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

Politik pazarlamada marka bağlılığı ve bir uygulama

POLİTİK PAZARLAMADA MARKA BAĞLILIĞI VE BİR UYGULAMA Bütün sosyal bilimlerde olduğu gibi politikanın da konusu insandır. Demokratik ülkelerde, yasama ve yürütmedeki birçok kişi, seçimle işbaşına gelmektedirler. Demokratik ülkelerde siyasi güç seçimle kazanılıp kaybedildiğinden ötürü karar aşamasındaki en büyük etkiye sahip seçmen memnuniyeti sağlanması gereken, tek unsur olarak karşımıza çıkmaktadır. Politik pazarlama uygulamaları demokrasi ile birlikte ortaya çıkmış bir kavram olarak ulusları yöneten ya da yönetmeye aday olan siyasi partilerin hem ayakta kalıp büyümek hem yarışmakta oldukları rakiplerinin önüne geçebilmeleri amacıyla pazarlamadan faydalanmanın önemini kavramışlar ve faaliyetlerinde pazarlama uygulamalarından yararlanmaktadırlar. Siyasi partilerin temel amacı sürekli olarak kendilerini destekleyen bir seçmen grubu yaratmaktaki gereklilikleridir ki buda bizi marka bağlılığı kavramına götürmektedir. Politik pazarlamada marka bağlılığı siyasi parti düzleminde; seçmenin bir siyasi partinin, politikalarına, ideolojisine, adaylarına inanması ve güvenmesi sonucu tercihini bu siyasi partiden yana kullandıktan sonra memnun kalması ve bundan sonraki seçimlerinde sürekli aynı partiyi desteklemesi, diğer seçmenlere tavsiye etmesi şeklinde tanımlanabilmektedir. Bu kavramlar ışığında konu üç aşamada ele alınmış; birinci bölümde, politik pazarlama ve ilgili kavramlar detaylı bir şekilde açıklanmış, ikinci bölümde marka bağlılığı kavramı politik pazarlama düzleminde ayrıntılı olarak anlatılmıştır. Son bölümde politik pazarlamada marka bağlılığı kavramı, örnekleme ait kütlenin demografik ve sosyo-ekonomik özelliklerine göre farklılık gösterip göstermediği incelenmiş, politik pazarlamada marka bağlılığını etkileyen faktörler ortaya çıkarılmış, seçmenlerin karar verme aşamalarında siyasi parti tercihlerini etkileyen faktörler belirlenmiş, marka değiştirme eğilimini etkileyen faktörler tespit edilmiştir. Anahtar Kelimeler: Politik Pazarlama, Marka, Marka Bağlılığı, Seçmen Davranışları ABSTRACT BRAND LOYALTY IN POLITICAL MARKETING AND AN IMPLEMENTATION As is the case in all social sciencies, politics deals with humanbeing. In democratic countries, many people in the legislative and the executive bodies are elected to such offices. As political power in democratic countries is acquired or lost through elections, voters have the biggest decisive power and, therefore, voter satisfaction turns out to be the only factor which must be achieved. Political marketing practices reflect a concept rooted in democracy itself and political parties ruling or presenting themselves as candidate for ruling nations have seized the importance of making use of marketing with an eye to both surviving and growing and getting ahead of their rivals and they, thus, tend to make use of marketing practices in their activities. Fundamental purpose of political parties is to create a group of voters who support them in a continuous way and this fact takes us to brand loyalty concept. Brand loyalty in political marketing can be defined, on a political party level, for voters, as having faith and confidence in policies, ideology and candidates of a political party and, as a result of such faith and confidence, making a choice in favour of such political party and, thereafter, being satisfied with such choice and supporting the same political party all the time at all subsequent elections and recommending such political party to other voters. We dealt with the issue in three phases under the light of such concepts; in first chapter, we discussed political marketing and related concepts in details and , in second chapter, we discussed brand loyalty concept on a political marketing plane in details. In final chapter, we discussed brand loyalty in political marketing and whether this varies according to demographic and socio-economic characteristics of the sample mass or not and we identified factors which effect brand loyalty in political marketing and we unveiled the factors which effect voters’ political party preferences at decision-making phases, as well as factors which effect brand-changing tendency. Key Words: Political Marketing, Brand, Brand Loyalty, Voter’s Behaviour

