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Article ; Online: Inspirational Women in Surgery: Professor Kokila Lakhoo, South Africa.

Laverde, Ruth / Ozgediz, Doruk

2022 Volume 46, Issue 12, Page(s) 2848–2849

MeSH term(s)	Female ; Humans ; South Africa ; Women, Working
Language	English
Publishing date	2022-10-12
Publishing country	United States
Document type	Editorial
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-022-06766-9
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Article ; Online: Understanding the role of race in abortion stigma in the United States: a systematic scoping review.

Brown, Katherine / Laverde, Ruth / Barr-Walker, Jill / Steinauer, Jody

Sexual and reproductive health matters

2022 Volume 30, Issue 1, Page(s) 2141972

Abstract: The impact of abortion stigma is broad. Stigma impacts abortion providers, abortion patients and the broader community. Understanding how race and culture affect aspects of abortion stigma may be an important piece of expanding access to and support of ... ...

Abstract	The impact of abortion stigma is broad. Stigma impacts abortion providers, abortion patients and the broader community. Understanding how race and culture affect aspects of abortion stigma may be an important piece of expanding access to and support of abortion. We conducted a systematic search for studies involving abortion stigma and race in PubMed, PubMed Central, Embase, PsycINFO, Sociological Abstracts, Social Services Abstracts, GenderWatch and Ethnic NewsWatch on 7 January 2020. Articles were eligible for inclusion if they explored stigma and included participant race and/or ethnicity, were in English, and included original research. Thirty studies were included in the final review, including 11 quantitative studies, 9 qualitative studies, 4 mixed methods studies and 6 dissertations. Most studies provided basic racial and demographic data but did not provide racial differences in experiences of abortion stigma. Three quantitative studies found that women of colour had different experiences of abortion stigma compared to White women. Non-peer-reviewed studies of qualitative PhD-level dissertation research found that race, culture, religion and immigration had unique and complex effects on abortion stigma experienced by Latinx women. While abortion stigma is common, we found that there is a lack of research contextualising the racialisation of the United States. Quantitative studies found that women of colour experience abortion stigma at lower levels compared to White women. However, qualitative analyses of experiences suggest that quantitative measures of abortion stigma may not capture unique aspects of abortion stigma as experienced by women of colour.
MeSH term(s)	Pregnancy ; Humans ; United States ; Female ; Abortion, Induced ; Social Stigma ; Religion ; Qualitative Research ; Ethnicity
Language	English
Publishing date	2022-11-23
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ISSN	2641-0397
ISSN (online)	2641-0397
DOI	10.1080/26410397.2022.2141972
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Article ; Online: Nutritional Management of Infants With a Giant Ruptured Omphalocele: Clinical Observations From a Single Institution Case Series.

Burke, Shannon / Laverde, Ruth / Klarich, Mary Kate / Vu, Lan Tuyet

Journal of pediatric gastroenterology and nutrition

2022 Volume 76, Issue 3, Page(s) e61–e65

Abstract: The nutritional requirements of neonates with congenital abdominal wall defects (AWDs) remain poorly described. In particular, there is a lack of literature on the calorie, protein, and micronutrient needs of those with AWD. Nutritional therapy is a ... ...

Abstract	The nutritional requirements of neonates with congenital abdominal wall defects (AWDs) remain poorly described. In particular, there is a lack of literature on the calorie, protein, and micronutrient needs of those with AWD. Nutritional therapy is a cornerstone of care in patients with burns due to the metabolic consequences of injury to the epithelial layer. Similarly, children with AWD may require specialized nutritional plans to support their growth and wound healing. This case series supports the theory that patients with ruptured omphaloceles may require higher calorie, protein, and micronutrient provisions in comparison to patients with intact omphaloceles, due to increased metabolic demand to support wound healing and skin epithelialization.
MeSH term(s)	Humans ; Infant ; Infant, Newborn ; Hernia, Umbilical/complications ; Hernia, Umbilical/surgery ; Nutrition Therapy
Language	English
Publishing date	2022-10-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000003650
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Article ; Online: Social vulnerability index (SVI) and poor postoperative outcomes in children undergoing surgery in California.

Yap, Ava / Laverde, Ruth / Thompson, Avery / Ozgediz, Doruk / Ehie, Odinakachukwu / Mpody, Christian / Vu, Lan

American journal of surgery

2022

Abstract: Introduction: Area-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions.: Methods: This retrospective ...

Abstract	Introduction: Area-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions. Methods: This retrospective cohort study investigated the effect of high social vulnerability index (SVI), defined as ≥90th percentile, on postoperative outcomes in children classified as ASA 1-2 who underwent surgery at a large institution participating in the National Surgical Quality Improvement Program (2015-2021). Primary outcome was serious postoperative complications, defined as postoperative death, unplanned re-operation, or readmission at 30 days after surgery. Results: Among 3278 pediatric surgical procedures, 12.1% had SVI in the ≥90th percentile. Controlling for age, sex, racialization, insurance status, and language preference, serious postoperative complications were associated with high overall SVI (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.02-2.44) and high socioeconomic vulnerability (SVI theme 1, OR 1.75, 95% CI 1.03-2.98). Conclusion: Neighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes in apparently healthy children, which could serve as a target for community-based intervention.
Language	English
Publishing date	2022-09-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2022.09.030
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Article ; Online: COVID-19, Racial Injustice, and Medical Student Engagement With Global Health: A Single-Institution Survey.

