Exposición a factores ambientales y riesgo de tumores en el sistema nervioso central en niños: revisión sistemática y metaanálisis

Se analiza el riesgo de tumores en el sistema nervioso central en niños en relación con la exposición a factores ambientales como radiaciones (ionizantes, no ionizantes), sustancias químicas (pesticidas, productos de belleza, contaminantes atmosféricos) y alimentos. Se realizó una revisión sistemática y un metaanálisis con estudios identificados en la búsqueda de PubMed (1987-2013). Los resultados obtenidos a partir de los valores de OR muestran que el riesgo de tumores en el sistema nervioso central en niños se asocia significativamente con la exposición de los padres y que el periodo prenatal es una ventana crítica para varios de los factores ambientales considerados. Aunque la fracción de riesgo atribuible a cada factor aún se desconoce, el análisis estadístico permitió determinar asociaciones significativas para factores químicos como pesticidas (OR: 1,93; IC 95 % 1,51-2,47), contaminantes atmosféricos (OR: 1,45; IC 95 % 1,17-1,80) y alimentos con compuestos N-nitroso (OR: 1,96; IC 95 % 1,40-2,73) especialmente durante la exposición prenatal. Abstract. We analyzed the risk of tumors in the central nervous system of children in relation to exposure to environmental factors such as radiation (ionizing, non-ionizing), chemicals (pesticides, cosmetics, air pollutants) and foods. We performed a systematic review and meta-analysis of studies identified through a PubMed search (1987-2013). The results obtained from OR values show that the risk of tumors in the central nervous system of children is significantly associated with parental exposure and that the prenatal period is a critical window for several of the environmental factors considered. Although the risk fraction attributable to each factor is still unknown, a statistical analysis allowed to determine significant relations for chemical factors such as pesticides (OR:1.93; 95% IC 1.51-2.47), air pollutants (OR: 1.45; 95% IC 1.17-1.80) and foods with N-nitrous compounds (OR: 1.96; 95% IC 1.40-2.73) especially for prenatal exposur

Steady Decline of Corals and Other Benthic Organisms in the SeaFlower Biosphere Reserve (Southwestern Caribbean)

Coral reef decline persists as a global issue with ties to climate change and human footprint. The SeaFlower Biosphere reserve includes some of the most isolated oceanic coral reefs in the Southwestern Caribbean, which provide natural experiments to test global and/or basin-wide factors affecting coral reefs. In this study, we compared coral and other substrate cover (algae, cyanobacteria, and octocorals), along population densities of keystone urchin species from two atolls (Serrana and Roncador Banks), during 1995, 2003, and 2015/2016. We also surveyed benthic foraminifera as a water quality proxy for coral growth in the last period. A steady reduction in coral cover was clearly observed at Roncador’s lagoon, but not at Serrana’s reefs, with significant differences between 1995 and 2015/2016. Percent cover of fleshy algae decreased significantly also at Roncador between 1995 and 2003 but did not change notably from 1995 to 2016 at Serrana. However, both Banks exhibited a loss in crustose coralline algae from 2003 to 2015/2016. Likewise, a reduction in bottom complexity, measured as bottom rugosity, was evident between 1995 and 2003. Roncador Bank had unprecedented high octocoral densities, which increased almost threefold from 2003 to 2015. In contrast, urchin densities were low in Roncador; only Diadema antillarum increased from 2003 to 2016 in Serrana Bank. The Foraminifera in Reef Assessment and Monitoring (FORAM) Index (FI) in the two Banks was below the range expected for healthy coral reefs. Although both Banks follow a reduction in CCA and CA cover, Roncador Bank also faces an alarming decline in coral cover, urchins and bottom complexity (rugosity) in contrast to increases in octocoral densities and potential loss of resilience and eutrophication suggested by the FI index. These unexpected findings led us to consider and discuss potential outcomes, where these reefs deteriorate (i.e., erode and drown) providing ideal conditions for octocoral growth. Hence, it is of utmost urgency to start monitoring reef budgets, octocorals and nutrient sources

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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

Exposição a fatores ambientais e risco de tumores no sistema nervoso central em crianças: revisão sistemática e meta-análise