Politik pazarlamada marka bağlılığı ve bir uygulama

ÖZETPOLİTİK PAZARLAMADA MARKA BAĞLILIĞI VE BİR UYGULAMABütün sosyal bilimlerde olduğu gibi politikanın da konusu insandır. Demokratik ülkelerde, yasama ve yürütmedeki birçok kişi, seçimle işbaşına gelmektedirler. Demokratik ülkelerde siyasi güç seçimle kazanılıp kaybedildiğinden ötürü karar aşamasındaki en büyük etkiye sahip seçmen memnuniyeti sağlanması gereken, tek unsur olarak karşımıza çıkmaktadır. Politik pazarlama uygulamaları demokrasi ile birlikte ortaya çıkmış bir kavram olarak ulusları yöneten ya da yönetmeye aday olan siyasi partilerin hem ayakta kalıp büyümek hem yarışmakta oldukları rakiplerinin önüne geçebilmeleri amacıyla pazarlamadan faydalanmanın önemini kavramışlar ve faaliyetlerinde pazarlama uygulamalarından yararlanmaktadırlar. Siyasi partilerin temel amacı sürekli olarak kendilerini destekleyen bir seçmen grubu yaratmaktaki gereklilikleridir ki buda bizi marka bağlılığı kavramına götürmektedir. Politik pazarlamada marka bağlılığı siyasi parti düzleminde; seçmenin bir siyasi partinin, politikalarına, ideolojisine, adaylarına inanması ve güvenmesi sonucu tercihini bu siyasi partiden yana kullandıktan sonra memnun kalması ve bundan sonraki seçimlerinde sürekli aynı partiyi desteklemesi, diğer seçmenlere tavsiye etmesi şeklinde tanımlanabilmektedir. Bu kavramlar ışığında konu üç aşamada ele alınmış; birinci bölümde, politik pazarlama ve ilgili kavramlar detaylı bir şekilde açıklanmış, ikinci bölümde marka bağlılığı kavramı politik pazarlama düzleminde ayrıntılı olarak anlatılmıştır. Son bölümde politik pazarlamada marka bağlılığı kavramı, örnekleme ait kütlenin demografik ve sosyo-ekonomik özelliklerine göre farklılık gösterip göstermediği incelenmiş, politik pazarlamada marka bağlılığını etkileyen faktörler ortaya çıkarılmış, seçmenlerin karar verme aşamalarında siyasi parti tercihlerini etkileyen faktörler belirlenmiş, marka değiştirme eğilimini etkileyen faktörler tespit edilmiştir.Anahtar Kelimeler: Politik Pazarlama, Marka, Marka Bağlılığı, Seçmen Davranışları ABSTRACTBRAND LOYALTY IN POLITICAL MARKETING AND AN IMPLEMENTATIONAs is the case in all social sciencies, politics deals with humanbeing. In democratic countries, many people in the legislative and the executive bodies are elected to such offices. As political power in democratic countries is acquired or lost through elections, voters have the biggest decisive power and, therefore, voter satisfaction turns out to be the only factor which must be achieved. Political marketing practices reflect a concept rooted in democracy itself and political parties ruling or presenting themselves as candidate for ruling nations have seized the importance of making use of marketing with an eye to both surviving and growing and getting ahead of their rivals and they, thus, tend to make use of marketing practices in their activities. Fundamental purpose of political parties is to create a group of voters who support them in a continuous way and this fact takes us to brand loyalty concept. Brand loyalty in political marketing can be defined, on a political party level, for voters, as having faith and confidence in policies, ideology and candidates of a political party and, as a result of such faith and confidence, making a choice in favour of such political party and, thereafter, being satisfied with such choice and supporting the same political party all the time at all subsequent elections and recommending such political party to other voters.We dealt with the issue in three phases under the light of such concepts; in first chapter, we discussed political marketing and related concepts in details and , in second chapter, we discussed brand loyalty concept on a political marketing plane in details. In final chapter, we discussed brand loyalty in political marketing and whether this varies according to demographic and socio-economic characteristics of the sample mass or not and we identified factors which effect brand loyalty in political marketing and we unveiled the factors which effect voters’ political party preferences at decision-making phases, as well as factors which effect brand-changing tendency.Key Words: Political Marketing, Brand, Brand Loyalty, Voter’s Behaviour