PREVALENCE OF MALOCCLUSION AMONG YEMENI CHILDREN OF PRIMARY SCHOOLS

Objective: Malocclusion is every difference in the arrangement of teeth beyond the standard of regular occlusion illustrated by anomalies within the dental arches. The purpose of this study was to measure prevalence of malocclusion between primary school children in Sana’a city Yemen. Methods: A cross sectional study was conducted on 1079 school children (546 girls and 533 boys), their age ranged from 7 to 12 years old from public and private schools selected randomly in Sana'a City, Yemen. The prevalence of malocclusion was investigated according to age, gender and school type based on Angle's classification. Results: The study showed that the overall prevalence of malocclusion among school children was 81.1%, in which Class I normal molar association was found only in 18.9% of school children, while Class I malocclusion included the highest percentage of the sample 70.4%, followed by Class II relation 9.5%, and Class III involved only 1.1%. The most prevalent malocclusion trait was spacing 35.7%, whereas the crowding was present in 30.0% of the sample. The deep bite was present in 10.1% followed by anterior crossbite 8.8%, midline diastema 8.6%, anterior open bite 4.5%, posterior crossbite 4.0%, and the least noted malocclusion trait was posterior open bite 0.4%. Conclusion: In conclusion, there was a high rate of malocclusion in school children and significantly increased with age, class I malocclusion was the most common followed by Class II malocclusion, while Class III was the rear. The most prevalent occlusal problem was spacing, followed by crowding.  Thus, 7-12 year-olds can benefit from interceptive and preventive oral health procedures which may either entirely prevent or reduce the development of serious types of malocclusions afterward in their lives.                         Peer Review History: Received 8 January 2020;   Revised 9 February; Accepted 1 March, Available online 15 March 2020 Academic Editor: Ahmad Najib, Universitas Muslim Indonesia,  Indonesia, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, [email protected] Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622,  Giza, Egypt, [email protected]   Similar Articles: COCCIDIAN INTESTINAL PARASITES AMONG CHILDREN IN AL-TORBAH CITY IN YEMEN: IN COUNTRY WITH HIGH INCIDENCE OF MALNUTRITION EVALUATION OF THE IMMUNE RESPONSE TO POLIO VACCINE IN MALNOURISHED CHILDREN IN SANA'A CITY PREVALENCE AND POTENTIAL RISK FACTORS OF HEPATITIS B VIRUS IN A SAMPLE OF CHILDREN IN TWO SELECTED AREAS IN YEME

OCCLUSAL CHARACTERISTICS OF THE PRIMARY DENTITION AMONG A SAMPLE OF YEMENI PRE-SCHOOL CHILDREN

Objective: The occlusal features change dynamically in the growing children and any disruption in the complex craniofacial growth process may lead to malocclusion, which is a major concern for the pediatric community because of its effects on dental function and beauty, as well as on the child's psyche. The aim of the present study was to study the prevalence of different occlusal traits in the primary dentition of the randomly selected pre-school children from three to five years in the city of Sana’a, Yemen. Methods: The study includes 1106 pre-school children subjected to a dental examination performed in the school premise, using the Foster and Hamilton criteria for occlusal traits. As well as inter- and intra-calibration tests were conducted for assessing the degree of agreeability. Results: Results of the study showed that the Bilateral flush terminal molar relationship was found in 60%, bilateral mesial step in 27.9%, asymmetrical relationship in 8.5% and distal step in 3.5% of tested children. The Bilateral canine class I was detected in 62.8%, asymmetrical relationship (13.6%), class II (12.5%) and class III (11.1%). Normal over-jet (OJ) of 1-3 mm was identified in 39.2%, decreased OJ <1 mm (32.7%) and edge-to-edge (8.8%). Ideal over-bite (OB) of 1-50% was detected in 64.5% and increased OB of > 50% (19.7%). Conclusion: In conclusion theBilateral flush terminal molar, class I canine relationships, normal overjet (OJ) of 1-3mm were the most commonly found sagittal occlusal traits in the current study. Ideal over-bite (OB) of 1-50% were identified in more than half of the children.                         Peer Review History: Received 2 February 2020;   Revised 21 February; Accepted 3 March, Available online 15 March 2020 Academic Editor: Dr. DANIYAN Oluwatoyin Michael, Obafemi Awolowo University, ILE-IFE, Nigeria, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Aya Mohammed Mohammed Essawy, MTI University- Mokattam, Egypt, [email protected] Dr. Nada Farrag, Misr International University, Egypt, [email protected] Similar Articles: COCCIDIAN INTESTINAL PARASITES AMONG CHILDREN IN AL-TORBAH CITY IN YEMEN: IN COUNTRY WITH HIGH INCIDENCE OF MALNUTRITION EVALUATION OF THE IMMUNE RESPONSE TO POLIO VACCINE IN MALNOURISHED CHILDREN IN SANA'A CITY PREVALENCE AND POTENTIAL RISK FACTORS OF HEPATITIS B VIRUS IN A SAMPLE OF CHILDREN IN TWO SELECTED AREAS IN YEME

