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

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 middle-income 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 low-income 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 low-income, 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

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

Give good get good do servant leadership behaviours work in a political organisational culture

In this thesis a mixed method research design is adopted to investigate the mechanisms underlying the relationships between servant leadership and employee task performance and citizenship behaviours. Also examined in this thesis is the impact of organisational politics on these relationships. The research, conducted in a South Asian context, comprises two studies utilising the sequential exploratory mixed-method research design. In the first qualitative study, 25 participants were purposefully selected from five different administrative departments of the case organisation. In the follow-up quantitative study, 236 participants were recruited using a convenience sample. Across both studies servant leaders were fund to work effectively to influence subordinates’ task performance and citizenship behaviours. This was the case even in highly political environments where self-centred activities are in abundance

The interplay between servant leadership and organizational politics

Purpose: Using the frameworks of social exchange theory (SET) and conservation of resources (COR) Theory, this study examined the influence of servant leadership on employees' performance through the social exchange indicator (trust), and how perceived organizational politics (POP) influences these relationships. Design/methodology/approach: Survey data were collected from 236 supervisor/subordinate dyads in a public sector organization in Pakistan. Structural equation modeling and bootstrapping were used to test the study hypotheses. Findings: Servant leadership was found to positively influence employees' task performance and organizational citizenship behaviors (OCBs). Further, analysis revealed that trust in leader partially mediated the positive relationship between servant leadership and subordinates' task performance and OCBs. However, although POP moderated the indirect relationship between servant leadership and subordinates' task performance, it did not moderate the indirect relationships between servant leadership and OCBs. Originality/value: This is one of the first studies to be conducted in the South Asian context, testing the relationship between servant leadership and employee performance through the social exchange indicator (trust) in a political organizational environment. Theoretical contributions, practical implications, study limitations and future research directions are discussed at the end of the study.</p

The combined effect of perceived organizational injustice and perceived politics on deviant behaviors

Purpose: The main purpose of this study is to examine the catalytic impact of perceptions of politics in organizations on the relationship between perceived unfairness and deviant behavior at work. Design/methodology/approach: To test the proposed research model, the authors collected field data in a public sector university located in Islamabad Capital Territory, Pakistan. A two-wave questionnaire was distributed to 400 employees. In the first wave, the questionnaire was used to collect data on participants’ perceptions of perceived injustice and organizational politics. After two weeks, the second wave of data collection was conducted by sending another questionnaire to the same respondents to collect data on their organizational and interpersonal deviance. Findings: Empirical findings revealed that perceived interactional injustice results in interpersonal deviance, and perceived distributive and procedural injustice results in organizational deviance. Moreover, the direct relationship between perceived injustice and deviant behaviors was stronger when the perception of politics factor was high. Originality/value: To the best of the authors’ knowledge, this study is one of the first to test the detrimental effect of perception of politics on deviance in a public organization in Pakistan.</p

The buffering role of servant leadership on the relationship between organizational politics and employee task performance and citizenship behaviors

Purpose: The purpose of this study was to examine whether servant leadership (SL) buffers the negative relationship between perceived organizational politics (POP) and employee performance outcomes. Design/methodology/approach: Time-lagged multi source data were collected from 236 supervisor-subordinate dyads in a public sector university in Pakistan. SL, POP and several control variables were measured in subordinates at time 1, and supervisor ratings of organization citizenship behaviors and task performance were measured at time 2. The authors performed moderated multiple regression analysis to test the hypotheses underpinning the study. Findings: Findings revealed that POP was negatively related to employee task performance and two types of organization citizenship behavior (individual and organizational). Findings also revealed that SL attenuated the negative effect of POP on employee task performance and the two types of organization citizenship behavior. Practical implications: SL is particularly important in organizational cultures characterized by high politics; therefore, managers seeking to enhance task performance and citizenship behavior in employees should adopt this style of leadership if possible. Originality/value: This is the first study conducted in the South Asian context that has examined whether, and how, SL buffers the negative effects of POP on employee task performance and organization citizenship behavior.</p

Management's internal governance policies on flexible work practices and the mediating lens of work life enrichment – Outcome for employee work engagement and organizational attractiveness

Purpose – Using Pakistan’s public sector higher education institutions as the study site, this study aims to empirically substantiate, under the theoretical underpinnings of job enrichment theory (Hackman and Oldham, 1976) and Maslow’s (1943) theory of the hierarchy of needs, the impact of flexible work practices (FWPs), on employee work engagement and organizational attractiveness, with the mediating lens of work life enrichment. Design/methodology/approach – Field data were collected at five higher education institutions located in the Islamabad Capital Territory (ICT) of Pakistan, using the convenience sampling technique and analyzed under the quantitative research paradigm. Findings – This study substantiates with an empirical evidence that flexible work practices (FWPs) have a significant positive impact on both employee work engagement and organizational attractiveness. Markedly, the study findings reveal that the said impact is significantly stronger than that of sabbaticals. Furthermore, the study reveals that the positive relationship is mediated by work life enrichment, signaling its significance in understanding FWP’s such impact on employee work engagement and organizational attractiveness. Practical implications – The study findings provide significant implications for academia, practitioners, and policymakers, in evidence-based recommendations for higher education institutions to design and implement FWPs that are effective in enhancing employee work engagement and organizational attractiveness, and, in turn, leading to improved organizational performance. Originality/value – This research study provides a novel contribution to the existing literature by exploring the combined impact of flexible work practices on employee work engagement and organizational attractiveness in the peculiar context of Pakistan’s public sector higher education institutions. Additionally, the study’s focus on the mediating role of work life enrichment further adds to its novelty

Correction: Aman et al. Impact of Tourist’s Environmental Awareness on Pro-Environmental Behavior with the Mediating Effect of Tourist’s Environmental Concern and Moderating Effect of Tourist’s Environmental Attachment. <i>Sustainability</i> 2021, <i>13</i>, 12998

The authors would like to make the following corrections about the published paper [...

Impact of Tourist’s Environmental Awareness on Pro-Environmental Behavior with the Mediating Effect of Tourist’s Environmental Concern and Moderating Effect of Tourist’s Environmental Attachment

Pakistan has been blessed with rich tourism potential because of its rich history, culture, biological and geographical diversity. Travelers have for quite some time been attracted to Pakistan to encounter a nation that flaunts rugged natural beauty, cultural richness, and unparalleled hospitality. Pakistan has various tourist destinations in the northern areas of Pakistan. Kumrat Valley has become a tourist hotspot in recent times after the prime minister of Pakistan, Mr. Imran Khan, visited the valley. To reduce the negative effects on these tourist destinations due to the accelerating increase in tourists, the present study used a quantitative approach to uncover whether there is an environmental awareness–behavior gap among the tourists, with their level of environmental awareness outweighing pro-environmental behavior. Using a sample of 426 tourists who have visited the valley, the analysis of the results indicates that the pro-environmental behavior is positively and significantly affected by the components, environmental awareness, environmental concern, and environmental attachment. Environmental attachment is added as a moderator between environmental awareness and pro-environmental behavior. This study suggests that environmental awareness must be promoted among tourists to ensure that they exhibit pro-environmental behavior