Miller, Phoebe / Laverde, Ruth / Thompson, Avery / Park, Paul / Ozgediz, Doruk / Boeck, Marissa A

The Journal of surgical research

2022 Volume 283, Page(s) 833–838

Abstract: Introduction: United States medical schools continue to respond to student interest in global health (GH) and the evolution of the field through strengthening related curricula. The COVID-19 pandemic and superimposed racial justice movements exposed ... ...

Abstract	Introduction: United States medical schools continue to respond to student interest in global health (GH) and the evolution of the field through strengthening related curricula. The COVID-19 pandemic and superimposed racial justice movements exposed chasms in the US healthcare system. We sought to explore the possible relationship between the pandemic, US racial justice movements, and medical student interest in GH to inform future academic offerings that best meet student needs. Methods: A novel, mixed-methods 30-question Qualtrics survey was disseminated twice (May-August 2021) through email and social media to all current students. Data underwent descriptive and thematic analysis. Results: Twenty students who self-identified as interested in GH responded to the survey. Most (N = 13, 65%) were in preclinical training, and half were women (N = 10, 50%). Five (25%) selected GH definitions with paternalistic undertones, 11 (55%) defined GH as noncontingent on geography, and 12 (60%) said the pandemic and US racial justice movement altered their definitions to include themes of equity and racial justice. Eighteen (90%) became interested in GH before medical school through primarily volunteering (N = 8, 40%). Twelve (60%) students plan to incorporate GH into their careers. Conclusions: Our survey showed most respondents entered medical school with GH interest. Nearly all endorsed a changed perspective since enrollment, with a paradigm shift toward equity and racial justice. Shifts were potentially accelerated by the global pandemic, which uncovered disparities at home and abroad. These results highlight the importance of faculty and curricula that address global needs and how this might critically impact medical students.
MeSH term(s)	Female ; Humans ; Male ; COVID-19 ; Curriculum ; Global Health ; Pandemics ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires ; United States ; Racism
Language	English
Publishing date	2022-11-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.11.020
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Article ; Online: Cost-effectiveness of a pediatric operating room installation in Sub-Saharan Africa.

Yap, Ava / Halid, Salamatu I / Ukwu, Nancy / Laverde, Ruth / Park, Paul / Klazura, Greg / Bryce, Emma / Cheung, Maija / Marseille, Elliot / Ozgediz, Doruk / Ameh, Emmanuel A

PLOS global public health

2024 Volume 4, Issue 3, Page(s) e0001748

Abstract: The unmet need for pediatric surgery imposes enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of knowledge about the economic impact of ... ...

Abstract	The unmet need for pediatric surgery imposes enormous health and economic consequences globally, predominantly shouldered by Sub-Saharan Africa (SSA) where children comprise almost half of the population. Lack of knowledge about the economic impact of improving pediatric surgical infrastructure in SSA inhibits the informed allocation of limited resources towards the most cost-effective interventions to bolster global surgery for children. We assessed the cost-effectiveness of installing and running two dedicated pediatric operating rooms (ORs) in a hospital in Nigeria with a pre-existing pediatric surgical service by constructing a decision tree model of pediatric surgical delivery at this facility over a year, comparing scenarios before and after the installation of the ORs, which were funded philanthropically. Health outcomes measured in disability-adjusted life years (DALYs) averted were informed by the hospital's operative registry and prior literature. We adopted an all healthcare payor's perspective including costs incurred by the local healthcare system, the installation (funded by the charity), and patients' families. Costs were annualized and reported in 2021 United States dollars ($). The incremental cost-effectiveness ratios (ICERs) of the annualized OR installation and operation were presented. One-way and probabilistic sensitivity analyses were performed. We found that installing and operating two dedicated pediatric ORs averted 538 DALYs and cost $177,527 annually. The ICER of the ORs' installation and operation was $330 per DALY averted (95% uncertainty interval [UI] 315-336) from the all healthcare payor's perspective. This ICER was well under the cost-effectiveness threshold of the country's half-GDP per capita in 2020 ($1043) and remained cost-effective in one-way and probabilistic sensitivity analyses. Installation of additional dedicated pediatric operating rooms in Nigeria with pre-existing pediatric surgical capacity is therefore very cost-effective, supporting investment in children's global surgical infrastructure as an economically sound intervention.
Language	English
Publishing date	2024-03-27
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0001748
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Article ; Online: Pediatric Emergency Surgery Course in Uganda: Long-Term Follow-Up and Insights From Further Dissemination.

