Home based physical activity intervention programme in war-torn country like Iraq

The unsuitable conditions as the result of a decade of war had made it difficult to raise the level of physical activity among the youth in Iraq. Lack of awareness, as well as misconceptions about diets and the concept of physical activity among young people and the society in general especially pertaining women involvement in sports had made this matter worsen. Hence, designing home-based intervention program to enhance the physical activity level among the sedentary undergraduate female students in Iraq is crucial. The home based intervention program consists of simple exercises to be carried out at home and some nutrition information on balance diet. Forty-four sedentary undergraduate female students aged 18-22 years old were selected as subjects in this study. They were randomly selected from Northern Region of Iraq. The subjects completed a 12-weeks home based intervention program that combining simple exercises and diet information. Their daily physical activity level was measured using a pedometer. The results showed that there were a significant difference between the steps counts from pre-test to post-test1 (6-weeks) and pre-test to post-test2 (12-weeks) (p<0.001) in the experimental group. The mean steps increased by 6825.73 steps from pre-test to post-test1, and 9007.71 steps from pre-test to post-test2. Additionally, the results of these two groups were different in test (time) pre, post1 and post2 (F(2, 84)= 713.00, P<0.05, ɳ2= .944). Based on these results, it was concluded the 12-weeks home based intervention program was effective in enhancing physical activity level among sedentary undergraduate female students in Iraq

Effects of a home-based programme on physical activity among undergraduate female students in Iraq

The study aimed to evaluate the effect of home-based programme to improve physical activity among undergraduate female students in Iraq. The participants were Iraqi sedentary undergraduate female students (N=44) who were assigned to two groups consisted of experimental group (N=22) and control group (N=22) respectively. The experimental group received a 12-week home based intervention programme which focuses on PA, while the control group were maintaining their usual life. Measurements for all the variables were taken prior to the intervention (pre-test), at week 6 (post-test1), and after 12 weeks (post-test2). The results of Mixed between-within subjects analysis of variance shows a statistically significant between the mean test scores in the pre-test, post-test1, and post-test2 measurements of PA in the experimental group. This study provided evidence that home-based intervention programme which focused on physical activity had a significant effect on improving physical activity

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research