Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Qualità della vita e carico assistenziale dei caregiver di pazienti affetti da demenza

Obiettivo: In questo lavoro intendiamo valutare la qualità della vita e il grado di distress dei caregiver di pazienti affetti da demenza afferenti presso il Centro di Riferimento Regionale Demenze Senili-Alzheimer - Unità Valutativa Alzheimer, dell’A.S.P. di Palermo. Metodi: L’assessment si compone di una batteria testo-logica che comprende i seguenti tests: Relative Stress Scale, Caregivere Burden Inventory, Neuropsychiaric Inventory, Short Form-36 Healty Survey. Risultati: Dall’analisi dei dati emerge che il grado di stress del caregiver risulta proporzionale al numero di anni di accudimento del paziente. Inoltre i caregiver di sesso femminile dedicano un numero sensibilmente maggiore di ore rispetto ai caregiver di sesso maschile e ricevono minor supporto, riferendo una compromissione maggiore sulla sfera emotiva e sulla vita socio-relazionale. Conclusioni: La demenza essendo una patologia con una sintomatologia variegata e complessa che inficia inesorabilmente la salute del soggetto richiede un interessamento globale e totalizzante del caregiver con notevoli ripercussioni sulla sua salute fisica e psichica. Ciò evidenzia la necessità di un support

Influência da superabundância por Aulonemia aristulata (Bambuseae) sobre o banco de sementes transitório em um fragmento de Floresta Atlântica

The aim of our study was to evaluate the community structure and species composition of seeds present in the transient seed bank in two areas of Atlantic forest fragment in São Paulo: an area where the bamboo is overabundant and another without bamboos, both located in a secondary forest fragment. Our hypothesis is that bamboo overabundance influences the availability and species diversity of seeds in the transient soil seed bank, what, in tum, can influence the potential for natural forest recovery. We collected 45 samples of litter in each site and sorted, quantified and identified seeds to the most precise taxonomic levels. We found lower species richness and higher proportion of exclusive species in the area where bamboo is overabundant, but there was no difference in the abundance of seeds in the transient seed bank between areas. Our results show that seed distribution in the bamboo overabundant area was more limited than in control area because 50% of collected samples did not present any seeds. It was not possible to conclude whether the reduction on species richness of the transient seed bank was a result of the lower density of tree species or just a side effect of the overabundance of bamboo. The decrease in species richness and seed dispersal limitation in transient seed bank found in bamboo overabundant area suggest the decreased contribution of this pathway regeneration of vegetation