Meningococcal disease epidemiology in Brazil (2005-2018) and impact of MenC vaccination.

BACKGROUND: Meningococcal disease (MD) presents a substantial public health problem in Brazil. Meningococcal C conjugate (MenC) vaccination was introduced into the routine infant immunization program in 2010, followed by adolescent vaccination in 2017. We evaluated changes in national and regional MD incidence and mortality between 2005 and 2018, serogroup distribution and vaccine coverage. METHODS: Data were obtained from national surveillance systems from 2005 to 2018. Age-stratified incidence and mortality rates were calculated and a descriptive time-series analysis was performed comparing rates in the pre-(2005-2009) and post-vaccination (2011-2018) periods; MD due to specific meningococcal serogroups were analyzed in the pre-(2007-2009) and post-vaccination (2011-2018) periods. RESULTS: From 2005 to 2018, 31,108 MD cases were reported with 6496 deaths; 35% of cases and deaths occurred in children < 5 years. Incidence and mortality rates declined steadily since 2012 in all age-strata, with significantly lower incidence and mortality in the post-vaccine introduction period in children aged < 1-year, 1-4 years, 5-9 years and 10-14 years. A significant decline in MenC disease in children < 5 years was observed following MenC vaccine introduction; infants < 1 year, from 3.30/100,000 (2007-2009) to 1.08/100,000 (2011-2018) and from 1.44/100,000 to 0.42/100,000 in 1-4-year-olds for these periods. Reductions in MenB disease was also observed. MenW remains an important cause of MD with 748 cases reported across 2005-2018. While initial infant vaccination coverage was high (>95% nationwide), this has since declined (to 83% in 2018); adolescent uptake was < 20% in 2017/18). Regional variations in outcomes and vaccine coverage were observed. CONCLUSION: A substantial decline in incidence and mortality rates due to MD was seen following MenC vaccine introduction in Brazil, especially among children < 5 years chiefly driven by reductions in MenC serogroup. While these benefits are considerable, the prevalence of MD due to other serogroups such as MenW and MenB remains a concern. A video summary linked to this article can be found on Figshare: https://doi.org/10.6084/m9.figshare.13379612.v1.

Evaluation of the Impact of Physical Exercise in Reducing Pain in Women Undergoing Mammography: A Randomized Clinical Trial.

Objective: To evaluate the efficacy of exercise prior to mammography in reducing perceived postexamination pain. Methods: An open, randomized, and controlled clinical trial was conducted. The interventions consisted of warm-up and stretching exercises of the upper or lower limbs of women who consulted at Barretos Cancer Hospital, São Paulo State, Brazil. The women were divided into three groups based on the intervention and its location: upper limbs (group 1), lower limbs (group 2), and no intervention (group 0). Quantitative variables were compared between and within groups using analysis of variance and Student's t test with a 5% significance level. Relative risk (RR) calculations and their derived measurements such as efficacy, number needed to treat (NNT), absolute risk reduction (ARR), and relative risk reduction (RRR) were taken. This study was approved by the Institutional Committee of Research Ethics. Results: A total of 198 (66 per group) women were evaluated. Sociodemographic data and level of physical activity were not found to be associated with perception of pain after mammogram. However, group 1 had the greatest reduction in postprocedure perception of pain compared with groups 2 (relative risk [RR] = 3.54, 95% confidence interval [CI] = 2.12-5.51, P < 0.05) and 0 (RR = 1.92 (95% CI = 1.08-3.42, P < 0.05). Conclusions: Pre-examination upper limb exercises were most effective in reducing the perception and sensation of pain. However, women who performed lower limb exercises also had a decreased perception of pain compared with the control group.

Indenizações que envolvem o parto à luz do entendimento do Superior Tribunal de Justiça - STJ / Indemnities involving childbirth birth of the Superior Tribunal de Justiça-STJ's understanding / Indemnizaciones que implican el parto a la luz del entendimiento del Superior Tribunal de Justiça-STJ

