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

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

In memoriam. La huelga del Ferrocarril de Antioquia, 1934.

En este trabajo, la autora, cuando aún era estudiante de pregrado, reconstruyó un acontecimiento particularmente significativo para la historia del departamento de Antioquia, que tuvo repercusiones nacionales, cuando se llevó a cabo la huelga de 1934 en el Ferrocarril de Antioquia. Acogiendo diversas fuentes documentales, como actas de la junta directiva de la empresa, documentos oficiales y periódicos locales, así como relatos directos de algunos obreros que participaron en el acontecimiento, muestra el panorama y los intereses políticos de conservadores, liberales y comunistas que convergieron en el conflicto, incluyendo la presencia del caudillo socialista Jorge Eliecer Gaitán Ayala y el papel que jugó el para entonces recién creado sindicato de la insigne institución ferroviaria. (Texto tomado de la fuente)Ponencia presentad a en el seminario “Gaitanismo y 9 de abril, Bogotá, abril de 1982.Publicado originalmente en la Revista de Extensión Cultural número 12 de julio de 1982

Corrupción, poder y abuso: El caso de los Capitanes a Guerra durante el tardío colonial en el Nuevo Reino de Granada

Este artículo presenta, fundamentado en fuentes primarias, una imagen de la forma como se ejerció el poder por parte de los funcionarios reales a fines del siglo XVIII. En este caso, los capitanes a guerra nombrados en poblaciones nuevas, resultado de la política borbónica de organización de territorio y población, o en zonas en franca decadencia en las que habían desaparecido los cabildos. Estos funcionarios, en su mayoría sin preparación y sin salarios, aprovecharon sus cargos para explotar y abusar de la población. El artículo también ilustra cómo los vecinos libres (mestizos, zambos negros y pardos), denunciaron mediante quejas y reclamaciones estas situaciones e incluso, como ejercieron acciones políticas tales como  las asonadas, los desordenes y —en casos extremos— el uso de la violencia para protegerse del mal gobierno. Palabras clave: Capitanes a Guerra, plebe, libres, desacato, corrupción, despotismo.    Corruption, Power and Abuse:  The   Capitains of War  during  the late colonial period in Viceroyalty of  Nueva Granada   Abstract   In this paper it is shown, based on primary sources, an image of how power was exerted by Royal servants at the end of XVIIIth century. In this case, they were the war captains named in new settlements as a result of the Bourbon policy of territory and people organization, or in zones in clear decadence in which councils had disappeared. Most of those Royal servants, having no preparation or salaries, would take advantage of their position to exploit and abuse the people. This paper also illustrates how free residents (mestizo, half-breed and mulatto) denounce these situations with complains, and also how they exert a political experience which uses the riots, disturbance and —in extreme cases— violence to protect themselves from bad government. Keywords: captains of war, free people, rabble, disrepect, corruption, despotism

Corrupción, poder y abuso: el caso de los Capitanes a Guerra durante el tardío colonial en el Nuevo Reino de Granada

In this paper it is shown, based on primary sources, an image of how power was exerted by Royal servants at the end of XVIIIth century. In this case, they were the war captains named in new settlements as a result of the Bourbon policy of territory and people organization, or in zones in clear decadence in which councils had disappeared. Most of those Royal servants, having no preparation or salaries, would take advantage of their position to exploit and abuse the people. This paper also illustrates how free residents (mestizo, half-breed and mulatto) denounce these situations with complains, and also how they exert a political experience which uses the riots, disturbance and �in extreme cases� violence to protect themselves from bad government.Este artículo presenta, fundamentado en fuentes primarias, una imagen de la forma como se ejerció el poder por parte de los funcionarios reales a fines del siglo XVIII. En este caso, los capitanes a guerra nombrados en poblaciones nuevas, resultado de la política borbónica de organización de territorio y población, o en zonas en franca decadencia en las que habían desaparecido los cabildos. Estos funcionarios, en su mayoría sin preparación y sin salarios, aprovecharon sus cargos para explotar y abusar de la población. El artículo también ilustra cómo los vecinos libres (mestizos, zambos negros y pardos), denunciaron mediante quejas y reclamaciones estas situaciones e incluso, como ejercieron acciones políticas tales como las asonadas, los desordenes y �en casos extremos� el uso de la violencia para protegerse del mal gobierno

El derrumbe de la primera república en la Nueva Granada entre 1810 y 1816.

