Department for International Development

About: Department for International Development is a government organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Public health. The organization has 139 authors who have published 139 publications receiving 7961 citations. The organization is also known as: DFID.

Preoperative fasting for adults to prevent perioperative complications

Abstract: Background Fasting before general anaesthesia aims to reduce the volume and acidity of stomach contents during surgery, thus reducing the risk of regurgitation/aspiration. Recent guidelines have recommended a shift in fasting policy from the standard 'nil by mouth from midnight' approach to more relaxed policies which permit a period of restricted fluid intake up to a few hours before surgery. The evidence underpinning these guidelines however, was scattered across a range of journals, in a variety of languages, used a variety of outcome measures and methodologies to evaluate fasting regimens that differed in duration and the type and volume of intake permitted during a restricted fasting period. Practice has been slow to change. Objectives To systematically review the effect of different preoperative fasting regimens (duration, type and volume of permitted intake) on perioperative complications and patient wellbeing (including aspiration, regurgitation and related morbidity, thirst, hunger, pain, nausea, vomiting, anxiety) in different adult populations. Search methods Electronic databases, conference proceedings and reference lists from relevant articles were searched for studies of preoperative fasting in August 2003 and experts in the area were consulted. Selection criteria Randomised controlled trials which compared the effect on postoperative complications of different preoperative fasting regimens on adults were included. Data collection and analysis Details of the eligible studies were independently extracted by two reviewers and where relevant information was unavailable from the text attempts were made to contact the authors. Main results Thirty eight randomised controlled comparisons (made within 22 trials) were identified. Most were based on 'healthy' adult participants who were not considered to be at increased risk of regurgitation or aspiration during anaesthesia. Few trials reported the incidence of aspiration/regurgitation or related morbidity but relied on indirect measures of patient safety i.e. intra-operative gastric volume and pH. There was no evidence that the volume or pH of participants' gastric contents differed significantly depending on whether the groups were permitted a shortened preoperative fluid fast or continued a standard fast. Fluids evaluated included water, coffee, fruit juice, clear fluids and other drinks (e.g. isotonic drink, carbohydrate drink). Participants given a drink of water preoperatively were found to have a significantly lower volume of gastric contents than the groups that followed a standard fasting regimen. This difference was modest and clinically insignificant. There was no indication that the volume of fluid permitted during the preoperative period (i.e. low or high) resulted in a difference in outcomes from those participants that followed a standard fast. Few trials specifically investigated the preoperative fasting regimen for patient populations considered to be at increased risk during anaesthesia of regurgitation/aspiration and related morbidity. Authors' conclusions There was no evidence to suggest a shortened fluid fast results in an increased risk of aspiration, regurgitation or related morbidity compared with the standard 'nil by mouth from midnight' fasting policy. Permitting patients to drink water preoperatively resulted in significantly lower gastric volumes. Clinicians should be encouraged to appraise this evidence for themselves and when necessary adjust any remaining standard fasting policies (nil-by-mouth from midnight) for patients that are not considered 'at-risk' during anaesthesia.

The top 100 questions of importance to the future of global agriculture

Abstract: Despite a significant growth in food production over the past half-century, one of the most important challenges facing society today is how to feed an expected population of some nine billion by the middle of the 20th century. To meet the expected demand for food without significant increases in prices, it has been estimated that we need to produce 70-100 per cent more food, in light of the growing impacts of climate change, concerns over energy security, regional dietary shifts and the Millennium Development target of halving world poverty and hunger by 2015. The goal for the agricultural sector is no longer simply to maximize productivity, but to optimize across a far more complex landscape of production, rural development, environmental, social justice and food consumption outcomes. However, there remain significant challenges to developing national and international policies that support the wide emergence of more sustainable forms of land use and efficient agricultural production. The lack of information flow between scientists, practitioners and policy makers is known to exacerbate the difficulties, despite increased emphasis upon evidence-based policy. In this paper, we seek to improve dialogue and understanding between agricultural research and policy by identifying the 100 most important questions for global agriculture. These have been compiled using a horizon-scanning approach with leading experts and representatives of major agricultural organizations worldwide. The aim is to use sound scientific evidence to inform decision making and guide policy makers in the future direction of agricultural research priorities and policy support. If addressed, we anticipate that these questions will have a significant impact on global agricultural practices worldwide, while improving the synergy between agricultural policy, practice and research. This research forms part of the UK Government's Foresight Global Food and Farming Futures project.

Infrastructure for sustainable development

Abstract: Infrastructure systems form the backbone of every society, providing essential services that include energy, water, waste management, transport and telecommunications. Infrastructure can also create harmful social and environmental impacts, increase vulnerability to natural disasters and leave an unsustainable burden of debt. Investment in infrastructure is at an all-time high globally, thus an ever-increasing number of decisions are being made now that will lock-in patterns of development for future generations. Although for the most part these investments are motivated by the desire to increase economic productivity and employment, we find that infrastructure either directly or indirectly influences the attainment of all of the Sustainable Development Goals (SDGs), including 72% of the targets. We categorize the positive and negative effects of infrastructure and the interdependencies between infrastructure sectors. To ensure that the right infrastructure is built, policymakers need to establish long-term visions for sustainable national infrastructure systems, informed by the SDGs, and develop adaptable plans that can demonstrably deliver their vision. Investing in infrastructure systems will lock-in patterns of development for future generations. This study finds that infrastructure either directly or indirectly influences the attainment of all of the Sustainable Development Goals, including 72% of the targets.

The "roll back malaria" campaign.

Abstract: The World Health Organization9s new Director General, Gro Harlem Brundtland, assumes office on 21 July One of her major commitments is a renewed global effort to "Roll Back Malaria" This initiative, supported by leaders of the G8 countries and the Organization of African Unity, will strengthen health systems in developing countries, making effective treatment and prevention more accessible to poor people It will lead to sustained reductions in malaria mortality and reduce the economic burden of the disease, particularly among poorer people It is not a renewed attempt to eradicate the disease Brundtland is proposing an international partnership working toward common objectives through an agreed strategy: The partnership will be made up of organizations dedicated to research and disease control in the public and private sectors, together with national governments, international organizations, and development banks WHO will be the hub of the wheel, ensuring that partners9 efforts are as effective as possible in reducing the impact of malaria on our world We anticipate that this novel approach will succeed