Educação ambiental e o conhecimento do trabalhador em saúde sobre situações de risco Environmental education and health workers' knowledge on risk situations

Este texto trata da análise, no processo de trabalho em saúde, das características do conhecimento adquirido e produzido pelos trabalhadores, acerca da prevenção e controle de acidentes com materiais perfurocortantes e fluidos biológicos no ambiente hospitalar. Verifica a presença ou não de uma visão integrada de saúde entre trabalhador e instituição. Caracteriza-se como uma pesquisa quantitativa, com progressiva análise contextualizada e, portanto, com um enfoque qualitativo do problema, apoiada em conceitos de educação ambiental, trabalho e saúde. Um total de 130 trabalhadores, em dois Hospitais Universitários da Região Sul do extremo sul do Rio Grande do Sul, em setores de clínica médica, cirúrgica e de pronto atendimento. A análise dos dados foi realizada por meio do cruzamento dos ambientes institucionais e das categorias profissionais com variáveis que caracterizam o processo de trabalho. Entre os dois ambientes institucionais estudados, o Ambiente Institucional "B" apresentou um trabalho educativo, de prevenção e controle mais atuante do que no Ambiente Institucional "A" e, conseqüentemente, uma maior aderência de seus trabalhadores sobre a necessidade de trabalharem com mais segurança.<br>This work intents to analyse, on the health-care work environment, the characteristics of the knowledge acquired and produced by the workers, about accidents prevention and control with cutting material and biological fluids in the hospital environment. It verifies the presence or not of an integrated vision of health between the worker and the institution. It can be described as a quantitative research, in combination with a progressive and contextualized analysis that, therefore, brings a qualitative approach of the problem, supported in concepts as ambiental education, work and health. A total of 130 workers, in two college hospitals situated on the extreme south of the South region of the Rio Grande do Sul, of medical pratice, cirurgical clinic and emergency take part on this research. The data analysis was made through and the "cross tabulation" between the institutional environments and the professional cathegories together with variables, which characterize the health-care work. As a matter of fact, we can see that in the Institutional Environment "B" we see the existence of an educational work, the more active presence of control procedures on accidents preventions than in the Institutional Environment "A" and consequently a major educational level of its workers about the necessity of working with more safety

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit