Social assessment of landscapes of the Comarca Minera UNESCO Global Geopark, Hidalgo (Mexico)

Para evaluar la percepción social de los paisajes de Hidalgo, se desarrolló un cuestionario electrónico que se aplicó en dos instituciones de enseñanza media superior del Geoparque ‘Comarca Minera’. El tamaño de la muestra fue de 197 individuos (116 corresponden a una escuela rural y 81 a una urbana). El sitio preferido por su paisaje es el geositio emblemático ‘Prismas Basálticos’. Éste aparece también como el que más preocupa por su conservación. Huasca de Ocampo, Mineral del Monte y Mineral del Chico son las entidades preferidas; los tres son municipios del geoparque con la designación turística de ‘Pueblos Mágicos’. También se observa una preferencia por bosques y montañas, elementos característicos de los paisajes hidalguenses. El cuestionario no reflejó un peso de los factores edad, género, ambiente urbano o rural y municipio de residencia sobre la selección de los paisajes, mientras que la categoría académica (estudiante o docente) y el lugar de nacimiento sí tuvieron efecto. La diferencia más acusada es que los nacidos en Hidalgo mencionan más sitios. En cuanto al significado del geoparque, se manifiestan emociones relacionadas con valores de conservación y protección del territorio, así como con distintos atributos, entre los cuales la geología es el más mencionado.To assess the social perception of landscapes in Hidalgo state (Mexico), we developed a digital questionnaire that was answered by 197 people (mostly students) from two high-school centers located in the ‘Comarca Minera’ UNESCO Global Geopark. The preferred landscape site from Hidalgo is ‘Prismas Basálticos’, the emblematic geosite of the geopark. This geosite, also, raises most concerns for its conservation. Huasca de Ocampo, Mineral del Monte and Mineral del Chico are the preferred municipal areas mentioned; these possess the touristic brand as ‘Pueblos Mágicos’ (Magic Towns). On the other hand, a conspicuous preference for forests and mountains is observed, distinctive features of Hidalgo landscapes. Questionnaire results do not reflect a link of landscape preference to age, genre, environment (urban or rural) nor home municipality, whereas academic category (student or teacher) and birthplace (Hidalgo or elsewhere) played a role in the preferences. A pronounced difference is that those born in Hidalgo refer to a wider variety of sites, reflecting a greater knowledge of the territory. In terms of geopark meanings, manifested emotions relate to conservation values, care and protection of land, but also to other attributes, among which geology is the most cited

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Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research