We analyzed the risk of tumors in the central nervous system of children in relation to exposure to environmental factors such as radiation (ionizing, non-ionizing), chemicals (pesticides, cosmetics, air pollutants) and foods. We performed a systematic review and meta-analysis of studies identified through a PubMed search (1987-2013). The results obtained from OR values show that the risk of tumors in the central nervous system of children is significantly associated with parental exposure and that the prenatal period is a critical window for several of the environmental factors considered. Although the risk fraction attributable to each factor is still unknown, a statistical analysis allowed to determine significant relations for chemical factors such as pesticides (OR: 1.93; 95% IC 1.51-2.47), air pollutants (OR: 1.45; 95% IC 1.17-1.80) and foods with N-nitrous compounds (OR: 1.96; 95% IC 1.40-2.73) especially for prenatal exposure.Se analiza el riesgo de tumores en el sistema nervioso central en niños en relación con la exposición a factores ambientales como radiaciones (ionizantes, no ionizantes), sustancias químicas (pesticidas, productos de belleza, contaminantes atmosféricos) y alimentos. Se realizó una revisión sistemática y un metaanálisis con estudios identificados en la búsqueda de PubMed (1987-2013). Los resultados obtenidos a partir de los valores de OR muestran que el riesgo de tumores en el sistema nervioso central en niños se asocia significativamente con la exposición de los padres y que el periodo prenatal es una ventana crítica para varios de los factores ambientales considerados. Aunque la fracción de riesgo atribuible a cada factor aún se desconoce, el análisis estadístico permitió determinar asociaciones significativas para factores químicos como pesticidas (OR: 1,93; IC 95 % 1,51-2,47), contaminantes atmosféricos (OR: 1,45; IC 95 % 1,17-1,80) y alimentos con compuestos N-nitroso (OR: 1,96; IC 95 % 1,40-2,73) especialmente durante la exposición prenatal.Analisa-se o risco de tumores no sistema nervoso central em crianças e a relação com a exposição a fatores ambientais como radiações (ionizantes e não ionizantes), sustâncias químicas (pesticidas, produtos de beleza, poluentes atmosféricos) e alimentos. Realizou-se uma revisão sistemática e uma meta-análise com estudos identificados através de pesquisa realizada na PubMed (1987-2013). Os resultados obtidos a partir dos valores OR mostram que o risco de tumores no sistema nervosos central em crianças tem uma associação significativa com a exposição dos pais. Mostram também que o período pré-natal é uma janela crítica para vários dos fatores ambientais considerados, ainda que a fracção de risco atribuível a cada fator seja desconhecida, a análise estatística permitiu encontrar associações significativas nos factores químicos como pesticidas (OR: 1.93; IC 95 % 1.51-2.47), poluentes atmosféricos (OR: 1.45; IC 95 % 1.17-1.80) e alimentos que contêm compostos N-nitroso (OR: 1.96; IC 95 % 1.40-2.73), especialmente durante a exposição pré-natal

Exposure to environmental factors and risk of tumours in the central nervous system of children: A systematic review and meta-analysis

We analyzed the risk of tumors in the central nervous system of children in relation to exposure to environmental factors such as radiation (ionizing, non-ionizing), chemicals (pesticides, cosmetics, air pollutants) and foods. We performed a systematic review and meta-analysis of studies identified through a PubMed search (1987-2013). The results obtained from OR values show that the risk of tumors in the central nervous system of children is significantly associated with parental exposure and that the prenatal period is a critical window for several of the environmental factors considered. Although the risk fraction attributable to each factor is still unknown, a statistical analysis allowed to determine significant relations for chemical factors such as pesticides (OR: 1.93; 95% IC 1.51-2.47), air pollutants (OR: 1.45; 95% IC 1.17-1.80) and foods with N-nitrous compounds (OR: 1.96; 95% IC 1.40-2.73) especially for prenatal exposure

Exposure to environmental factors and risk of tumours in the central nervous system of children: A systematic review and meta-analysis

Se analiza el riesgo de tumores en el sistema nervioso central en niños en relación con la exposición a factores ambientales como radiaciones (ionizantes, no ionizantes), sustancias químicas (pesticidas, productos de belleza, contaminantes atmosféricos) y alimentos. Se realizó una revisión sistemática y un metaanálisis con estudios identificados en la búsqueda de PubMed (1987-2013). Los resultados obtenidos a partir de los valores de OR muestran que el riesgo de tumores en el sistema nervioso central en niños se asocia significativamente con la exposición de los padres y que el periodo prenatal es una ventana crítica para varios de los factores ambientales considerados. Aunque la fracción de riesgo atribuible a cada factor aún se desconoce, el análisis estadístico permitió determinar asociaciones significativas para factores químicos como pesticidas (OR: 1,93; IC 95 % 1,51-2,47), contaminantes atmosféricos (OR: 1,45; IC 95 % 1,17-1,80) y alimentos con compuestos N-nitroso (OR: 1,96; IC 95 % 1,40-2,73) especialmente durante la exposición prenatal.Analisa-se o risco de tumores no sistema nervoso central em crianças e a relação com a exposição a fatores ambientais como radiações (ionizantes e não ionizantes), sustâncias químicas (pesticidas, produtos de beleza, poluentes atmosféricos) e alimentos. Realizou-se uma revisão sistemática e uma meta-análise com estudos identificados através de pesquisa realizada na PubMed (1987-2013). Os resultados obtidos a partir dos valores OR mostram que o risco de tumores no sistema nervosos central em crianças tem uma associação significativa com a exposição dos pais. Mostram também que o período pré-natal é uma janela crítica para vários dos fatores ambientais considerados, ainda que a fracção de risco atribuível a cada fator seja desconhecida, a análise estatística permitiu encontrar associações significativas nos factores químicos como pesticidas (OR: 1.93; IC 95 % 1.51-2.47), poluentes atmosféricos (OR: 1.45; IC 95 % 1.17-1.80) e alimentos que contêm compostos N-nitroso (OR: 1.96; IC 95 % 1.40-2.73), especialmente durante a exposição pré-natal.We analyzed the risk of tumors in the central nervous system of children in relation to exposure to environmental factors such as radiation (ionizing, non-ionizing), chemicals (pesticides, cosmetics, air pollutants) and foods. We performed a systematic review and meta-analysis of studies identified through a PubMed search (1987-2013). The results obtained from OR values show that the risk of tumors in the central nervous system of children is significantly associated with parental exposure and that the prenatal period is a critical window for several of the environmental factors considered. Although the risk fraction attributable to each factor is still unknown, a statistical analysis allowed to determine significant relations for chemical factors such as pesticides (OR: 1.93; 95% IC 1.51-2.47), air pollutants (OR: 1.45; 95% IC 1.17-1.80) and foods with N-nitrous compounds (OR: 1.96; 95% IC 1.40-2.73) especially for prenatal exposure

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)