatuga A
- Faturoti O
- Faturoti O
- Faure A
- Fautz T
- Favero A
- Fawzy A
- Feidantsis T
- Felipe CO
- Fergany A
- Fergusson SJ
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- Fermani C
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- Fernandes C
- Fernandez C
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- Ferousis C
- Ferrero E
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- Filatau A
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- Francone E
- Freitas AV
- Frey D
- Frisk B
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- Fujii F
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- Guevara Torres S
- Guevara R
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- Gunawan R
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- Halicioglu I
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- Hashim A
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- Zerihun AB
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- Zohair A
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- Zuber M
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- Zulkifli A
- Zumbuhl L
- Publication venue
- Publication date
- 15/10/2018
- Field of study
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe
Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019
- Author
- Abbafati Cristiana
- Abbastabar Hedayat
- Abd-Allah Foad
- Abdollahi Mohammad
- Abedi Aidin
- Abolhassani Hassan
- Abosetugn Akine Eshete
- Abreu Lucas Guimarães
- Abrigo Michael R. M.
- Abu Haimed Abdulaziz Khalid
- Abushouk Abdelrahman I.
- Adabi Maryam
- Adebayo Oladimeji M.
- Adekanmbi Victor
- Adelson Jaimie
- Adetokunboh Olatunji O.
- Adham Davoud
- Advani Shailesh M.
- Afshin Ashkan
- Agarwal Gina
- Agasthi Pradyumna
- Aghamir Seyed Mohammad Kazem
- Agrawal Anurag
- Ahmad Tauseef
- Akinyemi Rufus Olusola
- Al-Aly Ziyad
- Al-Mekhlafi Hesham M.
- Al-Raddadi Rajaa M.
- Alahdab Fares
- Alam Khurshid
- Albertson Samuel B.
- Alemu Yihun Mulugeta
- Alhassan Robert Kaba
- Ali Muhammad
- Ali Saqib
- Alipour Vahid
- Aljunid Syed Mohamed
- Alla François
- Almadi Majid Abdulrahman Hamad
- Almasi Ali
- Almasi-Hashiani Amir
- Almasri Nihad A.
- Almulhim Abdulaziz M.
- Alonso Jordi
- Altirkawi Khalid A.
- Alvis-Guzman Nelson
- Alvis-Zakzuk Nelson J.
- Amini Saeed
- Amini-Rarani Mostafa
- Amiri Fatemeh
- Amit Arianna Maever L.
- Amugsi Dickson A.
- Ancuceanu Robert
- Anderlini Deanna
- Andrei Catalina Liliana
- Androudi Sofia
- Ansari Fereshteh
- Ansari-Moghaddam Alireza
- Antonio Carl Abelardo T.
- Antony Catherine M.
- Antriyandarti Ernoiz
- Anvari Davood
- Anwer Razique
- Arab-Zozani Morteza
- Arabloo Jalal
- Aravkin Aleksandr Y.
- Aremu Olatunde
- Asaad Malke
- Asadi-Aliabadi Mehran
- Asadi-Pooya Ali A.
- Ashbaugh Charlie
- Athari Seyyed Shamsadin
- Atout Maha Moh'd Wahbi
- Ausloos Marcel
- Avila-Burgos Leticia
- Ayala Quintanilla Beatriz Paulina
- Ayano Getinet
- Ayanore Martin Amogre
- Aynalem Getie Lake
- Aynalem Yared Asmare
- Ayza Muluken Altaye
- Azari Samad
- Azzopardi Peter S.
- B Darshan B.
- Babaee Ebrahim
- Badiye Ashish D.
- Bahrami Mohammad Amin
- Baig Atif Amin
- Bakhshaei Mohammad Hossein
- Bakhtiari Ahad
- Bakkannavar Shankar M.
- Balachandran Arun
- Balassyano Shelly
- Banach Maciej
- Banerjee Srikanta K.
- Banik Palash Chandra
- Bante Agegnehu Bante
- Bante Simachew Animen
- Barker-Collo Suzanne Lyn
- Barrero Lope H.
- Barthelemy Celine M.
- Bassat Quique
- Basu Sanjay
- Baune Bernhard T.
- Bayati Mohsen
- Baye Bayisa Abdissa
- Bedi Neeraj
- Beghi Ettore
- Behzadifar Masoud
- Bekuma Tariku Tesfaye Tesfaye
- Bell Michelle L.
- Bensenor Isabela M.
- Berman Adam E.
- Bernabe Eduardo
- Bernstein Robert S.
- Bhagavathula Akshaya Srikanth
- Bhandari Dinesh
- Bhardwaj Pankaj
- Bhat Anusha Ganapati
- Bhattacharyya Krittika
- Bhattarai Suraj
- Bhutta Zulfiqar A.
- Bijani Ali
- Bikbov Boris
- Bilano Ver
- Biondi Antonio
- Birihane Binyam Minuye
- Bockarie Moses John
- Bohlouli Somayeh
- Bojia Hunduma Amensisa
- Bolla Srinivasa Rao Rao
- Boloor Archith
- Brady Oliver J.
- Braithwaite Dejana
- Briant Paul Svitil
- Briggs Andrew M.
- Briko Nikolay Ivanovich
- Burugina Nagaraja Sharath
- Busse Reinhard
- Butt Zahid A.
- Bärnighausen Till Winfried
- Caetano dos Santos Florentino Luciano
- Cahuana-Hurtado Lucero
- Carreras Giulia
- Carrero Juan J.
- Carvalho Felix
- Castaldelli-Maia Joao Mauricio
- Castañeda-Orjuela Carlos A.
- Castelpietra Giulio
- Castro Franz
- Catalá-López Ferrán
- Causey Kate
- Cederroth Christopher R.
- Cercy Kelly M.
- Cerin Ester
- Chandan Joht Singh
- Chang Angela Y.
- Charan Jaykaran
- Chattu Vijay Kumar
- Chaturvedi Sarika
- Chin Ken Lee
- Cho Daniel Youngwhan
- Choi Jee-Young Jasmine
- Christensen Hanne
- Chu Dinh-Toi
- Chung Michael T.
- Ciobanu Liliana G.
- Cirillo Massimo
- Comfort Haley
- Compton Kelly
- Cortesi Paolo Angelo
- Costa Vera Marisa
- Cousin Ewerton
- Cámera Luis Alberto
- Cárdenas Rosario
- Dahlawi Saad M. A.
- Damiani Giovanni
- Dandona Lalit
- Dandona Rakhi
- Darega Gela Jiregna
- Darwesh Aso Mohammad
- Daryani Ahmad
- Dash Aditya Prasad
- Davey Gail
- Davletov Kairat
- De Neve Jan-Walter
- Denova-Gutiérrez Edgar
- Deribe Kebede
- Dervenis Nikolaos
- Desai Rupak
- Dharmaratne Samath Dhamminda
- Dhungana Govinda Prasad
- Dianatinasab Mostafa
- Dias da Silva Diana
- Diaz Daniel
- Dippenaar Ilse N.
