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

Problemas ambientais, saúde coletiva e ciências sociais Environmental problems, collective health and social sciences

Problemas ambientais e sua interface com a saúde estão sempre presentes nos discursos e práticas sanitárias. Em meados do século 19, com os intensos impactos do processo de industrialização e urbanização sobre as condições sanitárias e de saúde, esses problemas são vistos como resultados de processos políticos e sociais. Mas com o paradigma microbiano essa relação foi reduzida aos problemas de saneamento e a controle de vetores. A dimensão social e política passa a ocupar lugar marginal e periférico. Para os movimentos ambientalistas e a medicina social latino-americana a noção de problemas ambientais e de problemas de saúde é ampliada. Apesar dos avanços, a análise de dados sobre grupos de pesquisa, a produção de teses e dissertações e a publicação de artigos científicos revelam que o campo da saúde coletiva ocupa um papel marginal na pesquisa sobre o tema problemas ambientais e a pesquisa e a produção das ciências sociais respondem por uma parcela muito pequena. O quadro atual impõe a necessidade de se avançar quantitativa e qualitativamente na pesquisa e produção científica da saúde coletiva sendo urgente no que se refere às ciências sociais e, particularmente, nas ciências sociais em saúde.<br>Environmental problems relative to health conditions have been always present in the speeches and practises about health. During 19 century, however, the wide and intense impacts of industrialization and urbanization over sanitary conditions contribute to a comprehension of these problems as result of social and political processes. With the advent of microbiological paradigm the strategies for these problems solutions were reduced to sanitation and vector control and the social and political dimensions become marginal and peripheric. The notion of environmental and health problems was enlarged and the social and political dimensions were retaking only during the 70s with the emergence of environmental movement and of social medicine in Latin-America. In spite of these advances, data analyses about researches groups, thesis and dissertations production and articles published in scientific journals reveal the collective health have a marginal role in the research about environmental problems and the research and scientific production of social science is too few. The present situation requires quantitative and qualitative advances in collective health research and scientific production, especially in the field of social science and health

Prevenção de acidentes: o reconhecimento das estratégias operatórias dos motociclistas profissionais como base para a negociação de acordo coletivo Accident prevention: recognition of motorcycle couriers’ work strategies as the basis for collective bargaining

O objetivo deste artigo é apresentar como o estudo das estratégias operatórias contribui para elaborar medidas de prevenção dos acidentes sofridos pelos motociclistas profissionais, conhecidos popularmente como "motoboys". Os autores apresentam uma crítica à concepção do erro humano, hegemônica dentre os especialistas em segurança do trabalho. Os resultados apresentados foram obtidos de um estudo ergonômico iniciado por demanda do sindicato dos motociclistas profissionais de Minas Gerais. No total, 85 motociclistas profissionais foram observados e entrevistados. Os procedimentos adotados foram: registro da atividade por meio de filmagens nas ruas e avenidas da cidade; autoconfrontação das cenas do filme e das rotas elaboradas em mapas, e de certos aspectos das atividades de trabalho observadas na expedição das duas empresas selecionadas. Ao final, os autores discutem os limites das normas de segurança prescritas que não consideram o saber desenvolvido pelos próprios trabalhadores. As medidas de transformação das situações geradoras de acidentes elaboradas com apoio no estudo detalhado das estratégias implementadas pelos sujeitos estudados serviram para a elaboração da convenção coletiva de trabalho.<br>The aim of this study is to present, as operational strategies, the contribuition to elaborate some prevention measures to protect the professional motorcyclists, popularly known as "motoboys", against accidents. The authors present a critic to the human error conception that is hegemonic to the experts at work security. The results come from an Ergonomics study that started over an Union demand of the professional motorcyclists in Minas Gerais. The total come to 85 professional motorciclists who were interviewed and observed. The procedures were: report the activity filmed in the city streets and avenues; selfconfrontation of the scenes and of the map rutes, and of some aspects obeserved in the two selected companies. Finally the authors discuss the limits of the security rules without considering the knowledge obtained by the workers themselves. The measures to change the situation that make the accidents happen were used to elaborate the collective work convention. These measures were supported by a detailed study of the implemented strategies by the individuals who were analised

Trabalho e saúde: a atividade da queima de resíduos tóxicos em fornos de cimenteiras de Cantagalo, Rio de Janeiro Work and health: the activity of burning toxic waste in cement kilns in Cantagalo, Rio de Janeiro State

Este estudo ocupa-se de analisar as condições de trabalho e saúde a partir dos relatos dos trabalhadores envolvidos na atividade de coprocessamento de resíduos tóxicos em fornos de cimenteiras de Cantagalo (RJ). Realizamos uma investigação qualitativa baseada na utilização de roteiro semi-estruturado, na qual foram entrevistados treze indivíduos. Na análise do discurso, foi possível observar falhas no planejamento do processo de trabalho, na identificação de riscos, na prevenção de agravos, no monitoramento de impactos à saúde e ao ambiente, bem como na identificação e notificação aos órgãos competentes. A assimilação das incertezas do processo, favorecendo os interesses dos empreendedores, permitiu que recaísse sobre os trabalhadores o ônus do adoecimento, aceitável na medida em que se negam evidências clínicas. Torna-se imperioso amplo debate que envolva entes públicos e privados, a sociedade e suas representações, confrontando-se questões éticas, ambientais e de saúde aos interesses do capital, para que se estabeleçam novas diretrizes para o processo.<br>This study analyzes the work and health conditions through the discourse of the employees involved in the activity of toxic waste co-processing in cement kilns in Cantagalo, RJ. A qualitative approach was adopted using a semi-structured interview with 13 individuals. After analyzing the discourse, it was possible to observe relevant failures in the work process planning, in the identification of risks, in preventing diseases, in monitoring health impacts and to the environment, even their identification and notification to the competent authorities. The assimilation of the uncertainties of the process, favoring the interests of the entrepreneurs, has passed on the workers the burden of illness, rendered acceptable in that they deny clinical evidences. It is imperative to establish a broad debate involving public and private entities, the society in all its representations, confronting ethical, environmental and health issues to the interests of capital in order to set new guidelines for the process

Uma contribuição ao debate sobre as relações saúde e trabalho Contributions for a debate on the health and work relationships

O objetivo é apresentar os pressupostos teórico-metodológicos das investigações sobre problemas de saúde atuais marcados pelas mutações nos processos de trabalho em curso. Para isso, o artigo apresenta os resultados de algumas pesquisas recentes realizadas no campo de estudo das relações saúde e trabalho que observam os efeitos das mutações do trabalho, a partir das queixas que os trabalhadores vêm apresentando no que diz respeito à sua saúde e disposição para o enfrentamento cotidiano. Os resultados dos estudos descritos permitem visualizar um quadro de adoecimento dos trabalhadores em que as queixas são inespecíficas e suscitam o interesse pela abordagem da etnografia e pela metodologia da análise ergonômica do trabalho. As abordagens tradicionais são criticadas e o autor vislumbra a possibilidade de articular as disciplinas, a fim de resolver impasses colocados pelas abordagens clássicas.<br>This study aims to present theoretical and methodological principles of research about health problems that are marked by mutations in work processes. In order to reach its goal, this article present results of recent researches about the health and work relationship that observed the effects of work mutations from the perspective of workers’ complaints and the will to face daily life. The results from these studies reveals an illness process among workers with unspecific complaints and bring about the interest in the ethnographic approach and in the work ergonomic analysis. Traditional approaches to the theme are criticized and the author envisages the possibility of articulating disciplines in order to solve impasses posed by classic approache

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London