3 research outputs found

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

    Get PDF
    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

    Conexões entre o desenvolvimento cognitivo e o musical: estudo comparativo entre apreciação musical direcionada e não direcionada de crianças de sete a dez anos em escola regular

    No full text
    Exportado OPUSMade available in DSpace on 2019-08-14T03:49:50Z (GMT). No. of bitstreams: 1 disserta__o_de_mestrado___karla_jaber_barbosa.pdf: 12941502 bytes, checksum: cb3bd00a2ef29eb8949897a7829210b5 (MD5) Previous issue date: 30Esta pesquisa tem como objeto de estudo o desenvolvimento cognitivo-musical, de crianças de sete a dez anos de idade, alunos de 2ª à 5ª séries do Ensino Fundamental, em escola regular. Como referencial teórico, adotou-se a teoria de desenvolvimento cognitivo de Jean Piaget, a Teoria Espiral de Desenvolvimento Musical de Keith Swanwick (1994) e as contribuições de Lev Vygotsky sobre o conceito de zona de desenvolvimento proximal. Esse estudo investigou conexões entre a visão de Jean Piaget (1964, 1966) sobre o período operacional concreto e os níveis Vernacular e Especulativo da Teoria Espiral de Desenvolvimento Musical proposta por Swanwick (1994), na modalidade apreciação musical. Embora a Teoria Espiral seja uma contribuição expressiva sobre o desenvolvimento musical, esta não explica os processos cognitivos que permeiam a transição entre níveis ou estágios de desenvolvimento. O estudo é de natureza comparativa entre duas condições: apreciação não direcionada (de maneira independente) e direcionada (com o objetivo de observar a compreensão da estrutura formal da música após interferência do professor). Com a observação do desempenho desses alunos, do estudo do desenvolvimento do período operacional concreto e do detalhamento dos processos cognitivos, os dados apontaram que a aquisição da conservação e da noção de reversibilidade promove a passagem do nível Vernacular para o Especulativo. Esses dados indicaram também que as crianças atingiram níveis mais elevados de compreensão musical após a interferência do professor.This piece of research focuses on the study of cognitive-musical development of seven to ten years old children, students at 2nd to 5th grades of Brazilian basic school. Jean Piagets (1964; 1966) theory of cognitive development and Keith Swanwicks Spiral Theory of Musical Development and Vygotskys contributions about this zone of proximal development. The study investigated theoretical connections between Piagets view of the Concrete Operational Period and the Vernacular and SpeculativeSpiral levels as proposed by Swanwick, through the audience-listening modality of musical behavior. Although the Spiral Theory is a robust contribution about musical development, it does not explain the cognitive processes that underlie the transition between levels of development.It consists of a comparative study between two conditions: independent audiencelistening activity and directed audience-listening activity, after the teachers interference. The observation of students performance, the study of the Concrete Operational Period and the detailing of cognitive processes, the data show that the acquisition of conservation and reversibility may promote the transition from Vernacular to Speculative levels. These data also indicate that children achieved higher levels of musical understanding after the teachers interference. Keywords: audience-listening, musical development, conservation, zone of proximal development, Spiral Theory
    corecore