Adequação do uso de pílula anticoncepcional entre mulheres unidas

A total of 2,364 women in marital union, 15 to 49 years of age, were interviewed at home. They lived in poor neighbourhoods in the metropolitan area and in the interior of S. Paulo State, Brazil. The prevalence of contraceptive pill use and the association between socio-demographic characteristics of users and the presence or not of risk factors for pill use were studied. One fourth (25.8 percent) of the women interviewed were using contraceptive pills. Prevalence was higher among younger women, those with no more than one live child and those who had completed between three and eight grades of schooling. Over 40 percent of the users referred having risk factors for pill use at the time they initiated the method. No association was found between age and the percentage of women with risk factors. This percentage increased with number of children and decreased with women's schooling. The fact that pills were prescribed or obtained through the health system was not associated with the proportion of users with risk factors. The percentage of users with risk factors was similar when comparing women who did not consult any health service before initiating use with those who had consulted a public service. The prevalence of use observed in this study is similar to that described by other authors. Results show that the health system in the State of S. Paulo played no role in the improvement in the prescription of hormonal contraceptive pills. Central policy seemed not to have filtered down to the peripheral areas of the system.Foram entrevistadas em seus domicílios 2.364 mulheres unidas de 15 a 49 anos de idade, que moravam em bairros de baixa renda, na área metropolitana e no interior do Estado de São Paulo, Brasil. Estudou-se a prevalência de uso da pílula contraceptiva, a associação entre algumas características sócio-demográficas das usuárias e a presença ou não de fatores de risco para seu uso. Verificou-se que 25,8% das mulheres usavam pílula anticoncepcional. A prevalência de uso foi maior entre as mais jovens, entre as com até um filho vivo e nas com 5ª a 8ª séries de escolaridade. Mais de 40% das usuárias referiram apresentar fatores de risco ao iniciar o uso. Não se verificou associação entre a idade e a percentagem de mulheres com fatores de risco. Essa percentagem aumentou com o número de filhos e diminuiu com a escolaridade da mulher. A presença de fatores de risco foi igualmente freqüente entre as mulheres que não consultaram nenhum serviço de saúde para iniciar o uso como entre aquelas que consultaram em serviços públicos. As políticas do nível central não parecem ter atingido a periferia do sistema

Influência da reconstrução mamária imediata no prognóstico de pacientes com câncer de mama localmente avançado

OBJECTIVE: To evaluate the influence of immediate breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap in the prognosis of locally advanced breast cancer patients submitted to radical mastectomy. PATIENTS AND METHODS: Ninety patients were selected at the Breast Pathology Unit of the University of Campinas (CAISM - UNICAMP), from June 1982 to June 1989; 45 patients with immediate breast reconstruction with TRAM and the other 45 withoutbreast reconstruction (controls). We studied local and distant recurrence-free survival intervals and the overall survival. RESULTS: The local recurrence rate was low (6.6% for the experimental group and 4.4% for the control group). The distant recurrence rate was similar for both groups. There were no significant differences in the curves of local and distant recurrence-free survival between the two groups. We observed that recurrence was uniform during the first 5 years after mastectomy in both groups. The overall survival was approximately the same for both groups. The overall survival curve did not present significant differences between the experimental and control groups. CONCLUSION: We concluded that immediate breast reconstruction did not influence the parameters studied. OBJETIVO: O objetivo deste trabalho foi avaliar a influência da reconstrução mamária imediata com a técnica de rotação de retalho miocutâneo pediculado do músculo reto abdominal, no prognóstico de pacientes portadoras de câncer de mama localmente avançado.PACIENTES E MÉTODOS: Foram selecionadas no ambulatório de patologia mamária do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, no período de junho de 1982 a junho de 1989, 45 pacientes com câncer de mama estádio IIIa submetidas à mastectomia radical com reconstrução imediata e comparadas com um grupo-controle de 45 pacientes com câncer de mama estádio IIIa submetidas apenas à mastectomia radical. Os parâmetros estudados foram: intervalo livre de doença local, intervalo livre de doença à distância e sobrevida total.RESULTADOS: A taxa de recidiva local foi baixa, sendo 6,6% no grupo de estudo e 4,4% no grupo-controle. Em relação à curva de sobrevida livre de doença local, não houve diferenças significativas entre o grupo tratado com MRRI e o grupo tratado com MR. Em relação à taxa de recidiva à distância os resultados foram semelhantes nos dois grupos. A curva de sobrevida livre de doença à distância não mostra diferenças significativas. Verificou-se que as recidivas ocorreram homogeneamente durante os primeiros 5 anos pós-mastectomia nos dois grupos. A sobrevida total foi praticamente a mesma nos dois grupos. A curva de sobrevida total não mostra diferenças significativas entre o grupo de casos e os controles.CONCLUSÃO: Concluiu-se que não houve interferência da reconstrução imediata nos parâmetros estudados.&nbsp

2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries