Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

Health and safety at work : a comparative analysis of the Brazilian enforcement framework

The rate of work place accidents and consequential work place fatalities in Brazil is veryhigh. This thesis intends to analyse whether a structured enforcement body with clearpolicies, regulations, standards and guidance is necessary to improve working conditionsand to provide a safe work environment in Brazil.Central to this study is the Brazilian Enforcement Framework. This thesis will focus onenforcement powers and the forms of punishments that are provided to cover breaches ofhealth and safety legislation. It will also focus on the structure of the Enforcement Body.An assessment will be made of the Brazilian Judiciary System, Health and Safety at WorkLegislation and the political, social and economic issues. This will be done in order toidentify if improvements alone to enforcement will be sufficient to reduce the high level ofwork place accidents.The study concluded that Brazil lacks clear and specific health and safety at worklegislation which takes into account the circumstances today such as the workingenvironment, the work force, working relationships and what is necessary to provideprotection to the general public. The conclusion also claims that the political, social andeconomic reality in Brazil does not include a perspective that contributes to promoting ahealth and safety culture generally.Therefore this thesis does not recommend that a newly structured enforcement body beconstructed, it goes far beyond that and recommends that a whole new model of Health andSafety at Work should be created. The recommendation follows the conclusion that anewly structured enforcement body will not be enough to reduce the level of accidents atwork to a more acceptable level. The recommendation takes into account Brazil's realitytoday and a genuine commitment towards health and safety at work on all levels

Effect of calcium and/or barium crosslinking on the physical and antimicrobial properties of natamycin-loaded alginate films

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The preparation of alginate films with suitable properties requires a two-step contact with reticulating agents: initially a weakly structured pre-film is formatted which is further crosslinked in a second stage by immersion in a more concentrated solution. The present work evaluated the effects of a combined crosslinking procedure using calcium and barium ions on the physical and morphological properties of alginate-based films containing natamycin as antimicrobial agent. The release behavior of natamycin in water was evaluated as well as the antimicrobial activity against four target microorganisms, which are common cheese product contaminants. Films attributes were affected by the type of ion used in the second stage while the natamycin release rate and the antimicrobial activity were influenced by the ion used in the first stage. Films crosslinked with Ba2+ in the first and Ca2+ in the second stage (Ba-Ca films) exhibited physical properties very similar to films crosslinked with calcium in both stages. Release kinetics of natamycin in water fitted well to Fick's second law diffusional model, with effective diffusivity values ranging from 0.40 x 10(-11) to 1.74 x 10(-11) cm(-2)/s. Ba-Ca films presented the lowest natamycin diffusion coefficient and the smallest inhibition zone diameter against the four microorganisms tested. (C) 2014 Elsevier Ltd. All rights reserved.572494501Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Programa Ciencia (Portugal)COMPETE (Portugal) [PEst-C/EQB/UI0102/2011]Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)COMPETE (Portugal) [PEst-C/EQB/UI0102/2011

Influence of natamycin loading methods on the physical characteristics of alginate active films

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Natamycin, an antimicrobial agent sparingly soluble in water, was incorporated into alginate films in order to produce antimicrobial packaging, using three different approaches: the conventional loading method, when natamycin is added directly to the polymeric aqueous film-forming solution; the immersion procedure, by which a previously prepared films is contacted with natamycin solution, and by the supercritical solvent impregnation (SSI) method, with loading tests performed in CO2 containing natamycin, with and without addition of cosolvent (ethanol, 10% molar). The loading capacities were evaluated, as well as the influence on physical attributes of the films and on the release behavior of natamycin in water. The conventional method led to films heterogeneities with high surface roughness, and the immersion technique evinced several disadvantages like low incorporation yields, and negative influence on water vapor permeability and on the swelling degree of the film. The supercritical method showed that longer contact times and the use of ethanol as a cosolvent increased the natamycin loading yields and led to homogeneous films, where SSI (CO2 + EtOH) process produced visually attractive and tranlucent films. (C) 2013 Elsevier B.V. All rights reserved.767482Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Requirements for Brazilian Outpatient Centers of Excellence in Hidradenitis Suppurativa: Consensus Co-Creative Study

Ericles Andrei Bellei,1 Miriam Emi Makinodan Shirozaki,1 Ana Lia Pradella Puglia,2,3 André Vicente Esteves de Carvalho,4 Barbara Riquena,2,5 Camilla Carlini Vallilo,2,3 Danilo de Barros,6 Erika Yumi Tamashiro,2 Gabriela Cintra,2 Gleison Vieira Duarte,7 Maria Cecília da Matta Rivitti-Machado,8 Renata Ferreira Magalhães,9 Ricardo Figueiredo do Nascimento,2 Roberto Tunala,5 Roberto da Silva,10 Wagner Guimarães Galvão Cesar,11 Felipe Garutti Thies2 1Department of Data, Digital, and Innovation, Novartis, São Paulo, Brazil; 2Immunology Franchise, Novartis, São Paulo, Brazil; 3Department of Scientific Operations, Novartis, São Paulo, Brazil; 4Dermatology, Hospital Moinhos de Ventos de Porto Alegre, Porto Alegre, Brazil; 5Department of Medical Affairs, Novartis, São Paulo, Brazil; 6Dermatology Service, Hospital Irmandade Santa Casa de Curitiba, Curitiba, Brazil; 7Dermatology, Instituto Bahiano de Imunoterapia (IBIS), Salvador, Brazil; 8Hospital das Clínicas da Faculdade de Medicina, University of São Paulo (USP), São Paulo, Brazil; 9School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil; 10Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil; 11Dermatology, Hospital Alemão Oswaldo Cruz, São Paulo, BrazilCorrespondence: Ericles Andrei Bellei, Novartis Biociências S.A, 90 Av Prof Vicente Rao, São Paulo, 04706-900, Brazil, Tel +55 1155327122, Email [email protected]: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research.Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages.Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education.Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.Keywords: hidradenitis suppurativa, centers of excellence, co-design, consensus, health services research, patient-centered care, community-based participatory research, healthcare innovatio