Educação popular e extensão universitária em segurança alimentar e nutricional e direito humano à alimentação adequada e saudável : um caminho metodológico possível

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Nutrição, 2019.A temática da Segurança Alimentar e Nutricional e do Direito Humano à Alimentação Adequada e Saudável, tornou-se uma questão política, no Brasil, no período de 2003 a 2016, contudo, a tarefa de manutenção de direitos sociais não estava concluída e hoje encontra-se politicamente ameaçada, demandando, a necessidade de conscientizar e mobilizar seguimentos da sociedade civil para compreensão crítica da realidade e retomada da construção de caminhos possíveis para a exigibilidade do direito e garantia da segurança alimentar e nutricional. Na Universidade de Brasília, em 2018 instituiu-se um Programa de Extensão e Ação Continuada, o MultiplicaSAN, dentre suas atividades estava a realização de um curso de formação e promoção da cultura de direitos visando a formação da sociedade civil nas temáticas de segurança alimentar e nutricional e direito humano à alimentação adequada e saudável, utilizando-se como referência a pedagogia freireana e os princípios da educação popular. Este trabalho buscou relatar a experiência e evidenciar as expressões pedagógicas dos princípios da educação popular ao longo do processo de ensino-aprendizagem da edição de 2018 do curso, realizado no município de Colinas do Sul- Goiás. A experiência proporcionou aprofundamento sobre a educação popular, mostrou a riqueza da construção do conhecimento junto com uma comunidade de trabalhadoras, e revelou a potência de um processo educativo que empodera educadoras e educandas. Por fim, o trabalho destacou o papel da extensão universitária em democratizar e gerar conhecimento junto à sociedade civil buscando promover uma cultura de direitos por meio de processos educativos populares.Food and Nutrition Security and the Human Right to Adequate and Healthy Food became a political issue in Brazil from 2003 to 2016. However, the task of maintaining social rights was not completed, and today it is politically threatened, demanding the need to raise awareness and mobilize segments of civil society to understand this reality and resume the construction of possible paths to enforce the right and ensure food and nutritional security for all. At the University of Brasilia, an Outreach and Continued Action Program was instituted, named MultiplicaSAN, among its activities were to conduct a course to promote a culture of rights by empowering civil society in the themes of food and nutrition security and human right to adequate and healthy food, using Freire's pedagogy and the principles of popular education. This paper aims to report the experience of the first class of the course, held in the city of Colinas do Sul-Goiás, highlighting pedagogical expressions of the principles of popular education throughout the teaching-learning process. The experience provided insight into popular education, the richness of knowledge building with a working community, and revealed the power of an educational process that empowers educators and students. Finally, the paper highlights the role of university outreach in democratizing knowledge and knowledge building with civil society seeking to promote a culture of rights through popular educational processes

“A fome e a raiva (e o vírus) é coisas dos home” : reflexões sobre participação social em tempos de Covid-19

Objetivo Mapear e refletir sobre as iniciativas da sociedade civil para o combate à fome no contexto da pandemia de Covid-19 no Brasil. Métodos Para identificar as iniciativas da sociedade para o combate à fome foram conduzidas duas buscas sistemáticas independentes na plataforma Google®, utilizando as palavras-chave: “iniciativas sociedade civil covid” e “fome pandemia campanha solidariedade”. Resultados Foram localizadas quatorze iniciativas da sociedade civil de abrangência nacional que têm entre seus objetivos promover campanhas de financiamento coletivo para aquisição e distribuição de alimentos. Conclusão Historicamente, a sociedade brasileira é sensível ao tema do combate à fome e presta solidariedade como um valor social. Contudo, cabe ao Estado a obrigação legal do cumprimento da alimentação enquanto um direito de cidadania.Objective To identify and reflect about civil society’s initiatives to curb hunger in connection with the Covid-19 pandemic in Brazil. Methods In order to identify society’s initiatives to fight hunger, two independent systematic searches were conducted in the Google® search engine using the following keywords: “covid civil society initiatives” and “hunger pandemic solidarity campaign”. Results Fourteen nationwide civil society-promoted initiatives were identified, that among their objectives aimed at fostering collective funding to purchase and distribute foods. Conclusion Brazilian society has been historically sensitive to the hunger problem and shows solidarity as a social value. Nevertheless, the State is legally bound to provide food, as a social right

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research