[The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates]. / O parecer do Conselho Federal de Medicina, o incentivo à remuneração ao parto e as taxas de cesariana no Brasil.

This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.

O parecer do Conselho Federal de Medicina, o incentivo à remuneração ao parto e as taxas de cesariana no Brasil / The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates / La opinión del Consejo Federal de Medicina, remuneración por nacimiento y tasas de cesárea en Brasil

O estudo buscou investigar como o incentivo à remuneração ao parto, preconizado pelo Conselho Federal de Medicina (CFM) do Brasil, influencia as taxas de cesariana. Foi investigada uma amostra consecutiva de 600 puérperas. A proporção de cesarianas na amostra foi de 59,2%, sendo 92,3% entre as mulheres tendo parto e pré-natal com o mesmo profissional. As taxas de cesariana foram significativamente mais elevadas exatamente naqueles grupos com maior prevalência do mesmo profissional, ou seja, idade mais avançada (RP = 1,65), maior escolaridade (RP = 1,25), pré-natal privado (RP = 1,39) ou por convênio (RP = 1,43), cesariana prévia (RP = 2,78) e admitidas precocemente (RP = 1,93). O entendimento do CFM de que o incentivo ao acompanhamento presencial do trabalho de parto, pago à parte, para o mesmo obstetra que realizou o pré-natal, funcionará como incentivo ao parto normal, está exatamente na contramão de nossos resultados, mostrando que as mulheres atendidas pelo mesmo profissional no pré-natal e parto são exatamente aquelas que apresentam as taxas de cesariana mais elevadas.

This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.

El estudio investiga cómo el pago por parto, recomendado por el Consejo Federal de Medicina de Brasil (CFM), influye en las tasas de cesárea. Se investigó una muestra consecutiva de 600 mujeres embarazadas. La tasa de cesárea en la muestra fue de un 59,2% y un 92,3% entre las mujeres con parto y atención prenatal con el mismo profesional. Las tasas de cesáreas fueron significativamente mayores en los grupos exactamente con mayor prevalencia del mismo profesional, es decir, edad avanzada (RP = 1,65), educación superior (RP = 1,25), atención prenatal privada (RP = 1,39) o por acuerdo (RP = 1,43), cesárea anterior (RP = 2,78) y admisión precoz (RP = 1,93). La recomendación del CFM que incentiva la atención del parto por el mismo profesional que realizó la atención prenatal, es exactamente la contraria a la nuestra, debido a nuestros resultados, ya que demuestra que las mujeres atendidas por el mismo profesional en la atención prenatal y el parto son exactamente las que presentan las tasas más altas de cesárea.

Efeito do ultrassom associado ao gel de calêndula sobre a atividade reparadora em lesões musculares experimentais / Effect of ultrasound associated with calendula gel on restorative activity in experimental muscular injuries

Diversas técnicas têm sido propostas para o tratamento de lesões musculares, sendo a do ultrassom terapêutico uma das mais utilizadas. Além dos efeitos do ultrassom, este facilitaria, ainda, a permeação de drogas pelos tecidos (fonoforese). A calêndula é um fitoterápico que apresenta atividade cicatrizante empregada popularmente no tratamento de lesões. O objetivo deste estudo foi avaliar a eficácia do ultrassom, da fonoforese e a influência da aplicação tópica do gel extraído da Calendula officinalis na recuperação de lesão muscular experimental em ratos. A análise histológica do músculo e a determinação da área de lesão foram realizadas após o músculo tibial anterior lesionado ser tratado durante cinco dias. Os resultados indicaram que todos os grupos tratados com ultrassom e calêndula apresentaram melhor resolução da lesão, por apresentarem maior quantidade de fibroblastos, neovascularização e mioblastos em relação ao Grupo-controle. Quanto à área de lesão, somente o grupo em que foi associado o ultrassom à calêndula apresentou uma área significativamente menor. Em conjunto, os dados obtidos demonstram que, no modelo experimental estudado, a fonoforese apresentou-se mais indicada para o tratamento de lesões musculares

Several techniques have been proposed as treatment for muscular injuries, and therapeutic ultrasound is one of the most used. Besides the effects of ultrasound, it also facilitates drug flow trough the tissues (phonophoresis). Calendula is a phytotherapic which presents healing elements, popularly used on injury treatments. The objective of this study was to evaluate ultrasound effectiveness, phonophoresis, and the influence of the topic application of the gel with Calendula officinalis extract, in the recovery from experimental muscular injury in rats. After the injured front tibial muscle was treated during five days, a histological analysis of the muscle was performed and the injury area was determined. The results indicated that all the ultrasound/Calendula-treated groups presented better evolution in the injury, sinasce they presented more fibroblasts, neovascularization and myoblasts in relation to the control group. As to the injured area, only the group in which the ultrasound was added to Calendula presented a significantly smaller area. In all, the obtained data demonstrate that in the experimental model studied, phonophoresis was more indicated for muscle injury treatment