Klazura, Greg / Stephens, Caroline / Musinguzi, Edwin / Mugarura, Robert / Nyonyintono, James / Laverde, Ruth / Nimanya, Stella / Situma, Martin / Bua, Emmanuel / Yap, Ava / Sims, Thomas / Ozgediz, Doruk / Kisa, Phyllis

The Journal of surgical research

2024 Volume 295, Page(s) 837–845

Abstract: Introduction: Approximately 170 pediatric surgeons are needed for the 24 million children in Uganda. There are only seven. Consequently, general surgeons manage many pediatric surgical conditions. In response, stakeholders created the Pediatric ... ...

Abstract	Introduction: Approximately 170 pediatric surgeons are needed for the 24 million children in Uganda. There are only seven. Consequently, general surgeons manage many pediatric surgical conditions. In response, stakeholders created the Pediatric Emergency Surgery Course (PESC) for rural providers, given three times in 2018-2019. We sought to understand the course's long-term impact, current pediatric surgery needs, and determine measures for improvement. Methods: In October 2021, we distributed the same test given in 2018-2019. Student's t-test was used to compare former participants' scores to previous scores. The course was delivered again in May 2022 to new participants. We performed a quantitative needs assessment and also conducted a focus group with these participants. Finally, we interviewed Surgeon in Chiefs at previous sites. Results: Twenty three of the prior 45 course participants re-took the PESC course assessment. Alumni scored on average 71.9% ± 18% correct. This was higher from prior precourse test scores of 55.4% ± 22.4%, and almost identical to the 2018-2019 postcourse scores 71.9% ± 14%. Fifteen course participants completed the needs assessment. Participants had low confidence managing pediatric surgical disease (median Likert scale ≤ 3.0), 12 of 15 participants endorsed lack of equipment, and eight of 15 desired more educational resources. Qualitative feedback was positive: participants valued the pragmatic lessons and networking with in-country specialists. Further training was suggested, and Chiefs noted the need for more trained staff like anesthesiologists. Conclusions: Participants favorably reviewed PESC and retained knowledge over three years later. Given participants' interest in more training, further investment in locally derived educational efforts must be prioritized.
MeSH term(s)	Humans ; Child ; Uganda ; Follow-Up Studies ; Specialties, Surgical ; Educational Measurement
Language	English
Publishing date	2024-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.11.058
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Article: Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals.

Klazura, Greg / Kayima, Peter / Situma, Martin / Musinguzi, Edwin / Mugarura, Robert / Nyonyintono, James / Yap, Ava / Cope, James / Akello, Richard / Kiwanuka, Emmanuel / Odonkara, Moses / Okellowange, Chelsea / Adongpiny, Jennifer / Lakwanyero, Daniels / Atim, Patricia / Cadrine, Aber Patience / Olara, Joshua / Boppana, Amulya / Laverde, Ruth /

d'Agostino, Sergio / Cigliano, Bruno / Ozgediz, Doruk / Sims, Thomas / Kisa, Phyllis

Research square

2024

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2024-05-07
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-4332253/v1
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Article ; Online: Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa.

Yap, Ava / Olatunji, Bolusefe T / Negash, Samuel / Mweru, Dilon / Kisembo, Steve / Masumbuko, Franck / Ameh, Emmanuel A / Lebbie, Aiah / Bvulani, Bruce / Hansen, Eric / Philipo, Godfrey Sama / Carroll, Madeleine / Hsu, Phillip J / Bryce, Emma / Cheung, Maija / Fedatto, Maira / Laverde, Ruth / Ozgediz, Doruk

Surgery

2023 Volume 174, Issue 3, Page(s) 567–573

Abstract: Background: Out-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient.: ...

Abstract	Background: Out-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient. Methods: A prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child's surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure. Results: In all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308-2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26-174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child's surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002). Conclusion: A full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.
MeSH term(s)	Humans ; Child ; Health Expenditures ; Poverty ; Prospective Studies ; Income ; Africa South of the Sahara
Language	English
Publishing date	2023-06-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2023.05.010
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Article ; Online: Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life-A Narrative Review.

Abbas, Alizeh / Laverde, Ruth / Yap, Ava / Stephens, Caroline Q / Samad, Lubna / Seyi-Olajide, Justina O / Ameh, Emmanuel A / Ozgediz, Doruk / Lakhoo, Kokila / Bickler, Stephen W / Meara, John G / Bundy, Donald / Jamison, Dean T / Klazura, Greg / Sykes, Alicia / Philipo, Godfrey Sama

World journal of surgery

2023 Volume 47, Issue 12, Page(s) 3419–3428

Abstract: Background: Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. ... ...

Abstract	Background: Many potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality. Methods: A narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated. Results: Outside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These "neglected" conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain. Conclusions: Delays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.
MeSH term(s)	Child ; Humans ; Adolescent ; Emergencies ; Incidence ; Emergency Treatment ; Emergency Medical Services ; Delivery of Health Care
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-023-07097-z
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