Income transfer programme for children and adolescents with disabilities in Brazil.

BACKGROUND: In Brazil, there are 55 million people living in extreme poverty. People with disabilities are doubly impacted by low income and the presence of the disability. The Continuous Cash Benefit Program (BPC) is an aid granted by the Brazilian federal government to people who attest to the condition of disability as an impediment to a life on an equal basis with other individuals. Requests to BPC are made to the national competence body that carries out an expert medical and social assessment, by means of an instrument that determines the degree of the disability. Our objective was to analyse the standard of BPC concessions for children and young people with disabilities and to identify the prevalence of major diseases in the concessions. METHODS: The exploratory, cross-sectional and retrospective research used primary data collected from 332 expert medical assessments of children under 16 years old. The standard and determinants of the concessions were established through Cluster Analysis by Ward's criterion and Euclidean distance, specifying the homogeneous groups of dysfunction classes. The prevalence of major diseases was performed by frequency analysis according to the International Classification of Diseases (ICD). The socioeconomic profile of BPC requirements and the main causes of BPC rejection were analysed through descriptive analysis. RESULTS: There was a predominance of male, preschoolers and illiterate individuals in the requirements and concessions. In the granting standard for impaired function class, problems related to congenital changes received benefits even in the absence of impairment, with childhood autism being the most prevalent diagnosis. CONCLUSIONS: The concessions seemed more dependent on the diagnosis itself and on the age of the beneficiaries than on the degree of dysfunction suffered, without exclusions, by the individuals.

Defensive medicine and cesarean sections in Brazil.

ABSTRACT: Brazil has a high rate of cesarean sections (CS) that cannot be solely justified by women's clinical conditions; thus, other causes, for example, CS on maternal request and physicians' fear of litigation as possible influencing factors, cannot be overlooked.This study aimed to identify through a survey whether Brazilian gynecologists and obstetricians (GOs) perform defensive CS.In this cross-sectional, descriptive study, a questionnaire was administered. The target population comprised of GOs who were members of premier Brazilian professional associations of gynecology and obstetrics. A total of 403 GOs participated in the survey using an obstetrics questionnaire about litigation and defensive medicine (DM). Statistical analyses were performed on pairs of variables to determine the risk factors of performing CS due to concerns of complications during vaginal delivery and to avoid lawsuits.The mean age of the GOs was 47.7 years who were mostly female (58.3%) and having worked professionally in both public and private sectors (71.7%). Of all participants, 80.6% had been sued or knew an obstetrician who had been sued. The obstetricians who had been sued or who knew a colleague that had been sued exhibited a significantly higher likelihood of performing defensive CS than physicians who had not been sued or did not know physicians who had been sued. The perception of a higher risk of lawsuits against obstetricians influenced the practice of DM and led to a more than six-fold increase in CSs in specialists with this perception compared to specialists who did not believe the presence of an increased risk of litigation in obstetrics existed.The majority of Brazilian GOs perform defensive CS. It is important to consider DM as one of the causes of high CS rates in Brazil and include it in the development of public policies to reduce these CS rates.

Cesarean section rates in Brazil: Trend analysis using the Robson classification system.

Cesarean section (CS) is a surgical procedure used to deliver babies that is medically indicated to prevent maternal and neonatal mortality. However, it is associated with short- and long-term risks. CS rates have increased, and efforts are being made to ensure that CS is performed only when necessary. The Robson classification system is considered useful for studying, evaluating, monitoring, and comparing CS rates within and between healthcare facilities. In Brazil, there are few studies on this subject, and no large epidemiological studies on this topic utilizing the Robson classification have been reported. This study aimed to report and analyze CS rates in Brazil using the Robson classification system, and subsequently suggest possible measures to address it.Data were collected from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos) that contains data of the entire obstetric population, from 2014 to 2017. All births in the country during this period were analyzed according to the Robson classification.A total of 11,774,665 live births were reported in Brazil during 2014 to 2017, most of which were mostly via CS (55.8%). Regions with high human development indexes had significantly higher CS rates than those with low human development indexes. The Robson group (RG) 1 to 4 accounts for 60.2% of live births and 47.1% of all CSs. RG5 was larger than all the other groups and contributed to the highest global rate of CS (31.3%), in addition to being the group who presented the largest growth.Although RG 1 to 4 present favorable initial conditions for vaginal delivery, CS accounted for almost half of births in these groups. The size of RG1 and RG2 in Brazil was comparable to that in countries with low CS rates; however, CS rates in these groups were 3 times higher in Brazil. Nulliparous women in RG1 and RG2 who undergo CS are subsequently categorized into RG5, increasing the global CS rate by 1% annually.We suggest the implementation of health policies to avoid the unnecessary performance of CS in RG1 and RG2 to decrease the CS rates in Brazil.

