Spina bifida folate fortification in Brazil, update 2022: a cross-sectional study.

INTRODUCTION: Despite improving maternal-child indicators in Brazil, congenital malformations are still the second cause of mortality in the first years of life. This work aims to compare statistical data before and after flour fortification with folic acid (FA) in Brazil. METHODS: A cross-sectional Brazilian-population-based study compares the spina bifida (SB) rates pre- and post-fortification of the flour with folate. Data collected from the public database of the Live Birth Information System (SINASC/SUS) was performed. The period 1999-2004 (pre-fortification) was compared with 2005-2010 (post-maize and wheat fortification with FA), and another analysis comparing 2005-2010 and 2011-2020 (cassava flour fortification) was performed. The estimator was the prevalence ratio (PRR); the confidence interval selected was 95%. We used a random effects analysis model and inverse variance. RESULTS: The review showed a tendency to decrease the PRR after flour fortification; however, there is no statistical significance between studies. DATASUS data analysis comparing 5 years before and 5 years after mandatory maize and wheat flour fortification demonstrated a rate ratio of 1.05 (95% CI 0.99-1.1; p = 0.075). Furthermore, comparing 10 years after additional cassava flour folate fortification, the rate ratio increased to 1.4 (95% CI 1.34-1.45; p < 0.01). CONCLUSION: This study demonstrated an increase in SB after FA fortification. Possible explanations rely on national registry improvement, not fortified staple food, or further unidentified causes. Moreover, suggestions can be made for creating a mandatory registry for malformations, inspecting the concentrations of FA in the flour, and fortifying all food.

Monitoring Indicators of Universal Access to Accessible and Safe Anesthetic and Surgical Care in a Peruvian Region: An Ambispective Study.

INTRODUCTION: The Lancet Commission on Global Surgery indicators for monitoring anesthetic and surgical care allow the identification of access barriers, evaluate the safety of surgeries, facilitate planning, and assess changes over time. The primary objective was to measure these indicators in all health facilities of a Peruvian region in 2020. METHODS: This was an ambispective observational study to measure the anesthetic and surgical care indicators in Piura, a region in Peru, between January 2020 and June 2021. Public and private health facilities in the Piura region that performed surgical care or had specialists from any surgical specialty participated in the study. Data were collected from all regional health facilities that provided surgical care to estimate the density of surgical workforce. Likewise, the percentage of the population with access to an operating room within 2 h was estimated using georeferenced tools. Finally, a public database was accessed to determine the surgical volume, the percentage of the regional population protected with health insurance. RESULTS: In 2020, 88.4% of the inhabitants of this Peruvian region had access to timely essential surgery. There were 18.4 surgical specialists and 1174 surgeries per 100,000 populations, and 91% of the population had health insurance. In addition, there was a rate of 2.1 working operating rooms per 100,000 inhabitants in 2021. CONCLUSIONS: This Peruvian region presented an increasing trend with respect to the population's access to essential and timely surgical care, and health insurance coverage. However, the workforce distribution was inequitable among the provinces of the region, the surgical volume was reduced, and timely access was hindered because of the SARS-CoV-2 pandemic.

Historical perspective of two technical standards developed in the 2ist century that gave rise to profound changes in Peruvian anesthesiology / Perspectiva histórica de dos normas técnicas desarrolladas en el siglo XXI que generaron cambios profundos en la anestesiología peruana

Abstract The technical standards in anesthesiology govern the professional practice and allow for the provision of safer anesthesia and surgery. This article gives a historical perspective on the creation, main content, and consequences of the implementation of the Peruvian standards in anesthesiology.

Resumen Las normas técnicas de anestesiología rigen el ejercicio profesional y permiten ofrecer una anestesia y una cirugía más seguras. El presente artículo brinda una perspectiva histórica sobre la creación, el contenido principal y las consecuencias de la implementación de las normas de anestesiología peruanas.

Neurocysticercosis control for primary epilepsy prevention: a systematic review.

