Nutritional risk factors for postoperative complications in Brazilian elderly patients undergoing major elective surgery.

OBJECTIVE: In this prospective study, we assessed nutritional and immunologic risk factors for infectious complications and deaths related to infection in elderly patients undergoing major elective surgery. METHODS: Seventy patients 60 y or older were enrolled in this study. The preoperative variables analyzed were body mass index, body mass index knee height, triceps skinfold, subscapular skinfold, mid-arm muscle circumference, mid-arm muscle area, albumin, transferrin, prealbumin, and retinol-binding protein levels, immunoglobulins G, A, and M, C3, and C4 levels, total lymphocyte counts, and the occurrence of delayed hypersensitivity reactions (multitest). RESULTS: Abnormally low levels of prealbumin (P = 0.004), retinol-binding protein (P = 0.05), and transferrin (P = 0.04) were related to infectious complications. Prealbumin levels (P = 0.02) and lymphocyte counts below 1500 cells/mm(3) (P = 0.04) were associated with mortality secondary to infection. Univariate regression analysis showed that levels of prealbumin (P = 0.02, odds ratio = 13.3, 95% confidence limits = 1.6, 110.9), retinol-binding protein (P = 0.03, odds ratio = 4.8, 95% confidence limits = 1.2, 19.3), and transferrin (P = 0.03; odds ratio = 4.2, 95% confidence limit = 1.2, 15.6) were associated with infectious complications. Multivariate analysis associated only prealbumin levels with infectious complications (P = 0.02, odds ratio = 13.3, 95% confidence limit = 1.6, 110.9). Regression analysis provided no conclusion regarding mortality because of the small number of deaths recorded. CONCLUSIONS: In patients with a good cardiac index (Goldman I and II) who underwent major elective surgery, prealbumin protein, retinol-binding protein, and transferrin levels below normal values represented a significant risk for postoperative infectious complications. Lymphocyte counts lower than 1500/m(3) and abnormal prealbumin values were associated with postoperative mortality secondary to infection. The anthropometric variables evaluated did not predict postoperative infectious complications and mortality.

A atenção à saúde do trabalhador nas unidades básicas de saúde do SUS: estudo de caso em Campinas, São Paulo / Workers Health service delivery by primary care units in theBrazilian Unified Health System: a case-study in Campinas

Objetivo: avaliar o processo de implantação das ações de vigilância em saúde do trabalhador nas Unidades Básicas de Saúde (UBS) do SUS, em Campinas, SP.Métodos: foram usados métodos qualitativos e quantitativos para produzir uma aproximação sob diferentes aspectos do objeto em estudo. Os acidentes e as doenças relacionados ao trabalho registrados em 2006 foram eleitos para verificar se as UBS conduziram ações de vigilância e se ocorreram mudanças preventivas e protetoras no processo de trabalho e no ambiente. Realizamos entrevistas com os profissionais responsáveis pela vigilância em saúde do trabalhador das unidades. Resultados: as ações de atenção à saúde e a notificação foramimplantadas com êxito principalmente para acidentes de trabalho. Todavia, o vínculo das doenças relacionadas com o trabalho foi menos reconhecido. Os acidentes e as doenças receberam uma abordagem burocrática, negligenciando a relevância epidemiológica para a tomada de decisão. Trabalhadores do mercado informal não receberam ações específicas. A gestão dos sistemas locais de saúde ainda necessita de regras específicas para estabelecer seu papel na integração dos sistemas de informação com a vigilância da saúde do trabalhador naatenção primária. Conclusão: o presente estudo apontou que a descentralização da vigilância da saúde do trabalhador para a atenção primária foi parcialmente efetivada em Campinas.

Objective: The purpose of this study was to analyze the implementation of workers health and epidemiological surveillance services at the primary healthcare units (UBS) of the Brazilian Unified Health System (SUS) in Campinas, São Paulo, Brazil.Method: Qualitative and quantitative methods were combined to yield a parallax approach to the research object. Work-related injuries and diseases recorded in 2006 were selected to investigate whether UBS conducted surveillance actions and if preventive and protective changes had occurred in work processes and environment. Professionals in charge of workers health surveillance in the units were interviewed. Results: The study showed that healthcare and disease notificationwere successfully implemented, mainly those with the purpose of reporting work injuries. Nevertheless, poor recognition was given to the causal links of workrelated diseases; they were dealt bureaucratically, and their epidemiologic relevance for decision taking was neglected. Informal workers did not receive specific attention.Administration of local health units still demands specific protocols to establish their role in integrating information systems to workers health surveillance in primary care level. Conclusion: Decentralization of workers health service was only partially implemented in the primary healthcare units in Campinas.