Summary Background 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.

Information regarding individual needs of older adults with intellectual disabilities (IDs) is scarce although it is very important both from a person-centered planning perspective and from a proactive service system perspective. This study has three main aims:(1) to identify and describe staff perceptions of the needs of a large group of adults aged 45 or over with IDs; (2) to analyze the perceived needs as function of age, gender, and level of disability;(3) to present information about the development and the psychometric properties of the assessment instrument used. The participants were 232 Portuguese older adults with IDs (mean age = 52), predominantly male (n = 129). There were 66 staff members who assessed the needs of the IDs participants through the Inventory of Identification of Needs (IIN). The IIN demonstrated satisfactory psychometric properties (e.g., internal consistency, interrater reliability, construct validity). The unmet needs were numerous and diverse, but those that were perceived as more prevalent were: literacy, handling of money, information on rights, self-care, information on services, communication, occupation at holidays, occupation at weekends, general physical health, cognitive rehabilitation, and daytime activities. The needs were influenced by the disability level: regarding Literacy/Information and Occupation/Community, needs were significantly more common in persons with a moderate and/or severe disability. The influence of age was registered only in Mental Health. The needs identified should guide the planning and development of service provision. These should offer literacy learning experiences, information about the rights of persons with disabilities, information about the services available, self-care assistance or training in self-care skills; and meaningful activities during regular time periods, weekends and holidays.

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As fraturas articulares são consideradas graves e ocasionam incapacidade, principalmente quando atingem uma articulação de carga, como o joelho. É necessário tratamento imediato a fim de obter estabilização dos fragmentos, evitando complicações secundárias. O objetivo do presente estudo foi analisar a capacidade funcional, durante as atividades de vida diária, de indivíduos que sofreram fraturas do planalto tibial e foram submetidos a tratamento cirúrgico entre os anos de 2002 a 2005. Foram analisados 20 pacientes com a aplicação do questionário ADLS (Activities of Daily Living Scale). Concluímos que 85% dos indivíduos apresentaram capacidade funcional próximo ao normal, de acordo com a pontuação estabelecida pela escala utilizada.