Correction: Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012).

[This corrects the article DOI: 10.1371/journal.pone.0201723.].

Validation of the TWIST score for testicular torsion in adults.

PURPOSE: The TWIST (Testicular Work-up for Ischemia and Suspected Torsion) score was developed to allow for expedited diagnosis of testicular torsion (TT) in children based on clinical variables: edema (2 points), hard mass (2), absent cremasteric reflex (1), high-riding testis (1) and nausea/vomiting (1). We sought to validate the TWIST Score applied by non-expert physicians for the diagnosis of testicular torsion in an adult population. METHODS: We prospectively analyzed all consecutive males presenting to a tertiary hospital with acute scrotum. Patients with previous scrotal pathology or trauma were excluded. Physical examination was performed by a general surgeon and variables of TWIST were recorded. All patients underwent Scrotal Doppler Ultrasound. Measures of accuracy of the TWIST score and ROC curves were generated to evaluate its performance in diagnosing TT in adults. RESULTS: Of 68 patients, 34 had TT (50%). Median age was 24.9 years. According to the original cutoffs of TWIST, 23 patients had a score ≤ 2 among which none had TT. Fifteen patients had a score of 3-4, among which seven had TT. Thirty patients had a score ≥ 5, among which 27 had TT. All 18 patients with a score of 6 or greater had TT (100% PPV). ROC curve revealed an AUC of 0.95. CONCLUSION: The TWIST Score is valid for the diagnosis of Testicular Torsion in adults, presenting a PPV of 90% for a cutoff of 5 points and 100% for six points. In all patients with a score of 2 or less, the disease could be safely excluded (100% NPV).

Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012).

Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors' supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.

Brazil's Family Health Strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012).

Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health improvements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors.

Transition to universal primary health care coverage in Brazil: analysis of uptake and expansion patterns of Brazil’s Family Health Strategy (1998-2012)

Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors’ supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.

Informações médicas na internet afetam a relação médico-paciente / Does the medical information currently available on the Internet affect the physician-patient relationship

Este artigo pretende avaliar o impacto, sobre a relação médico-paciente, das informações disponíveis na internet. Foram aplicados questionários para 221 pacientes e 84 médicos, seguidos de análise descritiva dos dados, bem como incluídos pacientes com fácil acesso à internet e médicos que os atendem. A pesquisa, feita pelo paciente, muitas vezes resultou em pacientes melhor informados. Relevante número de pacientes se sentiu preocupado pela falsa impressão de portar males descritos na internet. Alguns recorreram à automedicação, modificação da prescrição médica ou, mesmo, à troca de profissional. Não é infrequente ocorrer prejuízo ao tratamento e à relação médico-paciente relacionado às informações obtidas e seu entendimento pelo paciente. Conclui-se que ao potencial (iatrogênico) da internet se contrapõe sua capacidade de difundir importantes informações à população. A certificação de sites por entidade reguladora, gerando qualidade de informação e menor ?iatrogenia?, associada à orientação, poderia ser útil para aperfeiçoar a relação médico-paciente.

This article evaluates the impact of information available on the internet over the physician-patient relationship. The questionnaires were applied to 221 patients and 84 physicians followed by a descriptive data analysis. Patients with easy access to the internet and doctors who consult these people were included in the study. The research when done by the patient often resulted in better informed patients. A significantnumber of patients said they felt worried about having a false impression of having diseases described on theinternet. Some have resorted to self-medication, modification of the prescription or even the exchange of theattending professional. Not infrequently there is damage to treatment and doctor-patient relationship due toinformation obtained by the patient and their understanding of them. At conclusion the “iatrogenic” potentialof the internet is opposed to its ability to disseminate important information to the people. Certification ofsites by regulatory authorities, improving information quality and reducing “iatrogenic”, associated with the guidance of doctors, could be useful to improve the doctor-patient relationship.

Transplante cardíaco na doença de Chagas / Heart transplantation in Chagas’ disease

Dentre as diversas etiologias da insuficiência cardíaca, a miocardiopatia chagásica é considerada a mais agressiva. Como não há tratamento capaz de reverter a evolução da doença o transplante cardíaco torna-se a únicaopção. Foram analisados 107 pacientes portadores da doença de Chagas submetidos a transplante cardíaco, com idades compreendidas entre 11 e 62 anos (42,7±15,3 anos). Os pacientesportadores de megaesôfago e megacólon sintomáticos são automaticamente excluídos dos programas de transplante devido a uma maior possibilidade de complicações no pós-operatório a curto e longo prazo. A expectativa de resultados inferiores para o transplante em chagásicos em relação às demais cardiomiopatias não foi confirmada e, paradoxalmente,se encontram melhores taxas de sobrevida. Notou-se uma mortalidade imediata de 17,7% (19 casos), sendo as principais causas de morte: infecção (6 casos, 31,5%), disfunção do enxerto (6 casos, 31,5%), rejeição (4 casos 21,1%), parada cardiorrespiratória súbita (2 casos 10,5%) e incompatibilidades ABO (1 caso 5,3%). Tardiamente ao transplante, 27 (25,2%) pacientes morreram, sendo as principais causas de morte: rejeição (6 casos, 22,2%), infecção (6 casos, 22,2%), linfoma (4 casos, 14,8%), Kaposi (2 casos, 7,4%), pericardite constritiva (2 casos, 7,4%) e reativação da doença de Chagas no sistemanervoso central (1 caso, 7,1%). Por fim, pode-se concluir que: 1) o transplante cardíaco ainda é a única forma capazde modificar a evolução natural da cardiomiopatia chagásica; 2) o diagnóstico precoce aliado à rápida introdução de benzonidazol leva a um reconhecimento de padrões histológicosnormais do miocárdio sem que haja sequelas e 3) as doses de imunossupressores empregadas devem ser inferiores às utilizadas em outras etiologias.

