Abdominal cavity simulator for skill progression in videolaparoscopic sutures in Brazil

<div><p>Abstract Purpose: To develop and test a model of teaching by means of an abdominal cavity simulator. Methods: This study had two stages: development of a teaching model and an experimental prospective study that aimed to evaluate the residents’ competence. The participants were divided into 3 groups: first-year resident, second-year resident, and senior surgeon. The two groups of resident physicians received training in the simulator, under instructor supervision for skill acquisition, according to the model proposed in first stage. The surgeons did not receive this intervention. The correlations and associations were verified through simple and multiple linear regressions. The learning curves were analysed using Cox regression models. The impact of the epidemiological characteristics was tested. Results: All residents reached the maximum score at the end of 16 steps and were comparable to the experimental (p<0.001). Conclusion: Residents who underwent training using the methodology of the proposed teaching model, which is based on realistic simulation, acquired proficiency in the accomplishment of endosutures in up to 16 hours of training in the laboratory.</p></div

Drug-eluting stents Versus Coronary Artery Bypass Grafting in Multivessel Disease and Left Main Obstruction: Meta-analysis of Randomized Clinical Trials

<div><p>Abstract Background: The choice between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remains controversial. Objective: To conduct a meta-analysis of randomized studies comparing drug-eluting stents (DES) and CABG in multivessel disease or obstruction of the left main coronary artery. Method: Electronic databases were searched systematically to evaluate results of randomized trials comparing PCI with DES versus CABG in multivessel disease and obstruction of the left main coronary artery. Ten studies were identified. Results: In the aggregated results (n = 9268), mortality at 30 days and incidence of stroke favored PCI (0.8% versus 1.5%, p = 0.005; 0.4% versus 1.5%, p < 0.0001, respectively). There was no difference in mortality at 1 year (3.4% versus 3.5%, p = 0.50). The late mortality favored CABG (10.1% versus 8.5%, p = 0.01). In patients with diabetes derived from four studies (n = 3830), late mortality favored CABG (12.5% versus 9.7%, p < 0.0001). In six studies of left main coronary artery obstruction (n = 4700), the incidence of stroke favored PCI (0.3% versus 1.5%, p < 0.001) and there was no difference in mortality at 30 days (0.8% versus 1.3%, p = 0.15), mortality at 1 year, or late mortality (8.1% versus 8.1%). The subgroups with high SYNTAX score and diabetes were those influencing most strongly and adversely the PCI results. Conclusion: When compared with PCI, CABG was superior in regards to late mortality and inferior in regards to 30-day mortality and incidence of stroke. Diabetes and SYNTAX score strongly impacted the results.</p></div

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series

<div><p>Abstract Objectives: this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil. Methods: series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models. Results: a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 – 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 – 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 – 39.05) and not having any children (AOR= 3.43). Conclusions: rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.</p></div

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil

<div><p>Abstract Background Food insecurity has important effects on human health, particularly in children’s. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil. Objective Evaluate the association between cash transfer programs and reductions in inequity and food insecurity. Method Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, “ Bolsa Família”, have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security. Results Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children’s nutritional status. Conclusions CTPs and investment in education are initiatives that might be used to reduce food insecurity.</p></div