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

Nível de conhecimento de um grupo de idosos em relação à síndrome da imunodeficiência adquirida

Este trabalho teve por objetivo verificar o nível de conhecimento de um grupo de idosos em relação ao Síndromeda Imunodeficiência Adquirida (HIV/AIDS). O método utilizado foi uma pesquisa quantitativo-exploratória. Os dados foram coletados entre março e junho de 2008 por meio de um questionário semi-estruturado com questões abertas e fechadas, aplicado a 23 idosos, integrantes do Grupo de Terceira Idade Mexe Coração do município de Santa Maria, RS, Brasil. A faixa etária dos participantes variou de 58 a 96 anos. A análise dos dados revela a existência de lacunas no conhecimento dos idosos em relação conceito de HIV/AIDS, grupos de risco, formas de transmissão, vulnerabilidade e outros fatores que contribuem para a ascensão da doença nesta faixa etária.El objetivo de este trabajo se centró en verificar el nivel de conocimiento de un grupo de adultos mayores con respecto al Síndrome de Inmunodeficiencia Adquirida (VIH/SIDA), para ello se utilizó el método de investigación cuantitativa-exploratoria. Los datos se recolectaron entre marzo y junio de 2008 a través de un cuestionario semiestructurado compuesto por preguntas abiertas y cerradas, aplicado a 23 adultos mayores, miembros del Grupo de la Tercera Edad Mexe Coração del municipio de Santa Maria, RS, Brasil. El rango etario de los participantes varió desde 58 a 96 años. El análisis de los datos revela la existencia de vacíos en el conocimiento de los adultos mayores sobre el concepto VIH/SIDA, grupos de riesgo, formas de transmisión, vulnerabilidad y otros factores que contribuyen al aumento de esta enfermedad durante este rango etario.This study aimed to verify the level of knowledge of agroup of elderly in relation to Acquired Inmunodeficiency Syndrome (HIV/AIDS). The method used was an exploratory quantitative research. Data were collected in 2008 between March and June, through a semistructured questionnaire with open and closed questions, applied in 23 elderly, members of the Group of Elderly Mexe Coração in Santa Maria, RS, Brazil. The ages of participants ranged from 58 to 96 years. Data analysis revealed the existence of gaps in knowledge of the elderly about the concept of HIV/AIDS, risk groups, ways of transmission and vulnerability and other factors that contribute to the rise of the disease in this age group

Atentando para as singularidades humanas na atenção à saúde por meio do diálogo e acolhimento

Objetivou-se compreender como os trabalhadores de saúde se posicionam frente ao seu principal objeto de trabalho – o usuário – sujeito e autor da sua história de vida. Pesquisa qualitativo-exploratória. Participaram 11 profissionais de enfermagem em Unidade Básica de Saúde, por meio de um instrumento semi-estruturado nos meses de março e abril de 2008. As falas resultaram em dois temas convergentes: Atentando para as singularidades humanas na atenção à saúde; Diálogo e acolhimento como possibilidades interativas. Evidenciou-se que a atenção à saúde vem ampliando os debates pela valorização da singularidade humana por meio do diálogo e acolhimento como possibilidades interativas

Nível de Conhecimento de um grupo de idosos em relação à Síndrome da Imunodeficiência Adquirida

Este trabalho teve por objetivo verificar o nível de conhecimento de um grupo de idosos em relação ao Síndromeda Imunodeficiência Adquirida (HIV/AIDS). O método utilizado foi uma pesquisa quantitativo-exploratória. Os dados foram coletados entre março e junho de 2008 por meio de um question ário semi-estruturado com questões abertas e fechadas, aplicado a 23 idosos, integrantes do Grupo de Terceira Idade Mexe Coração do município de Santa Maria, RS, Brasil. A faixa et ária dos participantes variou de 58 a 96 anos. A an álise dos dados revela a existência de lacunas no conhecimento dos idosos em relação conceito de HIV/AIDS, grupos de risco, formas de transmissão, vulnerabilidade e outros fatores que contribuem para a ascensão da doença nesta faixa et ária

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications