Ação pública na prevenção e erradicação do trabalho infantil no Distrito Federal

Trabalho de Conclusão de Curso (graduação) — Universidade de Brasília, Faculdade de Economia, Administração, Contabilidade e Gestão de Políticas Públicas, Departamento de Gestão de Políticas Públicas, 2021.O trabalho infantil se tornou uma violação dos direitos das crianças e adolescentes com a sociedade moderna. Durante muitos séculos a utilização da mão de obra infantil era normalizada e esses não eram reconhecidos como sujeitos de direitos. Este trabalho se subdivide em quatro capítulos e possui como objetivo compreender de que maneira o Distrito Federal executa a ação pública de prevenção e erradicação do trabalho infantil. O primeiro capítulo faz um resgate histórico sobre a construção do conceito de infância, o trabalho infantil no mundo e no Brasil. O segundo capítulo abarca a base teórica-metodológica conceitualizando a ação pública e seus instrumentos, estratégia pública, assim como o conceito de trabalho e trabalho infantil. No capítulo metodológico, demonstra-se que foi utilizada a abordagem qualitativa e os seguintes métodos científicos: pesquisa documental e bibliográfica, entrevista semiestruturada e análise de conteúdo. Como resultados, obteve-se que o Brasil possui um arcabouço de instrumentos normativos para prevenção e erradicação do trabalho infantil que avançou por vários anos a partir da participação da rede multiatorial. Quanto ao território do Distrito Federal, percebeu- se uma certa desarticulação da Rede de proteção com ações isoladas e dificuldade de integração, assim como a ausência de dados atualizados que demonstre a real situação do trabalho infantil. Duas estratégias de prevenção e erradicação se destacaram: campanhas publicitárias de conscientização e inclusão em programas de aprendizagem. O trabalho infantil é um fenômeno multifatorial e complexo. Devido a isso, este trabalho não buscou esgotar a temática, sendo necessária a produção de pesquisas e estudos a fim de aprofundar as relações socioeconômicas e culturais que ainda perpetuam o trabalho infantil no Brasil.Child labor has become a violation of the rights of children and adolescents with the modern society. For many centuries the use of child manpower was normalized and these were not recognized as subjects of rights. This paper is divided into four chapters and aims to understand how the Distrito Federal executes public action for the prevention and eradication of the child labor. The first chapter makes a historical rescue about the construction of the concept of childhood, the child labor in the world and in Brazil. The second chapter covers the theoretical- methodological basis conceptualizing public action and its instruments, public strategy as well as the concept of labor and child labor. In the methodological chapter, it is demonstrated that was used the qualitative approach and the following scientific methods: documentary and bibliography research, semi structured interview and content analysis. As a result it was found that Brazil has a framework of normative instruments to prevent and eradicate child labor which has advanced for several years from the participation of the multiple actors network. As for the Distrito Federal territory, was noticed a certain disarticulation of the protection network with isolated actions and difficulty in integration, as well as, the absence of updated data that demonstrates the real situation of child labor. Two strategies for prevention and eradication stood out: awareness campaigns and inclusion in learning programs. Child labor is a multifactiorial and complex phenomenon. Due to that, this paper did not seek to exhaust the topic and it was necessary to produce research and studies to deepen the socioeconomic and cultural relations that still perpetuate the child labor in Brazil

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