PREVALENCE AND ASSOCIATED FACTORS OF ORAL NON-CANDIDA ALBICANS CANDIDA CARRIAGE IN DENTURE WEARERS IN SANA'A CITY- YEMEN

Objective: The objective of this study was to contrast the prevalence and species of colonization of Non-Candida albicans (NCAC) in the oral cavity of denture wearers and non-denture wearers; also asses associated risk factors of their colonization. Methods: A total of 208 subjects were studied: 104 denture wearers and 104 non-denture wearers, matched by age, sex, comprised the experimental control groups, respectively. Each subject was instructed to perform oral rinsing using a phosphate-buffered saline solution, which was expectorated processed for the recovery of Candida species on on Sabouraud dextrose agar. Isolates were identified by culturing on chromogenic Candida agar noting species-specific colony characteristics. Results: There was a significant oral carriage rate of NCAC among denture wearers (5.83% versus 11.1% in controls) with associated risk factor (5.4) (PV<0.001). The most common isolated NCAC were C. Krusi C. tropicalis with significant OR (5.5  4.7 respectively). When co-infections were considered, there was highly significant association of C. albicans + C. krusi oral colonization in cases (OR=4.56, PV<0.001). There was a significant oral carriage rate of NCAC among male denture wearers (36.9%, OR=6.6, PV˂0.001). In addition, there was a significant rate of NCAC colonization with complete denture (rate= 50%, OR=2.4, PV= 0.02). While no significant increase associated with colonization of NCAC with partial, acrylic /or chrome cobalt denture.   Conclusion: Based on the results of this study ability of NCAC were greater in denture wearers than non-denture wearers, also greater risk of NCAC were found with males, older ages, complete denture.      Peer Review History: Received 10 July 2018;   Revised 19 July; Accepted 18 August, Available online 15 September 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:        Reviewer's Comments: Average Peer review marks at initial stage: 5/10 Average Peer review marks at publication stage: 8/10 Reviewer(s) detail: Dr. Mohammed Sadeg Abdullah Al-Awar, Physiology & Histopathology Queen Arwa University and Amran University, Yemen, [email protected] Dr. Mahmoud S. Abdallah, University of Sadat city, Egypt, [email protected] Similar Articles: ORAL C.ALBICANS COLONIZATION AND NON-CANDIDA ALBICANS CANDIDA COLONIZATION AMONG UNIVERSITY STUDENTS, YEME

