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

Trabalho, abuso de drogas e os aparelhos ideológicos de estado: um estudo com alunos do ensino médio e fundamental Work, drug addiction and apparatus of state: a study with students of elementary and secondary school

A pesquisa se baseia em trabalho de prevenção de dependência entre estudantes de 23 municípios de quatro regiões brasileiras. Foram analisados 68.210 questionários referentes a Região Norte (29.386 questionários / 7 cidades), Região Nordeste (17.971 questionários / 3 cidades), Região Sudeste (4.197 questionários / 4 cidades) e Região Sul (16.656 questionários / 9 cidades). Os questionários continham 25 perguntas, das quais oito foram estudadas. Encontraram-se respostas aproximadas em todas as regiões brasileiras. Observou-se ainda que não foi possível estabelecer uma relação entre o trabalho e a experiência de abuso de drogas. A Igreja e a escola se mostraram extremamente importantes na formação dos jovens. A escola se mostrou herdeira de um trabalho educativo antes restrito às famílias. O abuso de drogas foi encontrado, na Região Norte, em torno de 2%, sendo na Região Nordeste em torno de 6%, na Região Sudeste e Sul em cerca de 5%. A idade predominante para o primeiro uso se situou entre 11 e 15 anos em todas as regiões estudadas e o percentual maior foi de alunos do ensino fundamental. Encontrou-se alguma concordância com o trabalho de Althusser, no que se refere aos aparelhos ideológicos de Estado. A Igreja e a família tiveram uma importância muito grande para a busca de apoio ou esclarecimentos por parte desses jovens.<br>The research was based on a drug abuse prevent program among 68,210 students in Brazil. Questionnaires were applied in four Brazilian Regions: North (n = 29,386 in 7 cities); Northeast (n = 17,971 in 3 cities); Southeast (n = 4,197 in 4 cities) and South (n = 16,656 in 9 cities). This questionnaire included 25 questions and among then, eight were studied. Similar answers were found in all regions of the country. The main conclusions were: religion and school were pointed as an extreme importance as an educational aspect in the children's own lives. School replaced an educational role, that was a former family privilege. The experience of drug abuse in childhood was measured in: North (2%), Northeast (6%), South and Southeast (5%). The prevailing age of the first drug use was found between 11 and 15 years old in all the regions, during the fundamental school degree. Certain agreement with Althuser's work on ideological apparatus of State was found. Family and religion were important protection factors against drug abuse