Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Uso de serviços ambulatoriais nos últimos 15 anos: comparação de dois estudos de base populacional Ambulatory care utilization in the past 15 years: Comparison between two population-based studies

Houve profundas mudanças ocorridas no sistema de saúde brasileiro nas últimas décadas. Dados de dois estudos transversais de base populacional, realizados em 1992 (n = 1657) e 2007 (n = 2706), entre indivíduos de 20-69 anos, foram comparados objetivando descrever mudanças na utilização dos serviços de saúde nos últimos quinze anos, em Pelotas, RS. Calcularam-se as frequências percentuais de consulta médicas no ano e nos últimos três meses, estratificadas por sexo. A última consulta foi analisada conforme local e motivo. A utilização no último ano aumentou de 69,8% para 76,2% (p < 0,001) e nos três meses, de 39,5% para 60,6% (p < 0,001). Quanto ao local, houve aumento do uso de planos de saúde, exceto para pretos/pardos, que continuaram usando os serviços públicos (69%, em 1992 e 61,8%, em 2007). Entre homens, as consultas preventivas aumentaram mais de dez vezes. Nos últimos quinze anos, os planos de saúde absorveram grande parte da demanda pública. Essa absorção não foi uniforme, com os pretos/pardos permanecendo no setor público. O maior aumento de consultas preventivas pelo sexo masculino ocorreu na faixa etária de menor risco (20-39 anos).<br>Profound changes in the Brazilian health system have occurred in the past few decades. Data from two cross-sectional population-based studies carried out in 1992 (n = 1,657) and 2007 (n = 2,706), among individuals from 20-69 years, were compared aiming to describe changes in Pelotas, Brazil. Prevalence of consultations in the past twelve and three months were calculated and stratified by gender. The most recent consultation was analyzed according to place and reason. Utilization in the past year increased from 69.8% to 76.2% (p < 0.001) and in the past three months from 39.5% to 60.6% (p < 0.001). There was an increase in use of authorized services, except for black/brown people who mainly continued using public services (69% in 1992 and 61.8% in 2007). Among men, preventive consultations increased more than ten-fold. In the past fifteen years, most of public demand was absorbed by authorized services. This absorption was not even, black/brown users remained in public services. The greatest increase in preventive consultations by males occurred in the low risk age group (20-39 years)

Diet and feeding daily rhythm of Pimelodella lateristriga (Osteichthyes, Siluriformes) in a coastal stream from Serra do Mar - RJ

The present study was carried out in Mato Grosso fluvial system, a costal drainage from Serra do Mar. We analysed the diet and the feeding daily rhythm of Pimelodella lateristriga from samples carried out during 24 hours over a 4 hour fishing interval, in June, July and September, 2006 as well as in January and February, 2007. Diet was described from the Feeding Index (IAi) and feeding daily rhythm was verified through the Gut Fullness Index (GFI). Pimelodella lateristriga diet was composed of 37 items, being aquatic insects the most important ones. IAi analysis revealed that Diptera, Trichoptera and Ephemeroptera amounted to 90% of the diet. Autochthonous invertebrates were the most important consumed items. Pimelodella lateristriga concentrated its feeding activities in the nocturnal period (10:00 PM to 2:00 AM) with marked significant differences (F = 16.11; gl = 5; p < 0.05) between each diurnal and nocturnal periods. Between 6:00 AM and 6:00 PM, foraging activity was gradually reduced. We concluded that P. lateristriga has an insectivorous diet and a nocturnal feeding habit with greater activity between 10:00 PM to 2:00 AM

In situ Effect of Nanohydroxyapatite Paste in Enamel Teeth Bleaching

Federal University of Para. Department of Restorative Dentistry. Belem, PA, Brazil.Federal University of Para. Department of Restorative Dentistry. Belem, PA, Brazil.Federal University of Para. Department of Restorative Dentistry. Belem, PA, Brazil.Federal University of Para. Department of Restorative Dentistry. Belem, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Departamento de Toxicologia. Ananindeua, PA, Brasil.Federal University of Para. Department of Restorative Dentistry. Belem, PA, Brazil.AIM: Evaluate in situ the effect of nanohydroxyapatite paste (nano-HAP) before bleaching with hydrogen peroxide 35% (HP35%) by ion chromatography (IC) Knoop hardness number (KHN) and tristimulus colorimetry (TC). MATERIALS AND METHODS: A total of 60 fragments were obtained from third molars included (3 mm × 3 mm × 3 mm) and the specimens were divided into three groups (n = 20): Gas chromatography (CG) (negative control group) = no bleaching; HP35% (positive control group) = HP35% whitening (whiteness HP35%); nano-HAP = application for 10 minutes before bleaching treatment + HP35%. The specimens were fixed to the volunteers' molars. The KHN and TC were measured before and after bleaching. For IC, the dentin layer was removed, leaving the enamel that was crushed, and autoclaved for chemical quantification (calcium, fluorine, and phosphorus). The results of KHN and TC were analyzed statistically by analysis of variance (ANOVA) followed by Tukey test (p < 0.05). RESULTS: The HP35% group showed reduction of the Ca, F, and P ions. The initial and final KHN mean of the CG and nano-HAP did not differ statistically; however, the group of HP35% did differ statistically. The mean ΔE of the HP35% and nano-HAP groups did not differ statistically from each other. However, they differed from the CG. CONCLUSION: The nano-HAP paste preserved the KHN, promoted the lower loss of Ca and P ions and an increase of F ions when compared with the CG, but did not influence the effectiveness of the bleaching treatment. CLINICAL SIGNIFICANCE: Nano-HA is a biomaterial that has shown positive results in the prevention of deleterious effects on the enamel by the action of the office bleaching treatment