Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Vitamin A intake and factors influencing it amongst children and caretakers in Kosrae, Micronesia

A cross-sectional study was undertaken in Kosrae, Federated States of Micronesia to assess preschool children and caretaker dietary intake of vitamin A (VA) (including provitamin A carotenoids) and other nutrients contributing to VA status and to investigate relationships between VA intake and factors affecting dietary intake. Ethnography, food sample analysis, two dietary assessment methods (7-day food frequency questionnaire and quantitative 24-hour recall for three nonconsecutive days) administered by trained interviewers to a random sample group, and cultivar difference specification (yellow-fleshed versus white-fleshed bananas) contributed to the richness of the study. Vitamin A intake was low, approximately half of the estimated requirements for children (n = 65) and caretakers (n = 65), whereas protein intake was high. There were no clear significant relationships associated with gender, caretaker education, caretaker occupation, and socio-economic status with VA intake, indicating that a broad-based intervention over all population segments is needed to change dietary behavior, The ethnographic approach was critical for survey instrument development and data analysis

Gender and Aging in the Developing World: Where Are the Men?

In recent years, both population aging and gender issues have gained prominence in international forums concerned with population. It is frequently asserted or implied that older women are universally more vulnerable to social, economic, and health disadvantages than older men. The most significant manifestation of this exclusive concern with women when considering gender and aging is the Plan of Action adopted by the Second World Assembly on Aging in 2002. The assumed relative disadvantage of elderly women is commonly attributed to gender differences in earlier life experiences. But are older women truly disadvantaged globally with respect to all or most essential aspects of well-being? The authors provide empirical evidence that clearly shows that older women are not invariably disadvantaged vis-à-vis men. In particular, they call into question the wisdom and equity of a virtually exclusive emphasis on the needs of women when incorporating gender concerns into policies and programs related to aging. A more balanced perspective that recognizes gender as a potential, but not necessarily central, marker of vulnerability for various aspects of well-being in specific settings and times, and that allows for male as well as female disadvantage, would serve the current and future elderly generations far better. Copyright 2003 by The Population Council, Inc..

Home-Based Rehabilitation: Enabling Frequent and Effective Training

Rehabilitation studies have recently demonstrated that the amount of time spent training is one of the most important factors in one’s ability to regain motor control. The methods employed need to be effective, but individuals need to spend significant amounts of time retraining. One of the most effective ways to enable more training time is for rehabilitation to occur in one’s home so individuals have adequate access to it and there is no cost associated with traveling to the clinic. There are several challenges that need to be overcome to make home rehabilitation more common; for example adapting the methods from the clinical setting to the home setting, ensuring safety, and providing motivation. This chapter outlines existing technologies for upper and lower limb rehabilitation and how they could be adapted for use in one’s home. Although many types of disabilities would benefit from home-based rehabilitation, this discussion will focus on traumatic brain injuries, specifically stroke related. Many of the methods that could be used at home for stroke would also have application for helping in other circumstances