- Do Hoa Thi
- Dorostkar Fariba
- Doshmangir Leila
- Duncan Bruce B.
- Duraes Andre Rodrigues
- Dávila-Cervantes Claudio Alberto
- Eagan Arielle Wilder
- Edvardsson David
- El Sayed Iman
- El Tantawi Maha
- Elgendy Islam Y.
- Elyazar Iqbal R. F.
- Eskandari Khalil
- Eskandarieh Sharareh
- Esmaeilnejad Saman
- Esteghamati Alireza
- Ezekannagha Oluchi
- Farag Tamer
- Farahmand Mohammad
- Faraon Emerito Jose A.
- Farinha Carla Sofia e Sá
- Farioli Andrea
- Faris Pawan Sirwan
- Faro Andre
- Fazlzadeh Mehdi
- Feigin Valery L.
- Fernandes Eduarda
- Ferrara Pietro
- Feyissa Garumma Tolu
- Filip Irina
- Fischer Florian
- Fisher James L.
- Flor Luisa Sorio
- Foigt Nataliya A.
- Folayan Morenike Oluwatoyin
- Fomenkov Artem Alekseevich
- Foroutan Masoud
- Francis Joel Msafiri
- Fu Weijia
- Fukumoto Takeshi
- Fullman Nancy
- Furtado João M.
- Gad Mohamed M.
- Gaidhane Abhay Motiramji
- Gakidou Emmanuela
- Galles Natalie C.
- Gallus Silvano
- Gardner William M.
- Geberemariyam Biniyam Sahiledengle
- Gebrehiwot Abiyu Mekonnen
- Gebremeskel Gebreamlak Gebremedhn
- Gebremeskel Leake G.
- Gesesew Hailay Abrha
- Ghadiri Keyghobad
- Ghafourifard Mansour
- Ghashghaee Ahmad
- Ghith Nermin
- Gholamian Asadollah
- Gilani Syed Amir
- Gill Paramjit Singh
- Gill Tiffany K.
- Ginindza Themba G.
- Gitimoghaddam Mojgan
- Giussani Giorgia
- Glagn Mustefa
- Gnedovskaya Elena V.
- Godinho Myron Anthony
- Goharinezhad Salime
- Gopalani Sameer Vali
- Goudarzian Amir Hossein
- Goulart Bárbara Niegia Garcia
- Gubari Mohammed Ibrahim Mohialdeen
- Guimarães Rafael Alves
- Guled Rashid Abdi
- Gultie Teklemariam
- Guo Yuming
- Gupta Rahul
- Gupta Rajeev
- Hafezi-Nejad Nima
- Hafiz Abdul
- Haile Teklehaimanot Gereziher
- Hamadeh Randah R.
- Hameed Sajid
- Hamidi Samer
- Han Chieh
- Han Hannah
- Handiso Demelash Woldeyohannes
- Hanif Asif
- Hankey Graeme J.
- Haro Josep Maria
- Hasaballah Ahmed I.
- Hasan Md Mehedi
- Hashi Abdiwahab
- Hassan Amr
- Hassan Shoaib
- Hassanipour Soheil
- Hassankhani Hadi
- Havmoeller Rasmus J.
- Hay Simon I.
- Hayat Khezar
- Heidari Golnaz
- Heidari-Soureshjani Reza
- Hendrie Delia
- Herteliu Claudiu
- Hird Thomas R.
- Ho Hung Chak
- Hole Michael K.
- Holla Ramesh
- Hollingsworth Bruce
- Hoogar Praveen
- Hopf Kathleen Pillsbury
- Horita Nobuyuki
- Hossain Naznin
- Hosseini Mostafa
- Hosseinzadeh Mehdi
- Hostiuc Mihaela
- Hostiuc Sorin
- Househ Mowafa
- Hsieh Vivian Chia-rong
- Hu Guoqing
- Huda Tanvir M.
- Humayun Ayesha
- Hwang Bing-Fang
- Iavicoli Ivo
- Ibitoye Segun Emmanuel
- Ikeda Nayu
- Ilesanmi Olayinka Stephen
- Ilic Irena M.
- Ilic Milena D.
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- Waheed Yasir
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- Wang Yuan-Pang
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- Weiss Jordan
- Werdecker Andrea
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- Wilner Lauren B.
- Woldu Gebremariam
- Wolfe Charles D. A.
- Wu Ai-Min
- Wulf Hanson Sarah
- Xie Yang
- Xu Rixing
- Yahyazadeh Jabbari Seyed Hossein
- Yamagishi Kazumasa
- Yano Yuichiro
- Yaya Sanni
- Yazdi-Feyzabadi Vahid
- Yearwood Jamal A.
- Yeshitila Yordanos Gizachew
- Yip Paul
- Yonemoto Naohiro
- Younis Mustafa Z.
- Yousefi Zabihollah
- Yousefinezhadi Taraneh
- Yusefzadeh Hasan
- Zadey Siddhesh
- Zahirian Moghadam Telma
- Zaidi Syed Saoud
- Zaki Leila
- Zaman Sojib Bin
- Zamani Mohammad
- Zamanian Maryam
- Zandian Hamed
- Zastrozhin Mikhail Sergeevich
- Zewdie Kaleab Alemayehu
- Zhang Yunquan
- Zhao Xiu-Ju George
- Zhao Yingxi
- Zheng Peng
- Zhu Cong
- Ziapour Arash
- Zlavog Bianca S.
- Zodpey Sanjay
- Ärnlöv Johan
- Øverland Simon
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2020
- Field of study
Background
Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.
Methods
Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023.
Findings
Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach 1398pooledhealthspendingpercapita(US adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia.
