The impact of disability on the lives of children; cross-sectional data including 8,900 children with disabilities and 898,834 children without disabilities across 30 countries.

BACKGROUND: Children with disabilities are widely believed to be less likely to attend school or access health care, and more vulnerable to poverty. There is currently little large-scale or internationally comparable evidence to support these claims. The aim of this study was to investigate the impact of disability on the lives of children sponsored by Plan International across 30 countries. METHODS AND FINDINGS: We conducted a cross-sectional survey including 907,734 children aged 0-17 participating in the Plan International Sponsorship Programme across 30 countries in 2012. Parents/guardians were interviewed using standardised questionnaires including information on: age, sex, health, education, poverty, and water and sanitation facilities. Disability was assessed through a single question and information was collected on type of impairment. The dataset included 8,900 children with reported disabilities across 30 countries. The prevalence of disability ranged from 0.4%-3.0% and was higher in boys than girls in 22 of the 30 countries assessed - generally in the range of 1.3-1.4 fold higher. Children with disabilities were much less likely to attend formal education in comparison to children without disabilities in each of the 30 countries, with age-sex adjusted odds ratios exceeding 10 for nearly half of the countries. This relationship varied by impairment type. Among those attending school, children with disabilities were at a lower level of schooling for their age compared to children without disabilities. Children with disabilities were more likely to report experiencing a serious illness in the last 12 months, except in Niger. There was no clear relationship between disability and poverty. CONCLUSIONS: Children with disabilities are at risk of not fulfilling their educational potential and are more vulnerable to serious illness. This exclusion is likely to have a long-term deleterious impact on their lives unless services are adapted to promote their inclusion

Perspectives from those involved in healthy stadia

Healthy stadia is a growing agenda across industry and in turn academia. In this era of growth, much of the research literature is primarily sourced from academics with little contribution from applied and industry stakeholders. As such, the editors have sought to offer practitioners a platform to share novel projects, perspectives and preliminary intervention evaluation findings. This applied article intends to share evaluation and insight from applied practice, to encourage closer debate between the academic community and applied industry

Online community engagement in response to COVID-19 pandemic.

This is the final version. Available on open access from Wiley via the DOI in this recordNational Institute for Health Research (NIHR)Barts Charit

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Law as a tool: the challenge of HIV/AIDS in Uganda

This paper aims to explore the role of human rights law in addressing the HIV/Aids epidemic, with particular reference to Uganda. The emphasis is on law as a tool, not as the tool, since the impact of law is always either constrained or facilitated by other factors - social, political and economic. The paper has been written primarily from a legal perspective, drawing on expertise regarding the function and operation of both national and international law. Uganda is selected as the 'case study' in part because it is widely regarded as a country that has succeeded, perhaps more than any other country in sub-Saharan Africa, in reducing the rate of HIV/Aids prevalence in its population. It is considered to have achieved this largely through a combination of civil society initiatives, governance and aid from international donors. The perception generally is that law has not been a feature of this strategy and this paper examines whether law was, in fact, insignificant in Uganda's apparent success. It also looks at a number of related questions, including whether legal reform could have an impact on the current situation or whether it is indeed marginal