This article describes the multiple efforts undertaken by Creole elites to organize a new political order in New Granada between 1810 and 1816. It takes into account the complexity of these efforts and shows how, nonetheless, the political fragmentation into numerous local sovereignties, the weight of local identities and projects, as well as the bureaucratic appetites of Creole elites, paved the way for the failure of the first Republic in New Granada even before the reconquest

Mujeres profesionales en Colombia, 2000-2015 : Algunas reflexiones

Los cambios culturales suscitados a partir de la década de 1960, y la inserción de la mujer en las aulas universitarias, le dieron a esta una autonomía que le ha permitido estar presente en todos los espacios de la sociedad, generando cambios sociales que hace cien años se creían impensables y que han afectado, inevitablemente, su presencia en el ámbito privado. El presente texto intentará mostrar un balance de lo que ha significado la inserción de la mujer profesional en la esfera pública, reflexionando acerca de las barreras que ha tenido que vencer, los obstáculos que ha debido superar y los retos que enfrenta en este momento, cuando es una profesional con todas las competencias para hacer parte de la cúspide organizaciona

Corrupción, poder y abuso: El caso de los Capitanes a Guerra durante el tardío colonial en el Nuevo Reino de Granada

Este artículo presenta, fundamentado en fuentes primarias, una imagen de la forma como se ejerció el poder por parte de los funcionarios reales a fines del siglo XVIII. En este caso, los capitanes a guerra nombrados en poblaciones nuevas, resultado de la política borbónica de organización de territorio y población, o en zonas en franca decadencia en las que habían desaparecido los cabildos. Estos funcionarios, en su mayoría sin preparación y sin salarios, aprovecharon sus cargos para explotar y abusar de la población. El artículo también ilustra cómo los vecinos libres (mestizos, zambos negros y pardos), denunciaron mediante quejas y reclamaciones estas situaciones e incluso, como ejercieron acciones políticas tales como  las asonadas, los desordenes y —en casos extremos— el uso de la violencia para protegerse del mal gobierno.Palabras clave: Capitanes a Guerra, plebe, libres, desacato, corrupción, despotismo.  Corruption, Power and Abuse:  The   Capitains of War  during  the late colonial period in Viceroyalty of  Nueva Granada  Abstract In this paper it is shown, based on primary sources, an image of how power was exerted by Royal servants at the end of XVIIIth century. In this case, they were the war captains named in new settlements as a result of the Bourbon policy of territory and people organization, or in zones in clear decadence in which councils had disappeared. Most of those Royal servants, having no preparation or salaries, would take advantage of their position to exploit and abuse the people. This paper also illustrates how free residents (mestizo, half-breed and mulatto) denounce these situations with complains, and also how they exert a political experience which uses the riots, disturbance and —in extreme cases— violence to protect themselves from bad government.Keywords: captains of war, free people, rabble, disrepect, corruption, despotism

Litigio estratégico en Colombia: Casos paradigmáticos del Grupo de Acciones Públicas

Este libro busca compartir los resultados del trabajo de investigación-acción participativa que realiza el Grupo de Acciones Públicas -GAP- de la Universidad del Rosario, como parte de un esfuerzo de fortalecimiento de la educación legal clínica y el litigio estratégico en derechos humanos, donde la agenda para Colombia y América Latina es muy amplia, así como las necesidades de formación jurídica de calidad. Así mismo, este libro da cuenta de los avances en materia legal clínica y litigio estratégico del GAP, en el periodo 2009-2013, como continuación del ejercicio que inició en el 2009, al presentar un primer balance de sus casos clínicos en la obra Educación Legal única y defensa de los derechos humanos: casos paradigmáticos del Grupo de Amanes Públicas -GAP- (Editorial Universidad del Rosario, 2009). Según se ha establecido en los encuentros nacionales e internacionales sobre clínicas jurídicas, la sistematización y realización de publicaciones sobre el quehacer de las clínicas jurídicas es el insumo necesario para la formación de nuevas clínicas y el fortalecimiento de las existentes. Una característica importante de esta propuesta es que en su construcción participaron los supervisores del grupo y los estudiantes de la clínica, con lo cual se propuso una forma diferente de reflexionar y analizar la labor del grupo alrededor de la determinación de los casos paradigmáticos, la definición de una agenda temática, el diseño de estrategias de litigio, el abordaje de la investigación formativa y, así mismo, el desarrollo de habilidades de argumentación y escritura académica

Historia que no cesa. La independencia de Colombia. 1780-1830

La historia de la Independencia no cesa de escribirse. Su escritura se inició en el momento mismo de los acontecimientos. El Diario Político de Santafé de Bogotá, creado apenas unos días después del 20 de julio de 1810, se ocupó, casi exclusivamente, de contar y, por supuesto, de justificar el levantamiento de los criollos y la creación de la nueva Junta de Gobierno. Y aún más importante, en el temprano año 1825, el político e intelectual José Manuel Restrepo dio a conocer su Historia de la Revolución de Colombia, obra ambiciosa y sorprendente sobre el curso de los aconteceres que habían fracturado el imperio español y dado origen a las nuevas repúblicas. Obviamente, hoy la historia de la Independencia es algo mucho más complejo que un minucioso relato de las confrontaciones militares entre patriotas y realistas