Interpretation
The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC
Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
- Author
- Abbas Mosapour
- Abbas Sheikhtaheri
- Abdallah M Samy
- Abdelrahman I Abushouk
- Abdiwahab Hashi
- Abdollah Mohammadian-Hafshejani
- Abdul Hafiz
- Abdulaziz Khalid Abu Haimed
- Abdulaziz M Almulhim
- Abhay Motiramji Gaidhane
- Abiyu Mekonnen Gebrehiwot
- Achala Upendra Jayatilleke
- Adam E Berman
- Addisu Melese
- Aditya Prasad Dash
- Adnan Kisa
- Adrian Otoiu
- Adrian Pana
- Agegnehu Bante Bante
- Aguilera
- Ahad Bakhtiari
- Ahamarshan Jayaraman Nagarajan
- Ahmad Daryani
- Ahmad Ghashghaee
- Ahmed I Hasaballah
- Ahmed Omar Bali
- Ai Koyanagi
- Ai-Min Wu
- Aidin Abedi
- Akine Eshete Abosetugn
- Akram Pourshams
- Akshaya Srikanth Bhagavathula
- Alan D Lopez
- Alberto Ortiz
- Alberto Raggi
- Aleksandr Y Aravkin
- Aletta Elisabeth Schutte
- Ali A Asadi-Pooya
- Ali Almasi
- Ali Bijani
- Ali H Mokdad
- Ali Rajabpour-Sanati
- Alireza Ansari-Moghaddam
- Alireza Esteghamati
- Alireza Rafiei
- Allemani
- Alton Lu
- Alyssa N Sbarra
- Alyssa Pennini
- Amin Mousavi Khaneghah
- Amin Soheili
- Amir Almasi-Hashiani
- Amir Hossein Goudarzian
- Amir M Khater
- Amir Radfar
- Amir Taherkhani
- Amira A Shaheen
- Amirhossein Sahebkar
- Amr Hassan
- Amy E Peden
- Anders O Larsson
- Andre Faro
- Andre M N Renzaho
- Andre Rodrigues Duraes
- Andrea Farioli
- Andrea Werdecker
- Andrew M Briggs
- Andrew T Leever
- Andrew T Olagunju
- Angela Y Chang
- Animut Tagele Tamiru
- Anirudh Kotlo
- Anna V Korotkova
- Antonio Biondi
- Anurag Agrawal
- Anusha Ganapati Bhat
- Arash Sarveazad
- Arash Ziapour
- Archith Boloor
- Arianna Maever L Amit
- Arielle Wilder Eagan
- Artem Alekseevich Fomenkov
- Arun Balachandran
- Aruna M Kamath
- Asadollah Gholamian
- Ashish D Badiye
- Ashkan Afshin
- Ashraf F Nabhan
- Asif Hanif
- Asma
- Aso Mohammad Darwesh
- Ata Rafiee
- Ataguba
- Atif Amin Baig
- Atte Meretoja
- Atun
- Avina Vongpradith
- Ayesha Humayun
- Azeem Majeed
- Aziz Sheikh
- B Suresh Kumar Shetty
- Babak Moazen
- Bach Xuan Tran
- Barber
- Bartosz Miazgowski
- Basema Saddik
- Bayisa Abdissa Baye
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- Benjamin Ballard Massenburg
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- Biniyam Sahiledengle Geberemariyam
- Binyam Minuye Birihane
- Birhanu Geta Meharie
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- Bolajoko Olubukunola Olusanya
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- Boris Bikbov
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- Bruce Hollingsworth
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- Carlo Eduardo Medina-Solís
- Carlo La Vecchia
- Carlos A Castañeda-Orjuela
- Caroline Stein
- Catalina Liliana Andrei
- Catherine M Antony
- Celine M Barthelemy
- Chandrashekhar T Sreeramareddy
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- Charlie Ashbaugh
- Chemouni
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- Chidozie C D Iwu
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- Chinwe Juliana Iwu
- Christian Razo
- Christoph Nowak
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- Christopher R Cederroth
- Chukwudi A Nnaji
- Chukwuma David Umeokonkwo
- Claudia I Mastrogiacomo
- Claudio Alberto Dávila-Cervantes
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- Deepa Jahagirdar
- Deepak Saxena
- Degena Bahrey Tadesse
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- Demelash Woldeyohannes Handiso
- Dharmesh Kumar Lal
- Dhirendra Narain Sinha
- Dian Kusuma
- Diana Dias da Silva
- Dickson A Amugsi
- Diego Augusto Santos Silva
- Dieleman
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- Diep Ngoc Nguyen
- Dimas Ria Angga Pribadi
- Dinesh Bhandari
- Dinh-Toi Chu
- Dmytraczenko
- Doris V V Ortega-Altamirano
- Ebrahim Babaee
- Edgar Denova-Gutiérrez
- Eduarda Fernandes
- Eduardo Bernabe
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- Ejaz Ahmad Khan
- Elena V Gnedovskaya
- Elisabetta Pupillo
- Emerito Jose A Faraon
- Emma Elizabeth Spurlock
- Emma U R Smith
- Emmanuel K Peprah
- Emmanuel Wandera Okunga
- Emmanuela Gakidou
- Enrico Rubagotti
- Ensiyeh Jenabi
- Entezar Mehrabi Nasab
- Era Upadhyay
- Erkin M Mirrakhimov
- Ernoiz Antriyandarti
- Ester Cerin
- Ettore Beghi
- Ewerton Cousin
- Fablina Sharara
- Fabrizio Tediosi
- Fakher Rahim
- Falk Schwendicke
- Farahnaz Joukar
- Fares Alahdab
- Farhad Islami
- Farhad Jadidi-Niaragh
- Fariba Dorostkar
- Farshad Pourmalek
- Fatemeh Amiri
- Felix Akpojene Ogbo
- Felix Carvalho
- Feng Sha
- Fereshteh Ansari
- Fereshteh Mehri
- Ferrán Catalá-López
- Florentino Luciano Caetano dos Santos
- Florian Fischer
- Foad Abd-Allah
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- Francisco Rogerlândio Martins-Melo
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- Gebremariam Woldu
- George A Mensah
- George C Patton
- Georges Nguefack-Tsague
- Getie Lake Aynalem
- Getinet Ayano
- Gholamreza Roshandel
- Ghulam Mustafa
- Giancarlo Logroscino
- Gina Agarwal
- Giorgia Giussani
- Giovanni Damiani
- Giulia Carreras
- Giulio Castelpietra
- Godfrey M Rwegerera
- Golnaz Heidari
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- Govinda Prasad Dhungana
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- Guoqing Hu
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- Haidong Wang
- Hailay Abrha Gesesew
- Haley Comfort
- Hamed Zandian
- Hamid Sharifi
- Hamidreza Pazoki Toroudi
- Hannah Han
- Hanne Christensen
- Hasan Yusefzadeh
- Hassan Abolhassani
- Hedayat Abbastabar
- Helena Ullyartha Pangaribuan
- Hesham M Al-Mekhlafi
- Hiroyasu Iso
- Hmwe Hmwe Kyu
- Hoa Thi Do
- Hogan
- Hosna Janjani
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- Hossein Samadi Kafil
- Hunduma Amensisa Bojia
- Hung Chak Ho
- Huong Lan Thi Nguyen
- Hurst
- Ikegami
- Ilse N Dippenaar
- Iman El Sayed
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- Tangcharoensathien
- Tanuj Kanchan
- Tanvir M Huda
- Taraneh Yousefinezhadi
- Tariku Tesfaye Tesfaye Bekuma
- Tauseef Ahmad
- Teferi Mekonnen
- Teklehaimanot Gereziher Haile
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- Telma Zahirian Moghadam
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- Valentin Yurievich Skryabin
- Valery L Feigin
- Vaman Kulkarni
- Van Charles Lansingh
- Vasily Vlassov
- Ver Bilano
- Vera Marisa Costa
- Victor Adekanmbi
- Vijay Kumar Chattu
- Vinay Nangia
- Vinod C Nayak
- Virginia Nunez-Samudio
- Vishnu Renjith
- Vivekanand Jha
- Vivian Chia-rong Hsieh
- Vladimir Andreevich Korshunov
- Vollset
- Wagstaff
- Wagstaff
- Walter Mendoza
- Weijia Fu
- Whitney L Teagle
- William M Gardner
- Wondimeneh Shibabaw Shiferaw
- Xiu-Ju George Zhao
- Xuefeng Liu
- Yahya Safari
- Yang Xie
- Yared Asmare Aynalem
- Yasir Waheed
- Yasser Vasseghian
- Yetunde O John-Akinola
- Yihun Mulugeta Alemu
- Yingxi Zhao
- Yohannes Kinfu
- Yonas Getaye Getaye Tefera
- Yordanos Gizachew Yeshitila
- Young-Eun Kim
- Young-Ho Khang
- Yousef Mohammad
- Yousef Saleh Khader
- Yuan-Pang Wang
- Yuichiro Yano
- Yuming Guo
- Yun Jin Kim
- Yunquan Zhang
- Zabihollah Yousefi
- Zahid A Butt
- Zahiruddin Quazi Syed
- Zemenu Tadesse Tessema
- Ziyad Al-Aly
- Zubair Kabir
- Zulfiqar A Bhutta
- Łukasz Szumowski
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2020
- Field of study
Background
Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages.