PREVALENCE AND CAUSES OF TRAUMATIC DENTAL INJURIES TO ANTERIOR TEETH AMONG PRIMARY SCHOOL CHILDREN IN SANA'A CITY, YEMEN

Objectives: The current study was conducted to reveal the prevalence and causes of traumatic dental injuries to permanent anterior teeth among mixed dentition of schoolchildren in Sana'a City, Yemen. Methods: A cross-sectional study was performed on 1252 schoolchildren aged 7-12 years in three districts of Sana'a city, Yemen. They numbered 700 males and 552 females from 26 randomly selected public and private schools. Clinical examination of permanent anterior teeth was done according to the classification of Ellis modified by Fried. Results: Prevalence of TDI was 10.30%, with a male ratio of 4.8: female 1, (P <0.05). Most of the children suffered only one damage to the tooth and most of them are in the maxillary central incisors. The TDI increased with older age (10-12 years old) (16.5%) with odds ratio 4.8, (p<0.05). Regarding the site of trauma, most injuries happened in males on the street (44.9%) while in females happened at home (31.81%) and falls were the main cause of TDI. In both sexes, the most common type of injury was class I (enamel fracture) followed by class II (enamel and dentine without pulp involvement). Conclusion: In conclusion, the prevalence of TDI in permanent anterior teeth among mixed dentition of school children in Sana’a was high, higher in males than in females, with a peak age of 10 to 12 years, falls was the common cause, and occurred mostly on the street for boys and home for females. Accordingly, educational programs should be developed that focus on ways to prevent dental trauma and the benefits of seeking urgent treatment to maintain avulsed and fractured teeth.                                 Peer Review History: Received 13 May 2020; Revised 15 June; Accepted 1 July, Available online 15 July 2020 Academic Editor: Dr. Asia Selman Abdullah, Al-Razi university, Department of Pharmacy, Yemen, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments:  Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Alfonso Alexander Aguileral, University of Veracruz,  Mexico, [email protected] Dr. Mohamed Awad Mousnad, Faculty of Pharmacy, International University of Africa (IUA), Khartoum, Sudan, [email protected]  Similar Articles: SERO-PREVALENCE OF HEPATITIS C VIRUS AMONG DENTAL CLINIC WORKERS IN SANA’A CITY- YEMEN AND THE RISK FACTORS CONTRIBUTING FOR ITS INFECTIO

KNOWLEDGE AND PERCEPTION OF MOLAR INCISOR HYPOMINERALIZATION AMONG DENTAL PRACTITIONERS IN SANA’A CITY- YEMEN

Background: Molar incisor hypomineralization (MIH) has been recognized as a global dental disorder and concern about this pathology is growing among clinicians around the world. Objectives: This study aimed to investigate the knowledge and perception of Yemeni dental practitioners in the city of Sana'a in relation to diagnosis, etiological factors and management of MIH. Materials and Methods: A questionnaire modified from similar previous studies was distributed to 311 Yemeni dentists providing oral health care in Sana'a city. The survey consists of two parts, the first is the demographic-occupational variables that was collected for the participants and the second part included questions related to perception of the diagnosis, possible etiological factors, severity of the condition and management, and the participants ’willingness for advance training in relation to MIH. Results: The overall response rate is (90%). The majority of respondents came across MIH in their practices (GDPs= 83.2%, SDPs= 90%).Yellow / brown demarcation is feasible as a common clinical symptom. The composite resin was the most used restorative material. The genetic factor was the most specific etiological factor. Most GDPs were significantly uncertain in the diagnosis of MIH compared to SDPs (P = 0.003). Most of the respondents (72.5%) had a low level of knowledge regarding MIH. Participants support the need to assess MIH occurrence and conduct clinical training. Conclusion: Molar incisor hypomineralization (MIH) is a common dental problem faced by dental practitioners in Sana'a City who have required clinical training regarding diagnosis, etiological factors and MIH management.                                Peer Review History: Received: 8 September 2020; Revised: 7 October; Accepted: 20 October, Available online: 15 November 2020 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, [email protected] Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Mohamed Awad AbdAlaziz Mousnad, International University of Africa (IUA) and Sudan, [email protected] Antonio José de Jesus Evangelista, Federal University of Ceará, UFC, Brazil,  [email protected] Similar Articles: PREVALENCE OF STAPHYLOCOCCUS AUREUS IN DENTAL INFECTIONS AND THE OCCURRENCE OF MRSA IN ISOLATES CAUSES FOR EXTRACTION OF PERMANENT TEETH IN GENERAL DENTAL PRACTICES IN YEMEN SERO-PREVALENCE OF HEPATITIS C VIRUS AMONG DENTAL CLINIC WORKERS IN SANA’A CITY- YEMEN AND THE RISK FACTORS CONTRIBUTING FOR ITS INFECTION PREVALENCE AND CAUSES OF TRAUMATIC DENTAL INJURIES TO ANTERIOR TEETH AMONG PRIMARY SCHOOL CHILDREN IN SANA'A CITY, YEMEN ETIOLOGY AND RISK FACTORS OF STOMATITIS AMONG YEMENI DENTURE WEARER