Neurocysticercosis (NCC) is a leading cause of preventable epilepsy in lower- and upper- middle-income countries (LMICs/UMICs). NCC is a human-to-human transmitted disease caused by ingestion of Taenia solium eggs from a Taenia carrier. T. solium infection control is the key to reduce NCC incidence. This systematic review aims to identify T. solium control programs that can provide frameworks for endemic areas to prevent NCC-related epilepsy. A systematic search was conducted in PubMed/Medline, Embase, Web of Science, and Cochrane Library databases in March 2021. After title and abstract review, full texts were screened for qualitative analysis. Additional articles were identified via citation search. Of 1322 total results, 34 unique studies were included. Six major intervention types were identified: national policy (8.8%), community sanitation improvement (8.8%), health education (8.8%), mass drug administration (29.4%), pig vaccination and treatment (32.4%), and combined human and pig treatment (11.8%). Overall, 28 (82.4%) studies reported decreased cysticercosis prevalence following the intervention. Only health education and combined human and pig treatment were effective in all selected studies. NCC causes preventable epilepsy in LMICs/UMICs and its incidence can be reduced through T. solium control. Most interventions that disrupt the T. solium transmission cycle are effective. Long-term sustained results require comprehensive programs, ongoing surveillance, and collaborative effort among multisectoral agencies.

Educating the Next Generation of Global Neurosurgeons: Competencies, Skills, and Resources for Medical Students Interested in Global Neurosurgery.

BACKGROUND: Global neurosurgery operates at the intersection of neurosurgery and public health. Although most global neurosurgery initiatives have targeted neurosurgeons and trainees, medical students represent the future of global neurosurgery. METHODS: A narrative review of the literature regarding research methodology, education, economics, health policy, health advocacy, relevant to global neurosurgery was conducted. RESULTS: We summarize pearls that all medical students interested in global neurosurgery should know. DISCUSSION: To become effective agents of change within global neurosurgery, medical students must master competencies of motivation, organization, collaborativeness, dependability, flexibility, resilience, creative problem-solving, ethical thinking, cultural humility, and global awareness and gain knowledge and skills regarding research, education, policy making, and advocacy. Discussions with neurosurgeons and trainees, neurosurgery interest groups, conferences, university global neurosurgery initiatives, and student organizations represent opportunities for learning and becoming involved in global neurosurgery.

Progress in neurosurgery: Contributions of women neurosurgeons in Latin America.

Nearly 75 years after the first woman neurosurgeon was trained in Latin America, the field of neurosurgery is changing and the prominence of women neurosurgeons within the specialty is increasing. By researching the histories of individual physicians and neurosurgeons, as well as neurosurgical departments and societies, we present, for the first time, the history of the women in neurosurgery in Latin America. Women neurosurgeons in the region have made notable progress, inspiring subsequent generations and actively participating in organized neurosurgery, medical leadership outside neurosurgery, academic neurosurgery, and leadership in contemporary society. The establishment of "Women in Neurosurgery" networks and organizations has been important to the success of many of these efforts. This collaborative study, which identifies the known women neurosurgeons in Latin America for the first time, may serve to provide background and context for further contributions of women neurosurgeons for our profession and our patients.

Promovendo equidade de gênero nas especialidades cirúrgicas: experiência de programa de mentoria na América Latina / Promoting gender equity in surgical specialties: experience from a mentorship program in Latin America

