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

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

Prevalência de sobrepeso e fatores associados em crianças ingressantes no ensino fundamental em um município da região metropolitana de São Paulo, Brasil

Este estudo verificou a prevalência de sobrepeso e sua associação com fatores sócio-ambientais em crianças ingressantes na primeira série do ensino público fundamental do Município de Cajamar, São Paulo, Brasil, em 2005. Sobrepeso foi definido pelo índice de massa corporal, segundo sexo e idade. As variáveis sócio-ambientais foram obtidas por meio de questionário aplicado junto às mães das crianças (58,6%). Associação entre sobrepeso e variáveis independentes foi verificada mediante técnica de regressão de Poisson. A prevalência de sobrepeso foi de 17%. Obesidade materna (RP = 3,54; IC: 2,16-5,80), freqüência elevada de consumo de alimentos "não saudáveis" (RP = 2,12; IC: 1,30-3,45), assistir à televisão por mais de quatro horas/dia (RP = 2,08; IC: 1,03-4,20) e disponibilidade domiciliar per capita de óleo (cerca de três colheres sopa/dia) (RP = 1,52; IC: 1,01-2,31) apresentaram-se como fatores independentes associados ao excesso de peso infantil. O ambiente familiar apresentou forte influência sobre a condição de sobrepeso em escolares ingressantes no ensino fundamental. Ações de prevenção e controle do sobrepeso deveriam envolver a instituição escolar e também os pais ou responsáveis pelas crianças

Comparative study of the effects of hydrotherapy and the Pilates method on the functional capacity of fibromyalgia patients

A síndrome da fibromialgia é complexa e a hidroterapia e os exercícios contido no método Pilates podem ser uma alternativa não farmacológico no tratamento destes pacientes. Objetivo: Avaliar os efeitos da hidroterapia e do método Pilates sobre a redução da dor, melhora da capacidade funcional e da qualidade do sono em pacientes com fibromialgia. Método: Estudo prospectivo no qual foram avaliados 80 pacientes do sexo feminino com diagnóstico clínico de SF, distribuídas aleatoriamente em dois grupos, o Grupo I realizava tratamento por meio da hidroterapia e o grupo II por meio do método Pilates. A dor foi avaliada por meio da EVA e da algometria, a qualidade de vida dos pacientes foi avaliada (QIF), qualidade do sono por meio (IQSP), o grau de sonolência durante oito atividades rotineiras por meio da escala de Epworth todos foram realizados antes e após tratamento. Resultados: 50 pacientes com SF fizeram parte do estudo, deste 30 foram para o GI e 20 para GII, média global da idade foi 50,8±12,5. Houve redução do impacto global da doença na vida dos pacientes de ambos os grupos. Ambos os grupos melhoraram igualmente qualidade do sono. Houve melhora da dor medida por ambos os métodos (p&lt;0,0001) e (p=0,013) grupo I e II respectivamente. Conclusão: A hidroterapia e os exercícios do método Pilates se mostraram igualmente eficazes na redução do impacto global, melhora do sono e capacidade funcional em pacientes com fibromialgia.Fibromyalgia syndrome is complex and the hydrotherapy and Pilates exercises may be a non-pharmacological alternative in the treatment of these patients. Objective: To evaluate the effects of hydrotherapy and the Pilates method on pain reduction, improvement of functional capacity and sleep quality in fibromyalgia patients. Method: A prospective study in which 80 female patients with clinical diagnosis of DES were randomly assigned to two groups. Group I underwent treatment using hydrotherapy and group II under the Pilates method. Pain was assessed by VAS and algometry, patients' quality of life (QIF), sleep quality by PSQI, degree of sleepiness during eight routine activities using the Epworth scale were all performed. before and after treatment. Results: Fifty patients with DES were part of the study, of which 30 were for GI and 20 for GII; overall mean age was 50.8 ± 12.5. There was a reduction in the overall impact of the disease on patients' lives in both groups. Both groups also improved sleep quality. There was pain improvement measured by both methods (p &lt;0.0001) and (p = 0.013) group I and II respectively. Conclusion: Touch hydrotherapy as Pilates solo exercises are effective in treating fibromyalgia patient

The links of stress, substance use and socio-demographic factors with domestic violence during the Covid-19 pandemic in Portugal

Background Lockdown, as a measure implemented to combat the coronavirus disease 2019 (COVID-19) pandemic, left many domestic violence (DV) victims trapped with their abusers. This study intends to explore the links between perceived stress, substance use and socio-demographic factors with DV experiences during COVID-19 pandemic in Portugal. Methods A cross-sectional study was carried out on a sample of 1062 participants over 16 years old, residing in Portugal. Data were collected through an online survey conducted between April and October 2020. The associations between potential factors and DV were investigated using bivariable analysis and multivariable logistic regression. Results The prevalence of DV reported was 13.75% (n = 146), disaggregated into psychological violence (13%, n = 138), sexual violence (1.0%, n = 11) and physical violence (0.9%, n = 10). Multivariable analyses confirmed that perceived financial difficulties (OR = 1.608; P = 0.019), use of medications to sleep or calm down (OR = 1.851; P = 0.002) and perceived stress (OR = 2.443; P = 0.003) were responsible for DV exposure during COVID-19 pandemic. Younger age (<25 years old) and consumption of alcohol were associated with a higher risk of DV victimization. Conclusions Interventions aimed at preventing and confronting DV are necessary within the strategies to combat COVID-19 in Portugal, especially aimed at groups in vulnerable situations, during and after the pandemic

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

12,500+ and counting: biodiversity of the Brazilian Pampa

Knowledge on biodiversity is fundamental for conservation strategies. The Brazilian Pampa region, located in subtropical southern Brazil, is neglected in terms of conservation, and knowledge of its biodiversity is fragmented. We aim to answer the question: how many, and which, species occur in the Brazilian Pampa? In a collaborative effort, we built species lists for plants, animals, bacteria, and fungi that occur in the Brazilian Pampa. We included information on distribution patterns, main habitat types, and conservation status. Our study resulted in referenced lists totaling 12,503 species (12,854 taxa, when considering infraspecific taxonomic categories [or units]). Vascular plants amount to 3,642 species (including 165 Pteridophytes), while algae have 2,046 species (2,378 taxa) and bryophytes 316 species (318 taxa). Fungi (incl. lichenized fungi) contains 1,141 species (1,144 taxa). Animals total 5,358 species (5,372 taxa). Among the latter, vertebrates comprise 1,136 species, while invertebrates are represented by 4,222 species. Our data indicate that, according to current knowledge, the Pampa holds approximately 9% of the Brazilian biodiversity in an area of little more than 2% of Brazil’s total land. The proportion of species restricted to the Brazilian Pampa is low (with few groups as exceptions), as it is part of a larger grassland ecoregion and in a transitional climatic setting. Our study yielded considerably higher species numbers than previously known for many species groups; for some, it provides the first published compilation. Further efforts are needed to increase knowledge in the Pampa and other regions of Brazil. Considering the strategic importance of biodiversity and its conservation, appropriate government policies are needed to fund studies on biodiversity, create accessible and constantly updated biodiversity databases, and consider biodiversity in school curricula and other outreach activities