Mammography in asymptomatic women aged 40-49 years

OBJECTIVE To assess findings of mammography of and interventions resulting from breast cancer screening in women aged 40-49 years with no increased risk (typical risk) of breast cancer. METHODS This cross-sectional study evaluated women aged 40-49 years who underwent mammography screening in a mastology reference center in Recife, PE, Northeastern Brazil, between January 2010 and October 2011. Women with breast-related complaints, positive findings in the physical examination, or high risk of breast cancer were excluded. RESULTS The 1,000 mammograms performed were classified into the following Breast Imaging-Reporting and Data System (BI-RADS) categories BI-RADS 0, 232; BI-RADS 1, 294; BI-RADS 2, 294; BI-RADS 3, 16; BI-RADS 4A, 2; BI-RADS 5, 1. There was one case of grade II invasive ductal carcinoma and various interventions, including 469 ultrasound scans, 53 referrals to mastologists, 11 cytological examinations, and 8 biopsies. CONCLUSIONS Mammography screening in women aged 40-49 years with typical risk of breast cancer led to the performance of other interventions. However, it also resulted in increased costs without demonstrable efficacy in decreasing mortality.OBJETIVO Avaliar os achados mamográficos e as intervenções decorrentes do rastreamento em mulheres de 40 a 49 anos de idade com risco habitual para o câncer de mama. MÉTODOS Estudo transversal com mulheres de 40 a 49 anos, submetidas ao rastreamento mamográfico em centro de referência em mastologia, em Recife, PE, de janeiro de 2010 a outubro de 2011. Foram excluídas mulheres com queixas mamárias, alterações no exame físico e com alto risco para câncer de mama. RESULTADOS Das 1.000 mamografias realizadas, 232 foram BI-RADS 0, 454 BI-RADS 1, 294 BI-RADS 2, 16 BI-RADS 3, duas BI-RADS 4A, uma BI-RADS 4C e uma BI-RADS 5. Observou-se um único caso de carcinoma ductal invasivo grau II e várias intervenções: 469 ultrassonografias, 53 encaminhamentos para a mastologia, 11 citologias e oito biópsias. CONCLUSÕES O rastreamento mamográfico em mulheres de 40 a 49 anos com risco habitual para o câncer de mama leva a outras intervenções e, assim, ao aumento dos custos com eficácia não mostrada para redução da mortalidade

Factors associated with severe maternal morbidity and near miss in the São FranciscoValley, Brazil: a retrospective, cohort study

BACKGROUND: Maternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries. The objective of this study was to determine the risk factors for severe maternal morbidity and near miss (SMM/NM) in pregnant and postpartum women at the maternity ward of the Dom Malan Hospital, Petrolina, in northeastern Brazil. METHODS: A retrospective, cohort study was conducted to evaluate the sociodemographic and obstetric characteristics of the women. Patients who remained hospitalized at the end of the study period were excluded. Risk ratios (RR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of relative risk. Hierarchical multiple logistic regression was also performed. Two-tailed p-values were used for all the tests and the significance level adopted was 5%. RESULTS: A total of 2,291 pregnant or postpartum women receiving care between May and August, 2011 were included. The frequencies of severe maternal morbidity and near miss were 17.5% and 1.0%, respectively. Following multivariate analysis, the factors that remained significantly associated with an increased risk of SMM/NM were a Cesarean section in the current pregnancy (OR: 2.6; 95% CI: 2.0 – 3.3), clinical comorbidities (OR: 3.4; 95% CI: 2.5 – 4.4), having attended fewer than six prenatal visits (OR: 1.1; 95% CI: 1.01 – 1.69) and the presence of the third delay (i.e. delay in receiving care at the health facility) (OR: 13.3; 95% CI: 6.7 – 26.4). CONCLUSIONS: The risk of SMM/NM was greater in women who had been submitted to a Cesarean section in the current pregnancy, in the presence of clinical comorbidities, fewer prenatal visits and when the third delay was present. All these factors could be minimized by initiating a broad debate on healthcare policies, introducing preventive measures and improving the training of the professionals and services providing obstetric care

Effectiveness of antenatal corticosteroids in reducing respiratory disorders in late preterm infants: randomised clinical trial

Objectives To determine the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks’ gestation

Who is responsible for Brazil’s COVID-19 catastrophe?

Despite being relatively well-placed to combat COVID-19, Brazil now has one of the highest death rates in the world. Often seen as a problem of coordination between levels of government, the real issue has been federal-level failures that stem back to a pre-existing political crisis. This catastrophic, top-down mishandling of the pandemic has effectively neutralised the strengths and often heroic efforts of the national healthcare system, write Gabriela Lotta (FGV), Michelle Fernandez (Universidade de Brasília), Deisy Ventura (Universidade de São Paulo), Danielle Rached (FGV), Melania Amorim (Universidade Federal de Campina Grande), Lorena Barberia (Universidade de São Paulo), Tatiane Moraes (Fiocruz), and Clare Wenham (LSE Health Policy)

Quem é responsável pela catástrofe Brasileira na crise de Covid-19?