Methods
Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023.
Findings
Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach 1398pooledhealthspendingpercapita(US adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia.
Interpretation
The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
- Author
- Aahlin Eirik Kjus
- Aamer Ahmed
- Aaniana Kenneth
- Ababneh Ali
- Abaliksta Tomas
- Abantanga Francis
- Abbas Athar
- Abbasy Jibran
- Abbo Olivier
- Abbott Tom
- Abbouch Meryem
- Abd El-Latif Nadia Khalid
- Abd Elkhalek Esraa
- Abd-Elmawla Manar
- Abdallah Emad
- Abdel-Aty Abdulrahman
- Abdel-Hameed Noran
- Abdel-Kader Sara Mahmoud
- Abdelaal Abdelaziz
- Abdelaty Mohamed
- Abdelazeam Anan Rady
- Abdelazim Galaleldin
- Abdelaziz Mohamed A
- Abdelbadeai Kholoud
- Abdelfatah Afnan
- Abdelhady Samar
- Abdelhamed Rasha
- Abdelhamid Amina
- Abdelhaq Aram
- Abdelkader Mostafa
- Abdelkader Omar
- Abdelkhalek Mohamed
- Abdelmageed Eman
- Abdelmotaleb Ibrahem
- Abdelraouf Ahmed Mahmoud
- Abdelrouf Doaa Maher
- Abdelshakour Mahmoud
- Abdrabou Abdulshafi Khaled
- Abdul-Latif Saiba
- Abdulaziz Hager
- Abdulaziz Mustafa
- Abdulbagi Omar
- Abdulhakeem Eman Mahmoud
- Abdullah Mohamed Abozed
- Abdullah Nik Azim Nik
- Abdullah Noha
- Abdullahi Lawal
- Abdurrazzaaq Abdussemiu
- Abem Owusu Emmanuel
- Abiola Olajide
- Aboelella Majed
- Aboelmagd Omnia
- Aboelsoud Moustafa R
- Aboul-Naga Mariam Saad
- Abouzaid Arwa
- Abu Qumbos Amjad
- Abu-toyour Maram
- Abubakr Marwan
- Abuowda Yousef
- Abuqwaider Eman
- Abusalem Lana
- Abushamleh Soha
- Ackom Eric
- Acquah Emmanuel
- Adam Ali
- Adam Nourhan
- Adamu Ahmed
- Adawi Ihdaa
- Adawi Mohammad
- Adebanjo Ademola
- Adebola Oluwaseyi
- Adedeji Adesina
- Adel Badr Eldin
- Adel Israa
- Adella Fidelis Jacklyn
- Adelshone Abdelrahman
- Ademuyiwa Adesoji
- Ademuyiwa Adesoji O
- Ademuyiwa Adesoji O
- Adenekan Babajide
- Adeniran James
- Adeniyi Adewale
- Adesanya Opeoluwa
- Adesina Alaba
- Adeyeye Ademola
- Adeyeye Ademola
- Adhitama Novia
- Adil Muhammad
- Adisa Adewale O
- Adiyaman Can
- Adu-Aryee Niiarmah
- Afana Samah
- Agalianos Christos
- Agarwal Arnav
- Agarwal Arnav
- Agbedinu Kwabena
- Aglan Amro
- Aguado Suarez Nuria
- Aguilera Maria Lorena
- Aguilera Maria Lorena
- Aguilera-Arevalo Maria-Lorena
- Ahlonsou Germain
- Ahlqvist Sandra
- Ahlqvist Sandra
- Ahmed Asdaq
- Ahmed Ataa
- Ahmed Hayam
- Ahmed Hussien
- Ahmed Lopna Ahmed Mohamed
- Ahmed Sara
- Ahmed Saraibrahim
- Ahounou Ernest Yemalin Stephane
- Ajah Jonathan
- Ajai Olalekan
- Ajao Akinlabi
- Ajiboye Anthony
- Akoto Elliot
- Akpenyi Onyinye
- Al Amin Shadid
- Al Attar Samaa Mahmoud
- Al Barraw Fayez Elian
- Al Bastawis Fatema
- Al Meligy Amgad
- Al Rafati Ahmad Abdel Razaq
- Al Raouf Eman Abd
- Al Saied Ghiath
- Al Subaie Norah
- Al-Bahrani Ahmed
- Al-Buhaisi Alaa
- Al-Dakka Emad
- Al-faqawi Maha
- Al-farram Hadeel
- Al-khatib Ahmed
- Al-Marakby Dina
- Al-saqqa Sara
- Al-Saqqa Sara W
- Al-Slaibi Ibrahim
- Al-taher Taher
- AlaaelDein Shahinaz
- Alada Muslimat
- Alakaloko Felix
- Alaloul Enas
- Alamin Shadid
- Alamoudi Mohammed
- Albiety Adel
- Alcca Ticona Willy
- Alejos Bermudez Ysabel Esthefany
- Alexander Philip
- Alexander Philip
- Alexandre Challine
- Alghamdi Ahmed
- Alghamdi Mohammed Saleh A
- Alhady Khaled
- Alhammali Tariq
- Alhassan Basmah
- Alhazmi Wedyan
- Alherz Mohammad
- Ali Ahmed
- Ali Citra Dewi Mohd
- Ali Elsayed
- Ali Safia
- Ali Syed Abdul Wahhab Eusoffee Wan
- Ali Tebian Hassanein Ahmed
- Ali Wadah
- Alihonou Thierry
- Alis Halil
- Aliyu Halima
- Aliyu Mohammad
- Aliyu Shamsudeen
- Aljboor Khaled
- Aljiffry Murad
- Alkaaki Aroub
- Alkelani Muhammad
- Allam Meran
- Allam Yomna
- Alnaby Mohamed Hassab
- Alnusairat Aseel
- Alqahtani Saleh
- Alsaggaf Mohammed Ubaid
- Alser Osaid H
- Alshareef Reham
- Altaf Abdulmalik
- Altamimi Abdullah
- Altamimi Afnan
- Altamini Afnan
- Altarayra Marwa
- Altibi Ahmed
- Altinel Yuksel
- Altinel Yuksel
- Altwijri Abdulaziz
- Alvi Abdul Rehman
- Aly Mohammed Yahia Mohamed
- Alyacoubi Said
- Alyahya Reem
- Alzahrani Ahmed
- Aman Nowrin F
- Amandito Radhian
- Amandito Radhian
- Ambrona-Zafra David
- Amin Hager Abdul Aziz
- Amjad Mohammadasim
- Amoah Michael
- Amoako Joachim
- Amoako Philip Taah
- Amoako-Boateng Mabel
- Amole Isaac
- Amreia Mahmoud
- Anderson Frank
- Andika Ferry Fitriya Ayu
- Andreotti Dario
- Andress Cedar
- Andriola Valeria
- Ang Yun Lin
- Angelieri Daniele
- Anis Echaieb
- Ansaloni Luca
- Ansaloni Luca
- Ansaloni Luca
- Antezana Diego
- Anthoulakis Christos
- Antoniozzi Angelo
