Paradoxos na divulgação de salários de servidores em municípios / Paradojas en la difusión de información sobre los sueldos de los funcionarios por los municipios / Paradoxes on the disclosure of civil servants' salary information by local governments

Resumo A folha de pagamento é uma das maiores despesas do município, porém uma das mais difíceis de serem monitoradas. Se a divulgação dos salários de servidores é de interesse público para controle, a divulgação das despesas com pessoal, na forma como previsto em lei, pode não ser suficiente para detectar diversos tipos de irregularidades. Analisamos os paradoxos envolvidos na divulgação de dados da folha de pagamento e as tensões que emergem do posicionamento de diversos interessados na questão. Entrevistamos profissionais de prefeituras, sindicatos, empresas de softwares, tribunais de contas, organizações sociais e jornalistas. Procuramos reunir diversas perspectivas e interesses envolvidos na divulgação de salários e benefícios de servidores como exemplo dos desafios de ampliar a transparência pública. Com abordagem indutiva, apresentamos uma lista não exaustiva de irregularidades que reconhecidamente ocorrem no país e que, por não serem detectadas apenas com os dados divulgados nos portais de transparência, demandam cooperação entre diversos atores de controle.

Resumen La nómina es uno de los mayores gastos del municipio, pero también es uno de los más difíciles de monitorear. Si la divulgación de los salarios de los funcionarios públicos es de interés público para su control, la divulgación de los gastos en personal según lo dispuesto por la ley puede no ser suficiente para identificar algunas irregularidades. Analizamos las paradojas presentes en la apertura de dichos datos y las tensiones que surgen del posicionamiento de los diferentes interesados en el asunto. Entrevistamos a profesionales de alcaldías, sindicatos, empresas de software, tribunales de cuentas, organizaciones sociales y periodistas para reunir diversas perspectivas e intereses involucrados en la divulgación de sueldos y beneficios de los servidores públicos como ejemplo de los desafíos para ampliar la transparencia pública. Con un enfoque inductivo, presentamos una lista no exhaustiva de las irregularidades que a menudo ocurren en Brasil que, por no ser detectadas simplemente a través de los datos publicados en los portales de transparencia, exigen la cooperación entre los diferentes agentes de control para combinar múltiples fuentes de datos y evidencias.

Abstract: Although local governments' payrolls are a significant expense, they are one of the most difficult to monitor. The disclosure of civil servants' salaries to improve control is a measure of public interest, but the mere information on the government's personnel expenses as provided by law may not be sufficient to detect irregularities. This study analyzes the paradoxes of disclosing salary information and the tensions among the parties related to this issue. We interviewed local government employees, unions, software companies, courts of accounts, nonprofit organizations, and journalists, gathering different interests and perspectives, addressing the issue as an example of the challenges to improve public transparency. Based on an inductive approach, the research offers a non-exhaustive list of irregularities in Brazil that are not detected by simply disclosing information in transparency portals. Our findings point out that detecting and addressing such irregularities require the cooperation of several control agents to combine multiple data sources and evidence.

Preoperative Nutritional Status and Clinical Complications in the Postoperative Period of Cardiac Surgeries.

Objective: This study aims to assess the preoperative nutritional status of patients and the role it plays in the occurrence of clinical complications in the postoperative period of major elective cardiac surgeries. Methods: Cross-sectional study comprising 72 patients aged 20 years or older, who underwent elective cardiac surgery. The preoperative nutritional assessment consisted of nutritional screening, anthropometry (including the measurement of the adductor pollicis muscle thickness) and biochemical tests. The patients were monitored for up to 10 days after the surgery in order to control the occurrence of postoperative complications. The R software, version 3.0.2, was used to statistically analyze the data. Results: Clinical complications were found in 62.5% (n=42) of the studied samples and complications of non-infectious nature were most often found. Serum albumin appeared to be associated with renal complications (P=0.026) in the nutritional status indicators analyzed herein. The adductor pollicis muscle thickness was associated with infectious complications and presented mean of 9.39±2.32 mm in the non-dominant hand (P=0.030). No significant correlation was found between the other indicators and the clinical complications. Conclusion: The adductor pollicis muscle thickness and the serum albumin seemed be associated with clinical complications in the postoperative period of cardiac surgeries.

Preoperative nutritional status and clinical complications in the postoperative period of cardiac surgeries

Abstract Objective: This study aims to assess the preoperative nutritional status of patients and the role it plays in the occurrence of clinical complications in the postoperative period of major elective cardiac surgeries. Methods: Cross-sectional study comprising 72 patients aged 20 years or older, who underwent elective cardiac surgery. The preoperative nutritional assessment consisted of nutritional screening, anthropometry (including the measurement of the adductor pollicis muscle thickness) and biochemical tests. The patients were monitored for up to 10 days after the surgery in order to control the occurrence of postoperative complications. The R software, version 3.0.2, was used to statistically analyze the data. Results: Clinical complications were found in 62.5% (n=42) of the studied samples and complications of non-infectious nature were most often found. Serum albumin appeared to be associated with renal complications (P=0.026) in the nutritional status indicators analyzed herein. The adductor pollicis muscle thickness was associated with infectious complications and presented mean of 9.39±2.32 mm in the non-dominant hand (P=0.030). No significant correlation was found between the other indicators and the clinical complications. Conclusion: The adductor pollicis muscle thickness and the serum albumin seemed be associated with clinical complications in the postoperative period of cardiac surgeries.

Potentially modifiable factors associated with non-adherence to phosphate binder use in patients on hemodialysis.

BACKGROUND: Despite the evidence that phosphate binder (PB) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen. Therefore, barriers to PB adherence should be identified and eliminated. The purpose of this study was to evaluate PB adherence among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence. METHODS: A cross-sectional study (502 patients) was performed in four dialysis units in Salvador, Brazil, using data from the second phase of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO). Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured questionnaire. RESULTS: Non-adherence to PB was observed for 65.7% of the patients. After adjustments for numerous covariates, cerebrovascular disease (odds ratio (OR), 3.30; 95% confidence interval (CI), 1.03-10.61), higher PTH (OR per each 300 pg/mL, 1.14; 95% CI, 1.01-1.28), lack of comprehension of the appropriate time to use PB (OR, 7.09; 95% CI, 2.10-23.95) and stopping PB use after feeling better (OR, 4.54; 95% CI, 1.45-14.25) or feeling worse (OR, 11.04; 95% CI, 1.79- 68.03) were significantly associated with PB non-adherence. By contrast, the adjusted odds of PB non-adherence were lower for patients with more years on dialysis (OR by each 2 years, 0.87; 95% CI, 0.80-0.95), with serum phosphorus above 5.5 mg/dL (OR, 0.53; 95% CI 0.34-0.82), who referred that were encouraged by the dialysis staff to be independent (OR, 0.52; 95% CI 0.30-0.90), and reported that the nephrologist explained how PB should be used (OR, 0.20; 95% CI 0.05-0.73). CONCLUSION: The results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients. A new questionnaire is presented and may help to evaluate systematically the patients regarding PB adherence in hemodialysis setting.