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

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 middle-income 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 low-income 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 low-income, 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

Earthworms, ants and other arthropods as soil health indicators in traditional and no-fire agro-ecosystems from Eastern Brazilian Amazonia

Deforestation of the Amazonian rainforest and conversion to agriculture with the use of fire creates a mosaic of occupied lands and secondary forests. Considering the fundamental role of soil macrofauna and the lack of information about its resilience to deforestation, this study characterized the earthworms, ants and other soil arthropod communities in secondary forests of 40 and 20 years of age and in cropping system and pastures prepared with slash-and-burn or chop-and-mulch in the Brazilian Eastern Amazonia. Soil macrofauna was sampled according to the TSBF (Tropical Soil Biological and Fertility) methodology. Four sub-indices and one macrofauna soil health index were calculated using five principal component analyses. The macrofauna index identified better soil health in chop-andmulch crops, followed by the 40 yr-old forest and the chop-and-mulch pasture. These results confirmed the fundamental role of old secondary forests for soil biodiversity conservation and the potential of the chop-and-mulch technique to mitigate the effects of land use changes

A experiência de cuidar da mulher alcoolista na família

Este estudo tem como objetivo investigar as práticas de cuidados desenvolvidas pela família à mulher alcoolista e conhecer a percepção desta em relação aos cuidados que recebe. Trata-se de um estudo de caso, desenvolvido com uma abordagem qualitativa, cujos dados foram coletados através de entrevistas semi-estruturadas, realizadas em 2008, no domicílio de uma família de classe média, residente em um município no extremo sul do Brasil e, posteriormente, submetidos à análise de conteúdo. Os resultados mostram que os cuidados desenvolvidos pela família são centrados nas necessidades de alimentação, higiene, sono, repouso, encaminhamento aos serviços especializados para a desintoxicação e que a mulher alcoolista interpreta esses esforços como sendo ações de controle sobre sua vida e punição pela sua condição de dependência. Destaca-se que a maneira da família cuidar modifica-se no mesmo compasso em que o alcoolismo evolui

Produção do conhecimento científico de Enfermagem em Nefrologia Producción del conocimiento científico de Enfermería en Nefrología Scientific knowledge production in Nephrology Nursing

Trata-se de uma pesquisa bibliográfica, com abordagem quantitativa, que teve como objetivo conhecer a produção científica das teses e dissertações disponíveis no banco de dados do Centro de Estudos e Pesquisa em Enfermagem (CEPEn) e sua aplicabilidade na área de enfermagem em nefrologia. Foram encontrados 48 resumos de teses e dissertações no período de 1979 a 2007. Os resultados apontam que estas produções se concentram nas regiões Sudeste e Sul. Com relação ao referencial teórico-metodológico, os mais freqüentes foram: método de assistência de enfermagem e abordagem compreensiva; os sujeitos investigados foram em sua maioria, os pacientes renais crônicos. Essa temática ainda é pouco investigada nos cursos de pós-graduação stricto senso, entretanto, há indícios de expansão dos estudos científicos nesta área.<br>Se trata de una búsqueda bibliográfica con abordaje cuantitativo, con el objetivo de conocer la producción científica de tesis y disertaciones disponibles en la base de datos del Centro de Estudios e Investigación en Enfermería (CEPEn) y su aplicabilidad en el campo de la enfermería en nefrología. Se han encontrado 48 resúmenes de tesis y disertaciones en el período 1979 a 2007. Los resultados indican que estos producciones se concentran en el Sudeste y Sur del Brasil. En lo que respecta al marco teórico y a la metodología, los más frecuentes fueron: método de atención de asistencia de enfermería y abordaje comprensiva; los sujetos investigados fueron en su mayoría, los pacientes renales crónicos. Este tema ha sido poco investigado en el postgrado stricto sensu, no obstante, hay pruebas de la ampliación de los estudios científicos en este ámbito.<br>This is a bibliographic research, with quantitative approach, that aimed to know the scientific production of theses and dissertations available in the database of the Center of Studies and Research in Nursing (CEPEn) and its applicability in the nursing area in nephrology. It was found 48 abstracts of theses and dissertations in the period from 1979 to 2007. The results point that these productions are concentrated in the Southeast and Southern regions of Brazil. Regarding the theoretical-methodological referential, the most frequent were: nursing assistance method and comprehensive approach; the investigated individuals were mostly the chronic renal patients. This thematic is still little investigated in the post-graduation stricto senso courses, however there are signs of expansion of the scientific studies in this area