- Anwar Nourhan
- Anyanwu Lofty-John
- Aonzo Paolo
- Appeadu-Mensah William
- Appiah Eric Kofi
- Aquilino Fabrizio
- Arafa Omar
- Arafa Sara
- Arango Maria Clara Mendoza
- Arcudi Claudio
- Armellini Andrea
- Arnaud Alexis
- Arnaud Alexis Pierre
- Arshad Mohammad Mohsin
- Arslan Ekin
- Arsyad Hasbi Maulana
- Arthur Tom
- Aruldas Neerav
- Asar Yomna Hosny
- Asare-Bediako Kwasi
- Ashour Ahmad
- Ashour Ahmad
- Ashour Khlood
- Ashtari Morvarid
- Asi Fatema
- Asilah Siti Mohd Desa
- Assal Abdelrahman
- Asturias Sabrina
- Asumah Hamza
- Ata Ahmed
- Ata Aya Yehia
- Atiyeh Anwar
- Atkins Ebenezer Takyi
- Attia Attia
- Augestad Knut Magne
- Aviles Susan
- Avoka Anthony
- Awad Israa
- Awad Sawsan Adel
- Awadallah Salwa
- Ayandipo Omobolaji
- Aydin Mehmet Can
- Aziz Dayang Nita Abdul
- Aziz Mohamed Rezal Abdul
- Aziz Nora Abdul
- Azizeldine Mohammed G
- Azzie Georges
- Azzis Olivier
- Baba Suleiman
- Bachri Houda
- Badawy Mahmoud
- Badenjki Mohamed Adel
- Badicel Maria
- Badr Mohamed Fawzy Mahrous
- Badwi Nermin Mohamed
- Bahar Suraya
- Baillie Katie
- Baki Bahadir Emre
- Bakr Ahmad
- Bakry Hesham Mohammed
- Bala Miklosh
- Balalis Dimitrios
- Balducci Genoveffa
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- Ruzzenente Andrea
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- Saad Reham
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- To Kathleen
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- Trompetto Mario
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- Turpo Espinoza Kevin
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- Tyler Robert
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- Tzikos Georgios
- Ubiali Paolo
- Ukwenya Yahaya
- ul Razi Syed Asaat
- Ulusahin Mehmet
- Upadhyaya Vijaid
- Urbonas Tomas
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- Uscinas Laimonas
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- Van Niekerk Michael
- Van Straten Stephanie
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- Werder Gabriela
- Whitaker John
- White Rebecca
- Whitehurst Katharine
- Wiborg Joachim
- Widiastini T Ariani
- Widmer Lukas Werner
- Wijayarathna LS
- Williams Omolara
- Wilson Ling
- Wilson Michael
- Wilson Michael
- Wimalge PMSN
- Wogensen Fredrik
- Wolf Bernhard
- Wondoh Paul
- Wondoh Paul
- Wong Chui Yee
- Wong Francisca
- Wong Hong Yee
- Wood Greta
- Worku Mengistu
- Worku Tewodros
- Wright Naomi
- Yahaya Muhammad Taqiyuddin
- Yakubu Musah
- Yam Sir Young
- Yang James
- Yap Suhhuey
- Yau Jih Dar
- Ye Joselyn
- Yeang Li Jing
- Yeung Man Hon Andrew
- Yifieyeh Abiboye
- Yildirim Reyyan
- Yip Chingwan
- Ymeri Shpetim
- Yoganathan Pigeneswaren
- Yolcu Sinem
- Yong Guo Liang
- Younis Abobaker
- Youssef Mohamed
- Yuksek Mahmut Arif
- Yusufali Taha
- Zaa'treh Rula
- Zadoroznas Antanas
- Zahran Diaaaldin
- Zakaria Esraay
- Zakaria Mahmoud
- Zakaria Yehia
- Zaki Ahmed
- Zammit Stefan
- Zampitis Nikolaos
- Zani Augusto
- Zani Augusto
- Zanini Nicola
- Zapata Felipe
- Zarb Ciskje
- Zeta Solis Ludwing Alexander
- Zielinski Martin
- Zilinskas Justas
- Zilinskas Justas
- Zilinskas Justas
- Zilinskiene Reda
- Ziubryte Greta
- Zohair Ahmed
- Zuber Markus
- Zuk Grzegorz
- Zulkifli Athirah
- Zumbuhl Lucius
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2018
- Field of study
Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.
Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.
Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001).
Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
- Author
- Abbafati Cristiana
- Abbas Kaja M.
- Abbasi Mohammad
- Abbasi-Kangevari Mohsen
- Abbasifard Mitra
- Abbastabar Hedayat
- Abd El Razek Hassan Magdy
- Abd El Razek Muhammed Magdy
- Abd-Allah Foad
- Abdelalim Ahmed
- Abdollahi Mohammad
- Abdollahpour Ibrahim
- Abdulkader Rizwan Suliankatchi
- Abdullah Kanaan Hamagharib
- Abedi Aidin
- Abedi Parisa
- Abegaz Kedir Hussein
- Abolhassani Hassan
- Abosetugn Akine Eshete
- Aboyans Victor
- Abrams Elissa M.
- Abreu Lucas Guimaraes
- Abrigo Michael R. M.
- Abu Haimed Abdulaziz Khalid
- Abu-Gharbieh Eman
- Abu-Raddad Laith Jamal
- Abualhasan Ahmed
- Abushouk Abdelrahman I.
- Acebedo Alyssa
- Ackerman Ilana N.
- Adabi Maryam
- Adair Tim
- Adamu Abdu A.
- Adebayo Oladimeji M.
- Adedeji Isaac Akinkunmi
- Adekanmbi Victor
- Adelson Jaimie D.
- Adeoye Abiodun Moshood
- Adetokunboh Olatunji O.
- Adham Davoud
- Advani Shailesh M.
- Afarideh Mohsen
- Afshari Mahdi
- Afshin Ashkan
- Agardh Emilie E.
- Agarwal Gina
- Agasthi Pradyumna
- Agesa Kareha M.
