Risk Factors of Early Mortality and Morbidity in Esophageal Atresia with Distal Tracheoesophageal Fistula: A Population-Based Cohort Study.

OBJECTIVE: To identify the risk factors for early mortality and morbidity in a population with distal esophageal atresia (EA)-tracheoesophageal fistula. STUDY DESIGN: Cohort study from a national register. Main outcomes and measures included early mortality, hospital length of stay (LoS), need for nutritional support at 1 year of age as a proxy measure of morbidity, and complications during the first year of life. RESULTS: In total, 1008 patients with a lower esophageal fistula were included from January 1, 2008, to December 31, 2014. The survival rate at 3 months was 94.9%. The cumulative hospital LoS was 31.0 (17.0-64.0) days. Multivariate analysis showed that intrahospital mortality at 3 months was associated with low birth weight (OR 0.52, 95% CI [0.38-0.72], P < .001), associated cardiac abnormalities (OR 6.09 [1.96-18.89], P = .002), and prenatal diagnosis (OR 2.96 [1.08-8.08], P = .034). LoS was associated with low birth weight (-0.225 ± 0.035, P < .001), associated malformations (0.082 ± 0.118, P < .001), surgical difficulties (0.270 ± 0.107, P < .001), and complications (0.535 ± 0.099, P < .001) during the first year of life. Predictive factors for dependency on nutrition support at 1 year of age were complications before 1 year (OR 3.28 [1.23-8.76], P < .02) and initial hospital LoS (OR 1.96 [1.15-3.33], P < .01). CONCLUSIONS: EA has a low rate of early mortality, but morbidity is high during the first year of life. Identifying factors associated with morbidity may help to improve neonatal care of this population.

Predictors of the Performance of Early Antireflux Surgery in Esophageal Atresia.

OBJECTIVE: To identify predictors of and factors associated with the performance of antireflux surgery during the first year of life in children born with esophageal atresia. STUDY DESIGN: All patients were included in a French registry for esophageal atresia. All 38 multidisciplinary French centers completed questionnaires about perinatal characteristics and one-year outcome for children born with esophageal atresia. RESULTS: Of 835 infants with esophageal atresia born in France from 2010 to 2014, 682 patients, excluding those with long-gap esophageal atresia, were included. Three patients had type I, 669 had type III, and 10 had type IV esophageal atresia. Fifty-three children (7.8%) received fundoplication during the first year of life. The median age at the time of the end-to-end esophageal anastomosis was 1.1 day (range 0-15). Multivariate analysis identified three perioperative factors that predicted the need for early antireflux surgery: anastomotic tension (P = .004), associated malformations (P = .019), and low birth weight (P = .018). Six other factors, measured during the first year of life, were associated with the need for antireflux surgery: gastroesophageal reflux (P < .001), anastomotic stricture (P < .001), gastrostomy (P < .001), acute life-threatening event (P = .002), respiratory complications (P = .045), and poor nutritional status (P < .001). CONCLUSIONS: Gastroesophageal reflux disease, low birth weight, poor nutrition, and surgical anastomosis difficulties predicted the performance of antireflux surgery in the first year of life in infants with esophageal atresia.

Spatial patterns of benthic foraminifera as a support to the oceanographic characterisation of Arvoredo biological marine reserve (South Atlantic, Brazil).

This paper analyses the distribution of benthic foraminifera in a sector of the inner continental shelf of Santa Catarina State (Brazil), which comprises a Marine Protected Area (MPA). Species indicators of continental input suggest that waters under the influence of continental drainage can eventually reach the southwestern part of the reserve, which might jeopardise the ecosystems of this MPA due to the transport of contaminants related to human activities. Species known to be indicators of high marine benthic productivity were more abundant below 30 m, and were associated with areas under the stronger influence of nutrient-enriched water mass. The high density of foraminifera and the low dominance of species found in most samples inside the reserve might be evidence for the positive effects of the prohibition of bottom trawling, ensuring a higher ecological equilibrium of benthic communities. These results can contribute to the current debate about the reclassification and change in the extent of this MPA.

Contribution des hôpitaux de jour en psychiatrie dans le champ contemporain de la santé mentale au Québec / Contribuição dos hospitais-dia de psiquiatria no campo da saúde mental em Quebec

Actuellement au Québec, les hôpitaux de jour en psychiatrie sont des milieux de jour offrant un programme thérapeutique intensif de courte durée, principalement dans un contexte d'activités de groupe. Alors que les hôpitaux de jour sont des acteurs qui font partie intégrante du système de soins en santé mentale depuis plusieurs décennies, la question de leur rôle et de leur contribution spécifique dans le champ des approches et des pratiques de traitement et pour les personnes qu'ils rejoignent est rarement posée. Cet article s'articule autour de l'hypothèse selon laquelle les repères et les cadres actuellement dominants dans le champ de la psychiatrie et de la santé mentale permettent mal de dégager et de prendre en compte certains des paramètres dont il faut tenir compte pour parvenir à préciser et à situer le rôle et la contribution des hôpitaux de jour, dans le système de soin comme pour les personnes auxquelles ces milieux de pratique s'adressent. À partir des résultats préliminaires d'une étude exploratoire poursuivie dans quatre hôpitaux de jour où différents acteurs ont été rencontrés lors d'entrevues (personnes utilisatrices, intervenants, gestionnaires), cet article propose de dégager quelques pistes d'analyse et de réflexion.