Among the several etiologies of heart failure, the chagasic myocardiopathy is considered the most aggressive. Once there is no treatment capable of reverting the disease evolution, the heart transplantation becomes the only option. We analyzed 107 patients with Chagas disease submitted to heart transplantation, aged between 11 and 62 years (42.7 ± 15.3 years). Patients with symptomatic megacolon andmegaesophagus are automatically excluded from transplant programs due to a higher possibility of postoperative short and long term complications. The expectation of inferior results for the transplantation of chagasic patients in comparison with other myocardiopathies was not confirmed and, paradoxically, were found better survival rates. We noticed an immediatemortality rated in 17.7% (19 cases), whose main cause of death were: infection (6 cases, 31.5%), graft dysfunction (6 cases, 31.5%), rejection (4 cases 21,1%), sudden cardiopulmonary arrest (2 cases 10.5%) and ABO incompatibilities (1 case 5,3%). Late after transplant, 27 (25.2%) patients died, and the majorcauses were: rejection (6 cases, 22.2%), infection (6 casos, 22.2%), lymphoma (4 cases, 14.8%), Kaposi sarcoma (2 cases, 7.4%), constrictive pericarditis (2 cases, 7.4%) and Chagas disease reactivation in the central nervous system (1 case, 7.1%). Finally, the conclusions are: 1) heart transplantation is still the only way to modify the natural course of chagasicmyocardiopathy, 2) early diagnosis coupled to the rapid introduction of benzonidazol leads to a pattern recognition of normal myocardial histology without sequelae and 3) the doses of immunosuppressants used should be lower than those usedin other etiologies.

Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP): descrição de um projeto musical de gestão, comunicação e relacionamento dos acadêmicos de medicina da Faculdade de Medicina da Universidade de São Paulo / “Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP)”: description of a project of music, management, communication and relationship of medical students of“Faculdade de Medicina da Universidade de São Paulo”

Recentemente tem se discutido muito sobre a formação médica dos acadêmicos das faculdades de medicina. A humanização é um aspecto que influencia a formação de um profissional médico com aptidão para lidar com seres humanos. Estudantes daFaculdade de Medicina da Universidade de São Paulo (FMUSP) com interesse em música se reuniram e formaram um grupo que realiza apresentações musicais em um recital. Assim foi criadoo Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP). Os membros do REMUSP realizam ensaios no Teatro da Faculdade de Medicina da USP de quatro a cinco horas por semana, aproximadamente, organizados através de grupos de Facebook e e-mail. No ano de 2011, durante a sua primeira apresentação, os membros do REMUSP executaram peças predominantemente do estilo clássico e popular, como: Canon In D – Johann Pachelbel, Ave Maria – Johann Sebastian Bach, Solfeggietto – C.P.E. Bach, Can You Feel The Love Tonight? – Elton John, New York, New York – Frank Sinatra, Kiss From a Rose – Seal etc. Atualmente, o REMUSP procuraestimular a cooperatividade e organização nas apresentações musicais, sendo que os ensaios são cada vez mais preenchidos por peças tocadas em conjuntos, em detrimento das individuais, visando à integração e ao aperfeiçoamento da comunicação eorganização de um grupo musical composto por futuros médicos mais humanizados...

Recently there has been an important discussion about the training of medical students from medical colleges.Humanization is an aspect that influences the formation of a medical professional with the ability to deal with human beings. Students of the Faculty of Medicine, University of SãoPaulo (USP) interested in music came together and formed a group that performs in a musical recital. Thus was created the Recital Students of Medicine, University of São Paulo(REMUSP). Members of REMUSP perform musical rehearsals at the Theatre, Faculty of Medicine, USP, four to five hours per week, approximately, organized through Facebook groupsand e-mail. In 2011, during their first presentation, members of the REMUSP performed predominantly classic style and popular as: Canon In D - Johann Pachelbel, Ave Maria - JohannSebastian Bach, Solfeggietto - CPE Bach, Can You Feel The Love Tonight? - Elton John, New York, New York - FrankSinatra, Kiss From a Rose - Seal etc. Currently, the demand REMUSP stimulate cooperatively and organization in musical performances, and musical rehearsals are increasingly filled by pieces to be played by a group, at the expense of the individual,aiming at integration and improvement of communication and organization of a musical group composed of future doctors more humanized...