- Aghaali Mohammad
- Aghamir Seyed Mohammad Kazem
- Agrawal Anurag
- Ahmad Tauseef
- Ahmadi Alireza
- Ahmadi Keivan
- Ahmadi Mehdi
- Ahmadieh Hamid
- Ahmadpour Ehsan
- Ahmed Muktar Beshir
- Aji Budi
- Akalu Temesgen Yihunie
- Akinyemi Rufus Olusola
- Akinyemiju Tomi
- Akombi Blessing
- Akunna Chisom Joyqueenet
- Al-Aly Ziyad
- Al-Mekhlafi Hesham M.
- Al-Raddadi Rajaa M.
- Alahdab Fares
- Alam Khurshid
- Alam Noore
- Alam Samiah
- Alam Tahiya
- Alanezi Fahad Mashhour
- Alanzi Turki M.
- Albertson Samuel B.
- Alcalde-Rabanal Jacqueline Elizabeth
- Alema Niguse Meles
- Alemu Biresaw Wassihun
- Alemu Yihun Mulugeta
- Alhabib Khalid F.
- Alhassan Robert Kaba
- Ali Muhammad
- Ali Saqib
- Alicandro Gianfranco
- Alijanzadeh Mehran
- Alinia Cyrus
- Alipour Vahid
- Alizade Hesam
- Aljunid Syed Mohamed
- Alla Francois
- Allebeck Peter
- Almadi Majid Abdulrahman Hamad
- Almasi Ali
- Almasi-Hashiani Amir
- Almasri Nihad A.
- Almulhim Abdulaziz M.
- Alonso Jordi
- Altirkawi Khalid A.
- Alumran Arwa Khalid
- Alvis-Guzman Nelson
- Alvis-Zakzuk Nelson J.
- Amare Azmeraw T.
- Amare Bekalu
- Amini Saeed
- Amini-Rarani Mostafa
- Aminorroaya Arya
- Amiri Fatemeh
- Amit Arianna Maever L.
- Amugsi Dickson A.
- Amul Gianna Gayle Herrera
- Anbesu Etsay Woldu
- Ancuceanu Robert
- Anderlini Deanna
- Anderson Jason A.
- Andrei Catalina Liliana
- Andrei Tudorel
- Androudi Sofia
- Angus Colin
- Anjomshoa Mina
- Ansari Fereshteh
- Ansari Iman
- Ansari-Moghaddam Alireza
- Antonazzo Ippazio Cosimo
- Antonio Carl Abelardo T.
- Antony Catherine M.
- Antriyandarti Ernoiz
- Anvari Davood
- Anwer Razique
- Appiah Seth Christopher Yaw
- Arab-Zozani Morteza
- Arabloo Jalal
- Aravkin Aleksandr Y.
- Arba Aseb Arba Kinfe
- Aremu Olatunde
- Ariani Filippo
- Aripov Timur
- Armoon Bahram
- Arnlov Johan
- Arowosegbe Oluwaseyi Olalekan
- Aryal Krishna K.
- Arzani Afsaneh
- Asaad Malke
- Asadi-Aliabadi Mehran
- Asadi-Pooya Ali A.
- Asgari Samaneh
- Asghari Babak
- Ashbaugh Charlie
- Assmus Michael
- Atafar Zahra
- Athari Seyyed Shamsadin
- Atnafu Desta Debalkie
- Atout Maha Moh'd Wahbi
- Atre Sachin R.
- Atteraya Madhu Sudhan
- Ausloos Floriane
- Ausloos Marcel
- Avila-Burgos Leticia
- Avokpaho Euripide Frinel Gbenato Arthur
- Ayano Getinet
- Ayanore Martin Amogre
- Aynalem Getie Lake
- Aynalem Yared Asmare
- Ayza Muluken Altaye
- Azari Samad
- Azarian Ghasem
- Azene Zelalem Nigussie
- Azhar Gulrez
- Azzopardi Peter S.
- Babaee Ebrahim
- Badawi Alaa
- Badiye Ashish D.
- Bagherzadeh Mojtaba
- Bagli Eleni
- Bahrami Mohammad Amin
- Baig Atif Amin
- Bairwa Mohan
- Bakhshaei Mohammad Hossein
- Bakhtiari Ahad
- Bakkannavar Shankar M.
- Balachandran Arun
- Balakrishnan Senthilkumar
- Balalla Shivanthi
- Balassyano Shelly
- Baldasseroni Alberto
- Bali Ahmed Omar
- Ball Kylie
- Ballew Shoshana H.
- Balzi Daniela
- Banach Maciej
- Bandpei Mohammad A. Mohseni
- Banerjee Srikanta K.
- Banik Palash Chandra
- Bannick Marlena S.
- Bante Agegnehu Bante
- Bante Simachew Animen
- Baraki Adhanom Gebreegziabher
- Barboza Miguel A.
- Barker-Collo Suzanne Lyn
- Barnighausen Till Winfried
- Barrero Lope H.
- Barthelemy Celine M.
- Barua Lingkan
- Barzegar Akbar
- Basaleem Huda
- Bassat Quique
- Basu Sanjay
- Baune Bernhard T.
- Bayati Mohsen
- Baye Bayisa Abdissa
- Bazmandegan Gholamreza
- Becker Jacob S.
- Bedi Neeraj
- Beghi Ettore
- Behzadifar Masoud
- Bejot Yannick
- Bekuma Tariku Tesfaye Tesfaye
- Bell Michelle L.
- Bello Aminu K.
- Bender Rose G.
- Bennett Derrick A.
- Bennitt Fiona B.
- Bensenor Isabela M.
- Benziger Catherine P.
- Berhe Kidanemaryam
- Berman Adam E.
- Bernabe Eduardo
- Bernstein Robert S.
- Bertolacci Gregory J.
- Bhagavathula Akshaya Srikanth
- Bhageerathy Reshmi
- Bhala Neeraj
- Bhandari Dinesh
- Bhardwaj Pankaj
- Bhat Anusha Ganapati
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- Yu Yong
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- Yuce Deniz
- Yusefzadeh Hasan
- Zadey Siddhesh
- Zahabi Saleh Salehi
- Zaidi Syed Saoud
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- Zakzuk Josefina
- Zamani Mohammad
- Zamanian Maryam
- Zandian Hamed
- Zangeneh Alireza
- Zarafshan Hadi
- Zastrozhin Mikhail Sergeevich
- Zewdie Kaleab Alemayehu
- Zhang Jianrong
- Zhang Yunquan
- Zhang Zhi-Jiang
- Zhao Jeff T.
