5 research outputs found

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

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    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

    Evaluation of a simplified top-down model for the spatial assessment of hot traffic emissions in mid-sized cities

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    Publicación ISITraffic emission estimation in developing countries is a key-issue for air pollution management. In most cases, comprehensive bottom-up methodologies cannot be applied in mid-sized cities because of the resource cost related to their application. In this paper, a simplified emission estimation model (SEEM) is evaluated. The model is based on a top-down approach and gives annual global hot emission. Particular attention is paid to the quality of the input traffic data. The quality of results is assessed by application of the SEEM model in the Chilean Gran Concepcion urban area and by comparison with a bottom-up approach that has been led for the year 2000. The SEEM model estimates emissions with an accuracy of about 20% and is related to important resource savings. The results of the SEEM model are then distributed in space with a disaggregation approach and using GIS techniques. The relevancy of the disaggregation approach is evaluated among several possibilities through statistical methods. A spatial disaggregation using principal roads density gives the best results in terms of emissions repartition and gives a globally accurate image of the distribution of hot emissions in a mid-sized city. (c) 2007 Elsevier Ltd. All rights reserved

    Desagregación espacio temporal del inventario nacional de emisión de contaminantes criterio, gases efecto invernadero y carbono negro provenientes de fuentes móviles en Colombia.

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    Los Inventarios de Emisión son esenciales para entender cómo influyen las actividades antropogénicas del país sobre la calidad del aire local, regional y global y cuál es su contribución específica. Esta importancia es evidente cuando se analizan los aportes a emisiones provenientes de fuentes móviles, teniendo en cuenta que son las principales generadoras de contaminantes de interés para la salud pública como compuestos orgánicos volátiles (COVs) de alta reactividad fotoquímica (precursores de ozono troposférico O3), material particulado (PM), CO y NOx. En Colombia, se han realizado diversos ejercicios para la cuantificación de las emisiones generadas por fuentes móviles en ámbitos locales, principalmente en las grandes ciudades. Así mismo, se ha estimado el inventario nacional de gases de efecto invernadero, el cual también se ha desagregado a escala municipal y por cada sector. Sin embargo, no se ha reportado un inventario nacional de emisiones vehiculares de contaminantes criterio ni de contaminantes climáticos de vida corta, como el carbono negro. Estos inventarios son necesarios para ser alimentados a modelos de calidad del aire, a una resolución que permita generar predicciones a escala urbana y regional. Suelen utilizarse inventarios globales con este propósito, pero dichos inventarios son construidos a partir de información agregada, sin el detalle que puede obtenerse utilizando información local. Este trabajo presenta una serie de metodologías usadas a nivel internacional para la estimación de los inventarios de emisión de fuentes móviles, así como la definición de una metodología para realizar la estimación para Colombia, con base en una experiencia reciente desarrollada en Chile. La armonización metodológica entre estos dos países será propuesta para extenderla a otros países del continente, en el marco del proyecto colaborativo entre América Latina y Europa PAPILA (Prediction of Air Pollution in Latin America)

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