Identificação de Near Miss materno em unidade de terapia intensiva / Identification of maternal Near Miss in an intensive care unit

O objetivo deste estudo foi identificar os casos de near miss materno e listar indicadores de saúde entre pacientes internadas em Unidades de Terapia Intensiva - UTI. Trata-se de estudo transversal retrospectivo realizado na 15ª Regional de Saúde de Maringá-PR. Constatou-se que houve 37 internamentos, dos quais, 16 foram casos de near miss e três de morte materna. As principais complicações foram as doenças hipertensivas (45%), complicações pulmonares (31%) e hemorrágicas (24%). O procedimento invasivo mais realizado foi a transfusão de hemácias em 51% dos casos. Os casos de morte materna tiveram o maior número de critérios identificadores de near miss. A identificação em conjunto dos casos de near miss materno e morte materna pode melhorar o monitoramento dos cuidados obstétricos, tratando-se de um instrumento útil e viável a ser usado pelos comitês de mortalidade materna.

Cases of maternal near miss were identified and health indexes were listed in hospitalized patients in ICUs. Current transversal and retrospective analysis was performed at the 15th Regional Health Unit in Maringá PR Brazil. There were 37 hospitalizations, of which 16 were near miss cases and 3 involved death of the mother. Main complications were hypertension (45%), lung condition (31%) and hemorrhage (24%). The most common invasive procedure comprised transfusion of red blood cells in 51% of cases. Mothers´ fatal cases had the greatest number of near miss criteria. The identification of maternal near miss cases and mother´s death may better monitor obstetric care and may be a useful tool for teams dealing with maternal mortality.

Oclusão laparoscópica das artérias uterinas no tratamento de leiomiomas uterinos / Laparoscopic uterine artery occlusion in the treatment of uterine leiomyomas

A procura por procedimentos menos invasivos, e o desejo das mulheres de manter o útero, fazem da oclusão laparoscópica das artérias uterinas no tratamento de leiomiomas uterinos uma alternativa. Este trabalho teve como objetivo revisar os estudos sobre essa cirurgia. Os resultados após as intervenções cirúrgicas relatam redução volumétrica do útero e leiomiomas, com melhora dos sintomas e menos dor no pós-operatório em relação à embolização das artérias uterinas, técnica que utiliza o mesmo conceito da desvascularização do tumor. Quanto ao futuro reprodutivo, os dados não são bem definidos e apresentam-se conflitantes. As recorrências dos sintomas e possível necessidade de novas cirurgias complementares podem causar insatisfação entre as pacientes. Novos estudos são necessários para melhor definir o papel dessa opção terapêutica no tratamento de leiomiomas uterinos

The search for less invasive surgical procedures, and the desire of women to keep the uterus, make laparoscopic occlusion of the uterine arteries an alternative in the treatment of uterine leiomyomas. Current paper reviewed studies on this type of surgery, volume reduction of uterus and leiomyomas, with improvement in symptoms and less pain in the postoperative period in relation to uterine artery embolization, a technique The results showed that after surgical intervention a decrease occurred in uterus volume and leiomyomas, with symptom improvement and less pain in the postoperative period when compared to the embolization of the uterine arteries, a technique that uses the same concept of devascularization of the tumor. Data are not clear with regard to future reproduction and they prove to be conflicting. The recurrence of symptoms and the need for other complementary surgeries may be a cause of dissatisfaction among the patients. Further studies are required to define convincingly the role of the therapeutic option in the treatment