- Zhao Xiu-Ju George
- Zhao Yingxi
- Zheleva Bistra
- Zheng Peng
- Zhou Maigeng
- Zhu Cong
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- Publication venue
- Publication date
- 01/01/2020
- Field of study
Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
- Author
- Aamir Faiqa Binte
- Aamir Syed Roohan
- Ababneh Adnan
- Abbal Muhammad Anas
- Abbas Ahmed M
- Abbas Mostafa
- Abd-Albain Montasir A
- Abdalei Abdulwahab
- Abdalla Ahmed
- Abdalla Ahmed Yassir
- Abdalla Mohamed Galal Ali
- Abdalla Zainab
- Abdallah Mohamed M
- Abdalmahmoud Noon Ezzeldien
- Abdalsadeg Rowa
- Abdelaal Ahmed M
- Abdelbagi Alnazeer Y
- Abdelbaky Mostafa
- Abdelbaset Doaa
- AbdElbaset Esraa
- Abdelbast Menhag
- Abdelfatah Mohammed Abdelnasser
- Abdelgawad Samia
- Abdelhamid Mohamed M
- Abdeljaber Mahmoud
- Abdelkhalig Mubarak
- Abdelmaksoud Mohamed
- Abdelmeguid Rana
- Abdelmelek Dhia Errahmane
- Abdelnaeam Samah
- Abdelnasser Mohammad K
- Abdelrahim Najwa
- Abdelrahman Amira
- Abdelrahman Ayman
- Abdelsalam Hebatalla
- Abdelsamed Enas Abdelbaset
- Abdelwahab Khaled
- Abdoun Meriem
- Abdulali Fatima
- Abdulaziz Mohamed
- Abdulla Dheba Almukhtar
- Abdullah Bahiyah
- Abdullah Bahiyah
- Abdullah Walaa
- Abdullahi Habiba Ibrahim
- Abdulrahman Ahmed
- Abdulrasheed Lubabatu
- Abdulwahed Eman
- Abdulwahed Eman
- Abeysirigunawardana Dewmi
- Abidin Muhammad Fihmi Zainal
- Abiola Olukayode
- Abiyere Henry
- Abodina Ahmed Mohammed
- Aboelela Reham
- AboElfarh Hadeer Elsaeed
- Aboudlal Husein
- AbouHiekal Osama
- Aboulfotouh Ahmed
- Abozid Anwaar
- Abubaker Noora
- Abubaker Noora
- Abufanas Asma
- Abughanima Mahmoud
- Abuhashem Shehab
- Abulafia Daniel
- Abushaala Fatima
- Abushanab Khaled
- AbuShawareb Issa
- Abuuqteish Hamza
- Abuzaho Amany
- Achem Arome
- Adam Eithar
- Adam Mohammed
- Adam Mohammed A
- Addalla Mohamed
- Addley Jordan
- Adeleye Gbadebo
- Adeniyi Adebayo
- Adewole Nathaniel
- Adeyemo Olabisi
- Adeyeye Ademola
- Adeyeye Ademola
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- Adze Joel Amwe
- Afeikhena Ehis
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- Ahmad Zatul Akmar
- Ahmed Abdalla
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- Ahmed Alaaaldeen
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- Ahmed Hatem
- Ahmed Reem
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- Ahmed Rogia Ahmed Abdalla
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- Ahmeed Sultan
- Airede Lydia Regina
- Aitchison Lori
- Ajredini Mirac
- Ajulo Adeshina A
- Akaba Godwin
- Akasha Mazin
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- Akbuz Seyma Orcan
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- Akpamgbo Chukwunonso Nnamdi
- Akwaisah Ayoub
- Al Hammoud Amr
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- Al-Baw Mahmoud
- Al-Dahdouh Mosheer
- Al-Haek Safa’
- Al-Hazaimeh Mo'ath
- Al-issawi Dima
- Al-Issawi Subhi
- Al-jammal Maryam
- Al-Juaifari Maytham A
- Al-Mwajeh Tesneem
- Al-Omary Sohaib
- Al-Quossi Mohammed
- Al-Shambaty Yasir Babkir Ali
- Al-Shami Qotadah
- Al-Smirat Heba
- Al-Tahayneh Sief-Addeen
- Al-Touny Aiman
- Al-Touny Shimaa
- Al-zawaydeh Alia
- Alaa Ali
- Alabed Ebtihal
- Alagelli Fatma
- Alagoz Ahmet Can
- Alameen Hind
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- Alaqoubi Retaj
- Alarabi Rehab
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- Alatefi Dawood
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- Albanopoulos Konstantinos
- Albarhomy Osama
- Albarki Aisha
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- Alboon Mosab
- Alboridy Muneera
- Alboueishi Asraa Ali
- Aldeges Marwan
- Aldreawi Mohammed
- Alflite Asil Omar Saleh
- Alfrijat Tamam
- Alfrjani Tariq
- Algabbasi Salima
- Algatanesh Nassib
- Alhadad Qamrah
- Alhaddad Hoda Salem
- Alhaleem Ayah
- Alhaleeq Saif
- Alharam Abtisam
- Alhashimi Abdulhadi Mohammed Alhadi
- Alhassan Monzer
- Alhudhairy Sara
- Ali Ahmed
- Ali Aml
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- Ali Iqra Fatima Munawar
- Ali Maab
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- Ali Rzan Ali Hamedelneel
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- Aljamal Mohammad
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- Alkaraja Layth
- Alkaseek Akram
- Alkazali Mustafa
- Alkchr Hayat Ben Hasan Mohamed A A
- Alkhatib Abed Alazeez
- Allam Shereen
- Almahroush Marin
- Almakki Doha Mohammed Ahmed
- Alnajjar Lara
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- Alnatsheh Wesam
- Alnour Ammar
- Alomar Rabiaa
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- Alqaarh Aya
- Alragig Zahra
- Alrifae Ghaliya Mohamed H
- Alrosan Risan
- Alsagoff Sharifah Nor Amirah Syed Abdul Latiff
- Alsaid Hamza
- Alsaify Esmat
- Alsaih Sawsan
- Alsari Najah
- Alshareea Entisar
- Alshawadfy Abdelrhman
- Alshawesh Aisha
- Alsheik Ahmad
- Alsori Mohamed
- Alsoudani Ali
- Altabbaa Hashem
- Altahir Mohamed
- Altair Mawadda
- Altaweel Ahmad
- Altughar Bushra
- Alvarez Matias
- Alvarez-Lozada Luis Adrian
- Alvarez-Lozada Luis Adrian
- Alwahaib Anas
- Alwash Mohammed
- Alzarga Ali
- Alzarouq Ebtisam
- Alzarroug Amal
- Alzghoul Bader
- Alzyoud Osama
- Amarasekara Mishka
- Amary Marwa
- Ametov Amet
- Amin Mostafa K
- Aminu Bashiru
- Aminu Muhammad Baffah
- Ammar Ahmed Siddique
- Amro Dana
- Ananthapadmanabhan Shravankrishna
- Anderson Paul
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- Andriani Adelaide
- Anestiadou Elissavet
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- Aqeel Syed Talha Bin
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- Atadag Yildiz Buyukdereli
- Atef Dina
- Athamneh Tayseer
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- Ather M Hammad
- Atherton Kristy
- Atia Ahmed
- Atici Semra Demirli
- Atilhan Ridvan
- Atim Terkaa
- Atiq Tabish
- Atta Raneem
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- Attiya Omar
- Awad Hasan
- Awadallah Safaa
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- Aydin Cemil
- Aydoğdu Erhan Onur
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- Sallam Abdelaziz
- Samalavicius Narimantas
- Sami Wesam
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- Yusuf Stephen
- Yuzgec Ayse Nilufer
- Zachomitros Fotios
- Zaed Moahmed
- Zafar Fatima
- Zaghloul Ahmed
- Zaheer Adil
- Zaidi Faseeh
- Zain Ahmad
- Zakaria Ahmed
- Zakaria Andee Dzulkarnaen
- Zakaria Mohd Zaim
- Zalloum Jihad
- Zamanbandhon Bushra
- Zambon Mattia
- Zapsalis Konstantinos
- Zargar Kamran
- Zarzour Mohamed A
- Zeng Raymond
- Zeng Raymond
- Zengin Kagan
- Zertuche Juventino Tadeo Guerrero
- Zhang Caitlin
- Zhang Edward
- Zhang Shane
- Zhang Yichi
- Zhao Hailin
- Zheng Helen
- Zhou Karen
- Zhou Yida
- Ziergiebel Felix
- Zou Peishan
- Zuylekom Kate Van
- Zuylekom Katie Van
- Zwain Yasir Adnan
- Zyul'korneeva Sof'ya
- Aladna Abdallah
- Aljoumaa Abdullah
- Nawfal Hamdi
- Niazi Ammar
- Publication venue
- Publication date
- 01/01/2024
- Field of study
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection
- Author
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- Ž
- &apos
- Aahlin Ek
- Aamer A
- Aaniana K
- Ababneh A
- Abaliksta T
- Abantanga F
- Abantanga F
- Abbas A
- Abbas M
- Abbasy J
- Abbo O
- Abbo O
- Abbott T
- Abbouch M
- Abd-Elmawla M
- Abd-Elrasoul Y
- Abdallah E
- Abdallah E
- Abdel-Aty A
- Abdel-Hameed N
- Abdel-Kader Sm
- Abdel-Wahab Nye
- Abdelaal A
- Abdelaty M
- Abdelazeam Ar
- Abdelazim G
- Abdelaziz Ma
- Abdelbadeai K
- Abdelfatah A
- AbdelFattah I
- Abdelgelil A
- Abdelghany S
- Abdelhady S
- Abdelhamed R
- Abdelhamid A
- Abdelhaq A
- Abdelkader M
- Abdelkader M
- Abdelkader O
- Abdelkareem A
- Abdelkhalek M
- Abdelmageed E
- Abdelmotaleb I
- Abdelraheim M
- Abdelraouf Am
- Abdelrouf Dm
- Abdelshafy M
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- Abdrabou Ak
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- Ardley R
- Arenas A
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- Balducci G