PREVALENCE OF STAPHYLOCOCCUS AUREUS IN DENTAL INFECTIONS AND THE OCCURRENCE OF MRSA IN ISOLATES

Objectives:  Staphylococcus aureus is an opportunist that causes systemic infections and dental infections in the human being body. This organism increases its resistance to many categories of antibiotics all day and turn out to be more resistant, and this led to a growing feeling of concern in this era. Given this fact, the aims of this study were to determine the frequency of S. aureus in oral infections and to determine the prevalence of MRSA strains and the sensitivity of isolated S. aureus to antibiotics, in patients who attended dental clinics in major public hospitals and private clinics in the city of Sana'a-Yemen. Subjects and methods:  The study was conducted for a year, early in December 2018 and ending in November 2019. The study included 296 patients, 153 male and 143 female, ages 5 to 65, with an average age of 36.2 years. Demographic and clinical data were collected in questionnaire, then pus or oral swabs were collected from patients, cultivated, isolated and identified by standard laboratory techniques. MRSA was ascertained by means of the method of disc diffusion to 1µg of oxicillin disc and 5 µg of methacillin disc; an antimicrobial sensitivity test was carried out by disc diffusion method of selected antibiotics.The oral  infections include  dental abscesses,  periodontal abscesses, gingivitis, periodentitis, dental caries,  pulpitis and oral thrush. Results:  Of a total of 296 cultured pus and swabs, only 217 produced a positive culture (73.3%). Gram-positive bacteria formed 67.4% of the total isolates where S. aureus was the predominant pathogen (43.1%).  The prevalence of MRSA was 23.5%. There was a higher rate of antibiotic resistance tested in MRSA isolates compared to a lower rate of resistance in MSSA as well as 22.2% of MRSA isolates were vancomycin resistant, while only 11.4% of MSSA were vancomycin resistant. Conclusion:  It can be concluded, S. aureus was the most widespread isolate in dental infections, high rate of  MRSA,  the appearance of S. aureus isolates resistant to vancomycin and other broad choice of antibiotics have raised MRSA in oral infections into a multi-drug-resistant, making it more and more hazardous in oral infections. Consistent assessment of oral associated infections and observing the pattern of antibiotic sensitivity and strict drug policy for antibiotics are recommended.                        Peer Review History: Received 16 April 2020; Revised 2 May; Accepted 12 May, Available online 15 May 2020 Academic Editor:Ahmad Najib, Universitas Muslim Indonesia, Makassar, Indonesia, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Mohamed Awad Mousnad, Faculty of Pharmacy, International University of Africa (IUA), Khartoum, Sudan, [email protected] Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, [email protected] Similar Articles: PREVALENCE OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS AT A PRIVATE HOSPITAL IN SANA'A, YEMEN PREVALENCE, ANTIMICROBIAL SUSCEPTIBILITY PATTERN AND RISK FACTORS OF MRSA ISOLATED FROM CLINICAL SPECIMENS AMONG MILITARY PATIENTS AT 48 MEDICAL COMPOUND IN SANA'A CITY-YEME

Prevalence and potential determinants of covid-19 vaccine hesitancy and resistance in qatar: Results from a nationally representative survey of qatari nationals and migrants between december 2020 and january 2021

Global COVID-19 pandemic containment necessitates understanding the risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lack vital representative vaccine hesitancy data. We conducted the first representative national phone survey among the adult population of Qatar, between December 2020 and January 2021, to estimate the prevalence and identify potential determinants of vaccine willingness: acceptance (strongly agree), resistance (strongly disagree), and hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between willingness groups and fifteen variables. In the total sample, 42.7% (95% CI: 39.5-46.1) were accepting, 45.2% (95% CI: 41.9-48.4) hesitant, and 12.1% (95% CI: 10.1-14.4) resistant. Vaccine resistant compared with hesistant and accepting groups reported no endorsement source will increase vaccine confidence (58.9% vs. 5.6% vs. 0.2%, respectively). Female gender, Arab ethnicity, migrant status/type, and vaccine side-effects concerns were associated with hesitancy and resistance. COVID-19 related bereavement, infection, and quarantine status were not significantly associated with any willingness group. Absence of or lack of concern about contracting the virus was solely associated with resistance. COVID-19 vaccine resistance, hesitance, and side-effects concerns are high in Qatar's population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants), and those of Arab ethnicity.Funding: The study received an Emergency Response Grant Fund from Qatar University (QUERG-CAS-2020-1).Scopu

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

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

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio