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

Spain (Mediterranean and Gulf of Cadiz): catch reconstruction update to 2018

This contribution updates to 2018 a reconstruction of the catches of the Spanish marine fisheries in the Mediterranean (excluding the Balearic Islands) and the Gulf of Cadiz region (i.e., in the Atlantic) that initially covered the years 1950 to 2010. One major issue in this update was the absence of fishing gear information for catch per taxon. To overcome this limitation, datasets from autonomous communities within the two regions were used to estimate the taxon proportions of catch taken by each fishing gear. The other major issue is that we used official landings for the Gulf of Cadiz region from 1985-1999 that were not available for the initial reconstruction to retroactively update catch from 1985-2009 for the Gulf of Cadiz. Assumptions for the reconstruction are explicitly stated in the description below

First Assessment of the Impacts of the COVID-19 Pandemic on Global Marine Recreational Fisheries

This work is the result of an international research effort to determine the main impacts of the COVID-19 pandemic on marine recreational fishing. Changes were assessed on (1) access to fishing, derived from lockdowns and other mobility restrictions; (2) ecosystems, because of alterations in fishing intensity and human presence; (3) the blue economy, derived from alterations in the investments and expenses of the fishers; and (4) society, in relation to variations in fishers? health and well-being. For this, a consultation with experts from 16 countries was carried out, as well as an international online survey aimed at recreational fishers, that included specific questions designed to capture fishers? heterogeneity in relation to behavior, skills and know-how, and vital involvement. Fishers? participation in the online survey (5,998 recreational fishers in 15 countries) was promoted through a marketing campaign. The sensitivity of the fishers? clustering procedure, based on the captured heterogeneity, was evaluated by SIMPER analysis and by generalized linear models. Results from the expert consultation highlighted a worldwide reduction in marine recreational fishing activity. Lower human-driven pressures are expected to generate some benefits for marine ecosystems. However, experts also identified high negative impacts on the blue economy, as well as on fisher health and well-being because of the loss of recreational fishing opportunities. Most (98%) of the fishers who participated in the online survey were identified as advanced, showing a much higher degree of commitment to recreational fishing than basic fishers (2%). Advanced fishers were, in general, more pessimistic about the impacts of COVID-19, reporting higher reductions in physical activity and fish consumption, as well as poorer quality of night rest, foul mood, and raised more concerns about their health status. Controlled and safe access to marine recreational fisheries during pandemics would provide benefits to the health and well-being of people and reduce negative socioeconomic impacts, especially for vulnerable social groups.Fil: Pita, Pablo. Universidad de Santiago de Compostela; EspañaFil: Ainsworth, Gillian B.. Universidad de Santiago de Compostela; EspañaFil: Alba, Bernardino. Alianza de Pesca Española Recreativa Responsable; EspañaFil: Anderson, Antônio B.. Universidade Federal do Espírito Santo; BrasilFil: Antelo, Manel. Universidad de Santiago de Compostela; EspañaFil: Alós, Josep. Consejo Superior de Investigaciones Científicas. Instituto Mediterráneo de Estudios Avanzados; EspañaFil: Artetxe, Iñaki. No especifíca;Fil: Baudrier, Jérôme. Institut Français de Recherche Pour l’Exploitation de la Mer; FranciaFil: Castro, José J.. Universidad de Las Palmas de Gran Canaria; EspañaFil: Chicharro, Belén. No especifíca;Fil: Erzini, Karim. Universidad de Algarve; PortugalFil: Ferter, Keno. No especifíca;Fil: Freitas, Mafalda. No especifíca;Fil: García-de-la-Fuente, Laura. Universidad de Oviedo; EspañaFil: García Charton, José A.. Universidad de Murcia; EspañaFil: Giménez Casalduero, María. Universidad de Murcia; EspañaFil: Grau, Antoni M.. No especifíca;Fil: Diogo, Hugo. Universidade Dos Açores; Portugal. Direção de Serviços de Recursos; PortugalFil: Gordoa, Ana. No especifíca;Fil: Henriques, Filipe. Universidad de Algarve; Portugal. Universidad de Coimbra; PortugalFil: Hyder, Kieran. University of East Anglia; Reino UnidoFil: Jiménez Alvarado, David. Universidad de Las Palmas de Gran Canaria; EspañaFil: Karachle, Paraskevi K.. No especifíca;Fil: Lloret, Josep. Universidad de Girona; EspañaFil: Laporta, Martin. No especifíca;Fil: Lejk, Adam M.. No especifíca;Fil: Dedeu, Arnau L.. Consejo Superior de Investigaciones Científicas. Instituto de Ciencias del Mar; EspañaFil: Sosa, Martín Pablo. No especifíca;Fil: Martínez, Lllibori. No especifíca;Fil: Mira, Antoni M.. No especifíca;Fil: Morales Nin, Beatriz. Consejo Superior de Investigaciones Científicas. Instituto Mediterráneo de Estudios Avanzados; EspañaFil: Mugerza, Estanis. No especifíca;Fil: Olesen, Hans J.. Technical University of Denmark; DinamarcaFil: Papadopoulos, Anastasios. No especifíca;Fil: Pontes, João. Universidad de Algarve; PortugalFil: Pascual Fernández, José J.. Universidad de La Laguna; EspañaFil: Purroy, Ariadna. Consejo Superior de Investigaciones Científicas. Instituto de Ciencias del Mar; EspañaFil: Ramires, Milena. Santa Cecília University; BrasilFil: Rangel, Mafalda. Universidad de Algarve; PortugalFil: Reis Filho, José Amorim. Universidade Federal do Pará; BrasilFil: Sánchez Lizaso, Jose L.. Universidad de Alicante; EspañaFil: Sandoval, Virginia. Universidad de Murcia; EspañaFil: Sbragaglia, Valerio. Consejo Superior de Investigaciones Científicas. Instituto de Ciencias del Mar; EspañaFil: Silva, Luis. No especifíca;Fil: Skov, Christian. Technical University of Denmark; DinamarcaFil: Sola, Iván Daniel. Universidad de Alicante; España. Universidad de Playa Ancha; ChileFil: Strehlow, Harry V.. No especifíca;Fil: Torres, María A.. No especifíca;Fil: Ustups, Didzis. No especifíca;Fil: van der Hammen, Tessa. No especifíca;Fil: Veiga, Pedro. Universidad de Algarve; PortugalFil: Venerus, Leonardo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Centro para el Estudio de Sistemas Marinos; ArgentinaFil: Verleye, Thomas. No especifíca;Fil: Villasante, Sebastián. Universidad de Santiago de Compostela; EspañaFil: Weltersbach, Marc Simon. No especifíca;Fil: Zarauz, Lucía. No especifíca