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

Expert advice on daytime talk television: A beneficial source of information for the general public?

Experts on talk television have an opportunity to disseminate useful information to the general public. However, many negative claims have been made about experts on talk television, including that experts are not utilized effectively by being delegated to the end of talk shows, by not being given much time to present advice, and by not providing useful advice. None of these claims have been examined utilizing empirical evidence. This study seeks to correct this deficiency. It examines 78 talk show transcripts for expert advice. Results indicated that talk shows utilized a small portion of their potential as a source of useful information; however, the analysis also suggested changes which talk shows could implement to increase the effectiveness of expert advice

The nature of close relationships as presented in television talk show titles

Although much controversy exists about the value of television talk shows, there is an absence of empirical investigation into the nature of these shows. The goal of this research was to analyze the titles from six months of the eleven top-rated television talk shows and corresponding content from one month of these shows. Results indicated that family relationships tended to be portrayed in predominantly negative ways. Personal relationships tended to be portrayed as neutral or negative. Analyses of corresponding content in the form of types of disclosures were conducted. On average, viewers were exposed to over 13 sexual activity, sexual orientation, embarrassing situation, abuse, and criminal disclosures per one hour talk show. Sexual activity disclosures occurred significantly more often in personal relationship shows, sexual orientation and embarrassing situation disclosures occurred significantly more often in positive topic personal relationship shows, while abuse disclosures occurred significantly more often in negative relationship topic shows. Individual attributes most often portrayed were sexual activity, personality traits, criminal behavior, celebrity status, anger, and appearance. An analysis of the valence of personality traits revealed that they, too, were portrayed predominantly in a negative manner. The findings are discussed in terms of the ways that television talk show events may function to distort viewer's judgments about close relationships

Notification pending: Online social support from close and nonclose relational ties via Facebook

Previous research in computer-mediated communication’s effect on social networks has generated questions about the role of weak ties in what was assumed to be a unique affordance of strong ties—obtaining effective social support. Eighty-eight college students completed a questionnaire based on their most recent Facebook status updates and the comments and likes those updates generated. Items queried participants’ perception of each response as well as the participants’ relationships characteristics with the responder. Strong ties were perceived to have significantly closer relationships and provided significant social support. However, weak tie relationships were more numerous than strong ties and were perceived by participants to provide social support that was equally significant. While the use of Facebook did not erode the importance of strong ties, this study found that traditional understandings of weak ties do not account for the strong social support afforded by weak tie relationships when mediated through social network sites