Em Quebec, atualmente, os hospitais-dia em psiquiatria oferecem um programa terapêutico intensivo de curta duração, focado em atividades de grupo. Esses hospitais-dia são parte integrante do sistema de saúde em psiquiatria e saúde mental depois de várias décadas, entretanto o seu papel em relação às suas práticas com a inclusão daqueles que seguiram esse tratamento é raramente colocado. Nessa perspectiva, este artigo se articula em torno da hipótese de que os valores de referencia, hoje dominantes no campo da psiquiatria e saúde mental, não permitem identificar e levar em conta certos parâmetros necessários para se precisar e situar o papel e a contribuição específica dos hospitais-dia no sistema de saúde mental e para as pessoas às quais se destinam. À partir de resultados preliminares de um estudo exploratório realizado em quatro hospitais-dia em psiquiatria, com entrevistas individuais (pessoas usuárias, trabalhadores e gestores), se propõe identificar algumas pistas de análise e reflexão.

Development of a clinical scoring system for the diagnosis of smear-negative pulmonary tuberculosis.

This study developed a clinical score based on clinical and radiographic data for the diagnosis of smear-negative pulmonary tuberculosis (SNPT). SNPT was defined as a positive culture in Ogawa in a patient with two negative sputum smears. Data from patients admitted to the emergency ward with respiratory symptoms and negative acid-fast bacilli (AFB) smears was analyzed by means of logistic regression to develop the predictive score.Two hundred and sixty two patients were included. Twenty patients had SNPT. The variables included in the final model were hemoptysis, weight loss, age > 45 years old, productive cough, upper-lobe infiltrate, and miliary infiltrate. With those, a score was constructed. The score values ranged from -2 to 6. The area under the curve for the ROC curve was 0.83 (95% CI 0.74-0.90). A score of value 0 or less was associated with a sensitivity of 93% and a score of more than 4 points was associated with a specificity of 92% for SNPT. Fifty-two point twenty-nine percent of patients had scores of less than one or more than four, what provided strong evidence against and in favor, respectively, for the diagnosis of SNPT. The score developed is a cheap and useful clinical tool for the diagnosis of SNPT and can be used to help therapeutic decisions in patients with suspicion of having SNPT.

Development of a clinical scoring system for the diagnosis of smear-negative pulmonary tuberculosis

This study developed a clinical score based on clinical and radiographic data for the diagnosis of smear-negative pulmonary tuberculosis (SNPT). SNPT was defined as a positive culture in Ogawa in a patient with two negative sputum smears. Data from patients admitted to the emergency ward with respiratory symptoms and negative acid-fast bacilli (AFB) smears was analyzed by means of logistic regression to develop the predictive score.Two hundred and sixty two patients were included. Twenty patients had SNPT. The variables included in the final model were hemoptysis, weight loss, age > 45 years old, productive cough, upper-lobe infiltrate, and miliary infiltrate. With those, a score was constructed. The score values ranged from -2 to 6. The area under the curve for the ROC curve was 0.83 (95 percent CI 0.74-0.90). A score of value 0 or less was associated with a sensitivity of 93 percent and a score of more than 4 points was associated with a specificity of 92 percent for SNPT. Fifty-two point twenty-nine percent of patients had scores of less than one or more than four, what provided strong evidence against and in favor, respectively, for the diagnosis of SNPT. The score developed is a cheap and useful clinical tool for the diagnosis of SNPT and can be used to help therapeutic decisions in patients with suspicion of having SNPT.

Street youths are the only high-risk group for HIV in a low-prevalence South American country.

OBJECTIVES: To measure HIV prevalence in various subpopulations in Bolivia. DESIGN: In 2002 in Cochabamba, we offered voluntary counseling and testing to homeless street youths, registered and unregistered commercial sex workers, truck drivers, and prisoners. We examined surveillance data of pregnant women and blood donors. RESULTS: Among street youths over 15, overall HIV prevalence was 3.5% (11/313), higher among those recruited in the street, lower among those recruited in centers for homeless; prevalence was 0.6% (2/334) and 0.5% (1/189) in female registered and nonregistered sex workers, respectively, and below 0.3% in all other groups. All HIV cases were attributed to sexual transmission. CONCLUSION: In a low-prevalence setting where intravenous drug use is uncommon, street youths are a threat for the expansion of the HIV epidemic. We argue that HIV prevention in this population requires a comprehensive approach to their health and social problems.