Resumo: Introdução: Cirurgia global é uma área que advoga por melhores desfechos e equidade para todos que demandam assistência cirúrgica, anestésica e obstétrica. No Brasil, embora as mulheres componham 46,6% da demografia médica em 2020, inequidades de gênero persistem nas especialidades cirúrgicas. O objetivo deste artigo é relatar a experiência do programa de mentoria do Gender Equity Initiative in Global Surgery como mecanismo de promoção de equidade de gênero. Relato de experiência: O programa almeja capacitar, empoderar e amplificar vozes de minorias de gênero, sendo voluntário e sem fins lucrativos. Baseia-se na criação de pequenos grupos heterogêneos, com diferentes graus de experiência acadêmica e pessoal. As inscrições ocorrem por formulário on-line, com perguntas relacionadas à identidade, a interesses e expectativas dos aplicantes, sendo os grupos organizados de acordo com essas informações. Os mentores são selecionados com base em: nível de treinamento, especialidade, identidade de gênero e expectativas. Realizam-se três acompanhamentos por preenchimento de questionário pelos participantes. Discussão: A necessidade de programas como este durante a pandemia é evidente, mostrando-se como uma iniciativa positiva para desenvolver estratégias de enfrentamento dos desafios vivenciados. Este relato fornece uma visão geral de como um programa de mentoria pode contribuir para que mais estudantes de Medicina sejam incentivados a seguir carreiras em cirurgia, anestesia e obstetrícia, de modo a promover equidade de gênero para além da perspectiva binária, e discute as principais dificuldades em se estabelecerem programas como esse na América Latina. Conclusão: É preciso reforçar que não basta apenas dar suporte a mulheres (cis e trans) e pessoas de gênero não binário, mas também educar a sociedade para compreender identidades de gênero além da perspectiva binária, reconhecendo os impactos nas relações de trabalho e perspectivas de carreira, especialmente dentro do campo cirúrgico.

Abstract: Introduction: Global surgery is an area that advocates for better outcomes and equity for everyone who requires surgical, anesthetic, and obstetric assistance. In Brazil, although women represent 46.6% of medical demographics in 2020, gender equity disparities persist in surgical specialties. The objective of this article is to report the experience of the mentoring program from the Gender Equity Initiative in Global Surgery as a mechanism for promoting gender equity. Experience report: The voluntary and non-profit program aims to train, empower, and amplify voices of gender minorities. It is based on the creation of small heterogeneous groups, with different degrees of academic and professional experience. Applications are made via an online form, with questions related to the identity, interests, and expectations of applicants, and the groups are organized according to this information. Mentors are selected based on the level of training, specialty, gender identity, and expectations. The participants then have three follow-up sessions conducted by completing questionnaires. Discussion: The need for programs like this during the pandemic is evident, proving to be a positive initiative to develop strategies to tackle the challenges experienced. This report provides an overview of how a mentoring program can contribute to greater adherence for medical students to pursue careers in surgery, anesthesia, and obstetrics, promoting gender equity beyond the binary perspective and discussing the main difficulties in establishing similar programs in Latin America. Conclusion: It is necessary to reinforce that educating and supporting women (cisgender and transgender) and non-binary gendered people are not enough, but to educate society to understand gender identities beyond the binary perspective, recognizing the impacts on work relationships and career perspectives, especially within the surgical field.

A Bibliographic Analysis of the Most Cited Articles in Global Neurosurgery.

OBJECTIVE: Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. The aim of this study is to identify the most frequently cited articles in global neurosurgery through a bibliographic review to characterize articles and trends around this growing topic. METHODS: The top most-cited articles in global neurosurgery were determined by searching the Web of Science database using a priori search terms. Articles with at least 5 citations were selected, and there were no time period or language restrictions. The data were extracted from each included article and all characteristics were summarized. RESULTS: A total of 932 articles were identified using the search terms; 69 articles fulfilled inclusion criteria and 17 articles were selected that had more than 5 citations. The articles' number of citations ranged from 6 to 98 for the most-cited article. Authors from, or affiliated with, 14 countries contributed to the 17 articles, and the country that had the greatest representation was the United States. The main topic discussed was surgical capacity, the second topic was the treatment of different neurosurgical conditions, and volunteerism was the third topic. CONCLUSIONS: There is currently a deficit in both the amount of literature surrounding the topic of global neurosurgery and how much that literature is cited. Developing innovative ways to increase academic productivity within, or in collaboration with, low-middle income countries is essential to contribute to global neurosurgery.