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

Sida et mouvement du corps

Defert Daniel. Sida et mouvement du corps. In: Chimères. Revue des schizoanalyses, N°28, printemps-été 1996. Les Arts de l'Éco. pp. 79-89

Fletcher, Robert James. Iles Paradis, Iles d'Illusion, Lettres des Mers du Sud. Un cas d'hébridisation : Robert James Fletcher

Defert Daniel. Fletcher, Robert James. Iles Paradis, Iles d'Illusion, Lettres des Mers du Sud. Un cas d'hébridisation : Robert James Fletcher. In: Journal de la Société des océanistes, n°70-71, tome 37, 1981. pp. 129-131

La pandémie du VIH / sida: l’émergence des collectifs de patients dans le champ politique

L’un des principaux événements des vingt dernières années a été l’identification aux Etats-Unis, en 1981, par les Centers for Disease Control (C.D.C.) d’une nouvelle maladie que rapidement l’Organisation mondiale de la santé (OMS) reconnaissait être une pandémie. A la fin de l’année 2000, on estime que 21 800 000 personnes sont déjà mortes du sida depuis le début de la pandémie et, selon l’OMS, 36 100 000 de personnes vivent aujourd’hui avec le VIH ou sida (tableau 1) Au cours de l’année 2000..

Le « dispositif de guerre » comme analyseur des rapports de pouvoir

Lorsque nous avons eu quelques discussions avec Alessandro Fontana et François Ewald, sur l’édition de ces cours, il y a une chose qui me semble nous avoir échappé, à savoir le projet qui animait les cours depuis leur début, en 1970-1971. D’une certaine façon, durant sa première année d’enseignement au Collège de France, en 1971, Foucault a annoncé la mise en œuvre d’une méthodologie originale, dont on n’a peut-être pas assez tenu compte dans la présentation de ce cours. Il me semble que nous..

Fletcher, Robert James. Iles Paradis, Iles d'Illusion, Lettres des Mers du Sud. Un cas d'hébridisation : Robert James Fletcher

Defert Daniel. Fletcher, Robert James. Iles Paradis, Iles d'Illusion, Lettres des Mers du Sud. Un cas d'hébridisation : Robert James Fletcher. In: Journal de la Société des océanistes, n°70-71, tome 37, 1981. pp. 129-131

A Political Life

Daniel Defert was Michel Foucault’s partner for more than the last 20 years of his life. A student during the early 1960s, he supported the Algerian liberation movement, participated in the activist Gauche prolétarienne and, together with Foucault, founded GIP (Groupe d’information sur les prisons), a group that gathered and published information about the conditions in French prisons. After Foucault died in 1984 of AIDS, without having been given the precise diagnosis by any of his doctors, Defert founded AIDES, to this day the largest organization for the support of HIV-positive people and people with AIDS in France. AIDES started out as a network of mutual assistance and care but also exerted political influence and fought against the discrimination of HIV-positive people and the vilification of homosexuality. The Berlin publisher Merve has just issued the German translation of Defert’s interview biography A Political Life. The conversation with Cord Riechelmann will revolve around the historical context of the political struggles which Defert and Foucault engaged in and critical questions about the relation between society and homosexuality that are still with us today. Daniel Defert, born in 1937, is a sociologist, philosopher, activist and founder of the organization AIDES, which he presided over until 1991. He has served as co-editor of the writings of Michel Foucault. Cord Riechelmann is a biologist, philosopher, and author who writes, among others, for the Frankfurter Allgemeine Sonntagszeitung and Jungle World. Introduction by Elisa Barth (Merve)Daniel Defert and Cord Riechelmann, A Political Life, discussion, ICI Berlin, 29 October 2015, video recording, mp4, 49:40 <https://doi.org/10.25620/e151029

Lectures de Michel Foucault. Volume 1

Les contributions réunies dans ce volume constituent une des premières tentatives pour prendre en compte la nouveauté qu’entraîne la mise à la disposition du public des cours de Foucault au Collège de France. Dans « Il faut défendre la société», Foucault envisage les questions du pouvoir, de la guerre comme analyseur des rapports de pouvoir et fait la généalogie du discours historico-politique de la guerre des races, depuis ses prémisses au XVIe siècle jusqu’à sa transformation en racisme d’état au XXe siècle. L’objectif visé par ces Lectures de Michel Foucault n’est pas de soumettre l’analyse de ce dernier à la grille d’un commentaire érudit, mais de problématiser le lien entre le discours historique de la guerre des races, aux XVIIe et XVIIIe siècles, et le racisme biologique de la fin du XIXe siècle, à travers l’hypothèse générale du développement du bio-pouvoir en Occident. Il s’agit ici avant tout, au-delà de toute volonté d’exégèse célébrative, d’ouvrir des voies nouvelles de réflexion qui prolongent parfois, mais aussi déplacent ou contestent, les pistes tracées par Foucault. On lira dans ce livre des contributions sur la généalogie des concepts foucaldiens - notamment celui de bio-pouvoir - leur mode d’articulation et la perspective militante dans laquelle ils s’inscrivent (M. Bertani et A. Fontana) ; une interrogation sur la nature du tournant que représente ce cours dans la pensée de Foucault (D. Defert) ; une réflexion sur l’articulation du problème politique du pouvoir et de la question historique de la race qui met en évidence la nécessité, pour que cette « généalogie du racisme» puisse aboutir, de faire intervenir l’histoire de la traite des noirs et du système esclavagiste (T. C. Holt) ; enfin, parce que ces réflexions furent, à l’origine, menées dans une journée d’étude passionnée, on y trouvera les interventions d’autres chercheurs sur ces hypothèses, ces analyses et ces questions.The contributions brought together in this volume constitute one of the first attempts to consider the unusual step of the lessons given by Foucault at the Collège de France being made available to the public. In “Society must be defended”, Foucault looks at the issue of power and the question of war as an analyser of power relations and traces the genealogy of historic-political discourse on the subject of race wars, from their premises in the 16th century to their transformation into state racism in the 20th century. The aim of these Lectures by Michel Foucault is not to expose his work to erudite commentary. The objective is rather to problematise the link between historical discourse on race wars during the 17th and 18th centuries and the biological racism of the late 19th century through the general hypothesis of the development of biopower in the West. The main aim here, beyond any desire for celebratory exegesis, is to open up new avenues for reflection which, on occasion, extend, but can also displace and challenge, the path forged by Foucault

"The Masked Assassination"

African and African Diaspora Studie

State-of-the-art : plenary session

Meeting: International Conference on AIDS, 5th, 4-9 June, 1989, Montreal, QC, CAPlenary speakers: Ian Weller, Bosenge N'Galy, Daniel Defert, David J. Roy, Roy M. Anderso