Introdução - O Ministério da Saúde tem apostado na mudança da cultura do parto, a fim de estabelecer diretrizes baseadas na assistência humanizada. Os médicos obstetras têm papel relevante nesse processo, pois participam de maneira ativa na aplicação do conhecimento e das melhores técnicas para realização de um parto seguro. Métodos - O trabalho analisou o discurso dos julgadores do Superior Tribunal de Justiça (STJ), nas ações indenizatórias envolvendo partos, mediante o estudo do Discurso do Sujeito Coletivo (DSC), o qual reflete opiniões e posicionamentos relacionados à área médica obstétrica. Resultados - O discurso dos julgadores do STJ ressaltou a responsabilidade objetiva dos hospitais, sejam públicos ou privados, ao passo que aos médicos foi atribuída a responsabilidade subjetiva, devendo ser comprovada a culpa do profissional. As provas periciais produzidas foram essenciais para o desfecho da ação. As ações improcedentes sustentaram que a obrigação de meio excluiu a responsabilidade, desde que realizados todos os procedimentos necessários e adequados. A União foi considerada parte ilegítima para responder pelos danos relacionados ao Sistema Único de Saúde. Discussão - Os discursos sugerem discussões acerca da mudança gradativa entre os envolvidos no processo gestacional e puerperal, inclusive aos operadores do direito, aplicadores da lei ao caso concreto, assim como aos profissionais da saúde obstétrica no exercício da profissão. Conclusão - Os casos analisados debateram sobre os riscos da prática médica obstétrica, o que pode ser objeto de reflexão, a fim de reduzir custos provenientes das altas indenizações, bem como incentivar a humanização, a qualidade e excelência na assistência ao parto.

Introduction - The Ministry of Health has focused on changing the birth culture in order to establish guidelines based on humanized care. Obstetric physicians play an important role in this process, as they actively participate in the application of knowledge and the best techniques to perform a safe delivery. Methods - This study analyzed the discourse of the Supreme Court of Justice (STJ) judges, in the indemnity actions involving deliveries, through the study of the Collective Subject Discourse (DSC), which reflects opinions and positions related to the obstetric medical area. Results - The STJ judges' speech emphasized the objective responsibility of hospitals, whether public or private, while physicians were assigned a subjective responsibility, and the professional's fault must be proven. The expert evidence produced was essential for the outcome of the action. The unfounded actions maintained that the obligation of means excluded liability, provided that all necessary and adequate procedures were carried out. Discussion - The speeches suggest discussions about the gradual change between those involved in the gestational and puerperal process, including the legal operators, law enforcers in the concrete case, as well as the And to obstetric health professionals in the practice of the profession. Conclusion - The cases analyzed discussed the risks of obstetric medical practice, which can be the object of reflection, in order to reduce costs from high indemnities, as well as to encourage humanization, quality and excellence in childbirth care.

Introducción - El Ministerio de Salud ha apostado por el cambio de la cultura del parto, a fin de establecer directrices basadas en la asistencia humanizada. Los médicos obstetras tienen un papel relevante en este proceso, pues participan de manera activa en la aplicación del conocimiento y de las mejores técnicas para la realización de un parto seguro. Métodos - El trabajo analizó el discurso de los juzgadores del Superior Tribunal de Justicia (STJ), en las acciones indemnizadoras involucrando partos, mediante el estudio del Discurso del Sujeto Colectivo (DSC), el cual refleja opiniones y posicionamientos relacionados al área médica obstétrica. Resultados - El discurso de los jueces del STJ resaltó la responsabilidad objetiva de los hospitales, ya sean públicos o privados, mientras que a los médicos se les atribuyó la responsabilidad subjetiva, debiendo comprobarse la culpa del profesional. Las pruebas periciales producidas fueron esenciales para el desenlace de la acción. Las acciones improcedentes sostuvieron que la obligación de medio excluyó la responsabilidad, siempre que se efectuaran todos los procedimientos necesarios y adecuados. Discusión - Los discursos sugieren discusiones acerca del cambio gradual entre los involucrados en el proceso gestacional y puerperal, incluso a los operadores del derecho, aplicadores de la ley al caso concreto, así como a los profesionales de la salud obstétrica en el ejercicio de la profesión. Conclusión - Los casos analizados debatieron sobre los riesgos de la práctica médica obstétrica, lo que puede ser objeto de reflexión, a fin de reducir costos provenientes de las altas indemnizaciones, así como incentivar la humanización, la calidad y excelencia en la asistencia al parto.

Analyses of Budget Impact Considering the Use of the Picture Archiving and Communication System.

OBJECTIVE: To analyze the budget impact of using the picture archiving and communication system (PACS) in comparison to the screen/film system. METHODS: The budget impact analysis was conducted on the basis of registry data from the Clinics Hospital of the Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil. The budget impacts were compared between the PACS, with high- and low-cost PACS architectures, and the screen/film system by considering reference and alternative scenarios over the course of 5 years. RESULTS: The budget impact associated with the use of PACS was lower than that associated with the use of the screen/film system in all the evaluated scenarios. The low-cost PACS architecture (mini-PACS) had an even lower budget impact, especially in the scenario in which a simulation of lower numbers of medical examinations was performed. CONCLUSIONS: The screen/film system had a high budget impact in all the scenarios evaluated, wherein its costs were higher than the available budget. In contrast, the PACS (high- and low-cost architectures) showed a budget impact that allowed for savings in resources, especially the mini-PACS. Therefore, we recommend the implementation and use of the PACS in health services with any volume of examinations performed.