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. MethodsWe 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. FindingsWe 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•4...
In this paper, the authors evaluate a global strategy to safeguard children against abuse in sport. The experiences of people within 32 of the organisations who were working towards the International Safeguards for Children in Sport were captured over a two-year study. At the organisational level, self-audits demonstrated that progress was made during the project by deliverers (who worked directly with children) from having 45% to 64% of the Safeguards fully in place. Governors (who governed other organisations which worked directly with children) improved on the same figure from 25% to 53%. Progress was also identified using the concept of Activation States through in-depth interviews at the start and end of the project. Positive changes were found at the personal level with respect to people's feelings, knowledge and behaviours related to safeguarding as well as how safeguarding is discussed in the organisation. Group discussions also revealed changes with respect to how children, coaches, parents and the broader community were behaving with respect to safeguarding. An increase in the number of disclosures was also identified as an important impact of the project. The International Safeguards for Children in Sport are now endorsed by 125 organisations who work with a total of over 35 million children. The implications of these findings are discussed along with the future directions of work in this area.
There is now undeniable evidence of child maltreatment in sport. This has provoked the gradual proliferation of safeguarding research aimed at protecting children from harm in sport. Such research recognises the need for a comprehensive and holistic approach that addresses individual, interpersonal and systemic contributors to child maltreatment in sport. This study sought to provide such an approach by applying the wellresearched concept of safety culture to safeguarding children in sport. The aim of this study was to conceptualise safety culture from a child safeguarding in sport perspective (i.e., safeguarding culture). To achieve this, 77 participants from five globally representative organisations took part in 45 Interviews and 7 focus groups. This produced 52 units of qualitative data which were analysed using thematic analysis.Findings suggested that safeguarding culture represents a holistic and integrated approach to prevent child maltreatment which comprises three first order themes; safety management systems, committed leadership and stakeholder engagement. These themes have dynamic and reciprocal relationships, with their ideal formation and application dependent on internal and external contextual factors. Based on these findings, the Safeguarding Culture in Sport Model is presented before practical implications, limitations and directions for future research are offered. By presenting a new approach and model to safeguarding children in sport, this study represents an important advancement of knowledge around safeguarding children in sport.
In October 2014, the International Safeguards for Children in Sport were launched. These Safeguards were developed, implemented and evaluated based on a pilot process which took place over the preceding 2 years. Throughout this piloting phase, a range of qualitative techniques were employed to capture the experiences of people within 32 of the organisations who were working towards the International Safeguards. The participant organisations varied based on their geographical focus (e.g., local, national and international) as well as their mission (e.g., participation, competition and sport for development). Based on a thematic analysis, 8 key pillars were identified on which systems which safeguard children can be built. These are known as the CHILDREN pillars: Cultural sensitivity, Holistic, Incentives, Leadership, Dynamic, Resources, Engagement and Networks. Illustrative examples are provided and the future directions of this project will be discussed.
This is not the version of record. The full published version of Owusu-Sekyere, Frank (2020) Assessing the effect of physical activity and exercise on nurses' well-being. Nursing Standard, 35(4), pp.
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