BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Background: Coronavirus disease (COVID-19) has accentuated the need for speedy access to information. Digital divide and socio-demographic disparity create an information hiatus and therefore unhealthy practices with regard to dealing with COVID-19, particularly in low-and middle-income countries. Aims: We assessed knowledge, attitudes, practices and their determinants regarding COVID-19 in Pakistan during March-April 2020. Methods: 905 adults ≥18 years (males and females) participated: 403 from a web-based survey; 365 from an urban survey; and 137 from a rural survey. Frequency of adequate knowledge, attitudes and practices for the three populations was determined based on available global guidelines. Multivariable logistic regression analysis determined factors of adequacy of knowledge, attitudes, practices, and association of knowledge with attitudes and practices. Results: Mean age of the participants was 33.5 (+ SD 11.1) years, 51% were females. More females and young adults (18-30 years) participated in the web-based survey. The urban survey and web-based survey participants had significantly higher adequate knowledge (2-7 times) and practices (4-5 times) towards COVID-19. Adequate knowledge had a significant influence on healthy attitudes and practices for COVID-19, after adjustment for covariates. Overall, two-third of the population had high levels of fear about COVID-19, which a was highest among the rural survey population. 1 / 12 WHO EMRO | Knowledge, attitudes and practices towards COVID-19 among Pakistani residents: informat Conclusion: Substantial gaps exist in adequate knowledge, attitudes and practices, particularly among rural population, and underscores the variation in access to information according to level of education and access to the internet. Thus, a comprehensive, contextually congruent awareness raising strategy is urgently needed to confront COVID-19 among these populations.

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Background: Verbal Autopsy/Social Autopsy (VASA) tools should be based on a well-holistic conceptual framework, allowing them to record and organize a wide range of determinants and contributors of child mortality in developing countries. This paper aims to review how successfully VASA studies have been able to record and organize biological and social determinants of child mortality, in pursuit of World Health Organization's (WHO) guidelines for verbal autopsy (VA) and Kalter's recommendations for social autopsy (SA). Methodology: A systematic search of literature from January 1995 to January 2018 was conducted on primary studies which attempted VA and SA on deceased cases of under-5 child mortalities using VA and SA questionnaires. A thorough search revealed 16 directly relevant papers. Results: Sixteen relevant studies from 14 countries revealed the two most common conceptual frameworks which were utilized for VASA studies. VA component of three studies followed W.H.O.'s guidelines, while the SA component of the other three studies followed Kalter's recommendations. The most robust VA tools identified were INDEPTH Network VA tool, INCLEN VA tool, and WHO VA tool; while CHERG SA tool and BASICS SA tool were found as the most robust SA tools. Conclusion: Due to the fact that only separate recommendations for VA, and conceptual frameworks for SA exists and no evidence on integrated conceptual framework exists, we suggest that there is a great need for developing a conceptual framework, based on which an integrated VASA tool can be developed and utilized in VASA based child mortality investigations in developing countries.

Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.