Apesar de ter um sistema de saúde relativamente bem colocado para combater a COVID-19, o Brasil tem hoje uma das maiores taxas de mortalidade do mundo. Frequentemente visto como um problema de coordenação entre os diferentes níveis de governo, o verdadeiro problema são as falhas do nível federal que se originaram em uma crise política pré-existente. Este tratamento catastrófico feito de cima para baixo da pandemia neutralizou os pontos fortes e, muitas vezes, os esforços heroicos do sistema nacional de saúde, escrevem Gabriela Lotta (FGV), Michelle Fernandez (Universidade de Brasília), Deisy Ventura (Universidade de São Paulo), Danielle Rached (FGV), Melania Amorim (Universidade Federal de Campina Grande), Lorena Barberia (Universidade de São Paulo), Tatiane Moraes (Fiocruz), e Clare Wenham (LSE Health Policy)

Maternal hemodynamic responses to two different types of moderate physical exercise during pregnancy: a randomized clinical trial

Background/Aim:  Maternal hemodynamic responses (heart rate, systolic and diastolic blood pressure) were compared during two types of moderate-intensity physical exercise. Methods:  A randomized clinical trial compared 120 pregnant women performing physical exercise on a treadmill (n=64) or stationary bicycle (n=56).  In 44 of these women (n=23 treadmill; n=21 bicycle), blood pressure was monitored for 24 hours following exercise.  Repeated-measures analysis compared maternal heart rate, systolic and diastolic blood pressure before, during and in the 24 hours following exercise in both groups.  Results:  Maternal heart rate increased significantly (p<0.001) with both types of exercise (from 84 at rest to 112 bpm on the treadmill and from 87 at rest to 107 bpm on the bicycle), without exceeding the limit of 140 bpm.  Systolic pressure increased from 110 at rest to 118 mmHg on the bicycle (p=0.06) and from 112 at rest to 120 mmHg on the treadmill (p=0.02).  Systolic pressure dropped steadily following exercise, reaching its lowest level (104 mmHg) after 14 hours, increasing thereafter and returning to pre-exercise levels by the 19th hour.  Diastolic pressure increased during exercise irrespective of the type of exercise (p=0.27), from 70 at rest to 75 mmHg on the bicycle (p=0.39) and from 70 at rest to 76 mmHg on the treadmill (p=0.18), with the lowest level (59 mmHg) being at the 13th hour. Conclusions:  A slight increase in blood pressure levels was found during exercise; however, this was not clinically significant and was followed by a substantial hypotensive effect that lasted around 19 hours. Register: Clinical Trials NCT01383889

Exercício de intensidade moderada durante a gravidez é seguro para o feto? Ensaio clínico aberto

To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks. Methods A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20-minute periods (resting, treadmill walking, and postexercise recovery). Results The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p <0.001), with bradycardia occurring in 56% of the fetuses in the first 10minutes of exercise, and in 47% after 20minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds ( p <0.001) and 7.6, 10.8 and 7.6 bpm ( p =0.002) in the resting, walking and recovery phases, respectively. The mean number of fetal movements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods ( p <0.001). In overweight/obese women, the mean FHR was lower ( p =0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28 (th) week of pregnancy (protective effect) and maternal weight (increased risk). Conclusion In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed419531538CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE APOIO À PESQUISA DO ESTADO DA PARAÍBA - FAPESQUniversal 480761/2008-6PPSUS2009Determinar o efeito da caminhada em esteira sobre a frequencia cardiaca materna (FCM) e parametros cardiotocograficos (batimentos cardiofetais basais [BCFs], movimentos ativos fetais [MAFs], numero de aceleracoes e desaceleracoes e variabilidade de curta [STV] e longa [LTV] duracAo da frequencia cardiaca fetal) em gestantes na 36 (a) semana. Metodos Foi realizado um ensaio clinico nAo randomizado e aberto com 88 gestantes saudaveis submetidas a caminhada de moderada intensidade na esteira e a cardiotocografia computadoriza em 3 momentos de 20 minutos (antes, durante e apos a caminhada). Resultados A media dos BCFs diminuiu durante a caminhada, retornando a niveis previos (antes: 137 bpm; durante: 98 bpm; apos: 140 bpm; p <0,001), com bradicardia ocorrendo em 56% dos fetos nos primeiros 10 minutos do exercicio, e em 47% apos 20 minutos. A bradicardia fetal nAo foi observada em outros momentos (antes ou depois). As medias da STV e da LTV foram 7,9, 17,0 e 8,0 milissegundos ( p <0,001) e 7,6, 10,7 e 7,6 bpm ( p =0,002) antes, durante e apos a caminhada, respectivamente. A media dos numeros dos MAFs em 1 hora foi 29,9, 22,2 e 45,5, respectivamente, nos tres momentos ( p <0,001). Nas mulheres com sobrepeso/obesidade, a media da FCM foi menor ( p =0,02). Apos a analise de regressAo logistica, duas variaveis permaneceram significativamente associadas a bradicardia: aptidAo maternal na 28 (a) semana de gravidez (efeito protetor) e peso materno (aumento do risco). ConclusAo Em fetos saudaveis, o exercicio fisico mostrou-se seguro, uma vez que, embora os BCFs e os MAFs diminuam durante a caminhada na esteira, foi observado um aumento da SVT e da LT

COVID-19 and maternal death in Brazil: an invisible tragedy

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How can countries create outbreak response policies that are sensitive to maternal health?

From BMJ via Jisc Publications RouterEnsuring women’s need for sexual and reproductive healthcare are met should be a priority during disease outbreaks, say Maira L S Takemoto and colleaguesOpen access fees were paid by the UN University-International Institute for Global Health.373pubpu