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

Background 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

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Síndrome da Má-adaptação ao trabalho em turnos: uma abordagem ergonômica

O sistema de trabalho em turnos e noturno por ir contra a natureza humana, eminentemente diurna, traz prejuízos para a saúde do trabalhador tanto nos aspectos físicos e psíquicos, como emocionais e sociais. As manifestações agudas como insónia, excessiva sonolência durante o trabalho, distúrbios de humor, aumento de acidentes e problemas familiares e as manifestações crônicas como desordens do sono, doenças cardiovasculares e gastrointestinais, separação e divórcio, compõem os sinais e sintomas da Síndrome da Má-adaptação ao Trabalho em Turnos. O presente trabalho teve por objetivos analisar a Síndrome da Má-adaptação ao Trabalho em Turnos e o Trabalho Noturno e apresentar um estudo de caso onde através de questionários foram pesquisados aspectos de cronobiologia, variáveis biológicas e psicossociais relacionadas com o trabalho em turnos e noturno em uma empresa do setor cerâmico de Santa Catarina que utiliza o sistema de trabalho em turnos não rodiziantes. O estudo de caso revelou que em média 1 em cada 5 trabalhadores apresentaram pelo menos um dos sintomas de inadaptação ao trabalho em turnos e noturno e que pelo menos 10% dos trabalhadores manifestaram sintomatologia característica da Síndrome da Má-adaptação ao Trabalho em Turnos.<br>The shiftwork and nightwork system, for going against human nature, wich is eminently a day one, harms a worker's health from a physical, psychic, emotional and social point of view. Acute manifestations such as isomnia, excessive s/eepness during work hours, changes of humor, increased rates of accidents and family problems, as well as chronic manifestations assleep disorders, cardiovascular and gastrointestinal diseases, separation and divorce, make up signs and symptoms of Shiftwork Maladaptation Syndrome. This work sought to investigate Shiftwork Maladaptation Syndrome, and to analyze Night Work. By means of questionnaires, chronobiology aspects, biological and psicossocial variables have been researched such as related to shift and night work in a Santa Catarina enterprise working with ceramic products, where a non - rotatory shift work system is employed. The study of the case showed that 7 in 5 workers presented at least one of maladaptation symptoms when placed on shift and night work, and that at least 10% at workers exhibited symptomatology identified with shiftwork maladaptation syndrome