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- Chidambaram S
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- Clegg-Lamptey Jn
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- De La Medina AR
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- De Leon MZP
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- Deutschmann P
- Devadasar Gh
- Dharamshi Ha
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- Diab A
- Diaconescu B
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- Dissanayake T
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- Domini E
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- Duffy L
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- El-Ma&apos
- El-Rabaa S
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- Elbatahgy A
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- Elkorashy Am
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- Elshobary M
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- Eng C
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- Esam A
- Escobar Eg.
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- Farhangmehr N
- Farinella E
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- Farooq T
- Farouk Sam
- Farquharson A
- Farrugia A
- Farrugia A
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- Fattah Aa
- Fatuga A
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- Faturoti O
- Faure A
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- Fawzy A
- Feidantsis T
- Felipe Co
- Fergany A
- Fergusson Sj
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- Fermani C
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- Fitsum A
- Fitzgerald Je
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- Ibrahem Aa
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- Ibrahim A
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- Ibrahim I
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- La Brocca A
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- Labib P
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- Latif A
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- Laugzemys E
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- Laurie K
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- Law Jh
- Lawal A
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- Lawani I
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- Lee C
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- Leusink A
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- Loaloa Mr
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- Macfarlane A
- Machaca M
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- Miranda C
- Mircea H
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- Mironescu A
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- Mirza A
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- Mistry A
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- Modolo Mm
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- Moe Tt
- Mogan Yp
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- Mohamed A
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- Mohamed Am
- Mohamed Ar
- Mohamed B
- Mohamed F
- Mohamed I
- Mohamed M
- Mohamed Ma
- Mohamed Maeh
- Mohamed Mm
- Mohamed O
- Mohamed Sr
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- Mohammad A
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- Mohammed H
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- Mohammed S
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- Molina G
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- Monaghan E
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- Monrad-Hansen Pw
- Montejo Msg
- Monteleone M
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- Montes I
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- Montrimaite M
- Montrimaite M
- Moodley Y
- Moore R
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- Mora Jjv
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- Moreira G
- Moreno Sc
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- Mosalum O
- Mostafa Ha
- Mostafa M
- Mostafa M
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- Moustafa A
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- Mowafy B
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- Mshelbwala P
- Msiska N
- Msosa V
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- Muddebihal U
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- Muktar U
- Mukuzunga C
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- Mutlu D
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- Nada F
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- Nagy Gs
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- Nanthakumaran S
- Napolitano L
- Napolitano L
- Naqvi Sa
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- Naranjo Aristizã
- Narayanan R
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- Nashaat A
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- Ndegwa W
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- Negida A
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- Nepogodiev D
- Nepogodiev D
- Nepogodiev D
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- Nesaratnam A
- Nessa A
- Nestorovic M
- Nevieraite V
- Newton T
- Ng S
- Ng Yk
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- Nicholson L
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- Nikoloudis N
- Nikoloudis N
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- Njokanma I
- Nnajiuba H
- Nocito A
- Nocito A
- Nofal E
- Noor F
- Normile C
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- Notarnicola M
- Notarnicola M
- Nouh T
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- Noukpozounkou B
- Novak A
- Nowers J
- Nsengimana Vjp
- Nsengiyumva C
- Ntirenganya F
- Nur&apos
- Nurqistan Hd
- Nwabuoku E
- Nwinee V
- Nwokoro C
- Nyberg J
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- O&apos
- O&apos
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- Obute Rd
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- Odeyemi B
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- Odutola O
- Ogunsua O
- Ogunyemi A
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- Olaolorun A
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- Redota Map
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- Sallinen V
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- Samaniego Cs
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- Senanayake Kj
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- Septiem Jg
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- Shah A
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- Shahbaz Ar
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- Snyder E
- Sobnach S
- Sodde P
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- Sokratous A
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- Summerour V
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- Sunderland G
- Sundstrom Sm
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- Sutandi N
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- Sutton P
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- Suyadi A
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- Tarek D
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- Teasdale E
- Teasdale E
- Tedeschi U
- Tedjaatmadja C
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- Temoche E
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- Urbonas T
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- Publication venue
- 'Wiley'
- Publication date
- 27/11/2018
- Field of study
Background
End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection.
Methods
This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.
Results
In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).
Conclusion
Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone