Doctors for Brazil Program: first results. / Programa Médicos pelo Brasil: primeiros resultados.

Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

O acesso ao cuidado médico é essencial para o alcance da atenção primária à saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em medicina de família e comunidade; e o fato de ser a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa por meio de seu processo seletivo, 97,1% de ocupação das vagas e 95,4% de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.

ZORRO: Z Omphaloplasty Repair for Omphalocele.

PURPOSE: To suggest a novel technique for omphalocele closure which uses the circular base of the umbilical cord, thus allowing for a more physiological healing process and natural-looking scar. METHODS: Among 16 neonates operated for omphalocele between 2011 and 2016, 12 were closed with a one-stage procedure using a Z omphaloplasty (ZORRO). Median gestational age was 36.5 weeks; median birth weight was 3210 g. The umbilical arteries were divided and ligated outside the peritoneal cavity above the parietal musculocutaneous plane. The upper part of the defect was closed vertically in the midline, while the lower part was closed in a circular fashion by imbricating 2 lateral cutaneous Z flaps thus forming a new cordonal base. RESULTS: The postoperative course was uneventful in all cases. The reconstructed cordonal bases healed as would a normal umbilical cord, with central umbilication surrounded by healthy skin. With a median follow-up period of 11 months, the umbilicus was in the normal position, with a 0.6 xyphoumbilical/xyphopubic ratio. CONCLUSIONS: This technique mimics the natural necrosis mechanism and physiological healing of the umbilicus thus allowing for an esthetic and "natural looking" umbilicus.

Programa Médicos pelo Brasil: primeiros resultados / Doctors for Brazil Program: first results

Resumo O acesso ao cuidado médico é essencial para o alcance da atenção primária à saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em medicina de família e comunidade; e o fato de ser a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa por meio de seu processo seletivo, 97,1% de ocupação das vagas e 95,4% de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Total Laparoscopic Approach for Transhiatal Esophagectomy and Gavriliu's Esophagoplasty in Children with Caustic Esophageal Injuries.

BACKGROUND: Esophageal repair after caustic injury is a surgical challenge in children. The aim of this study was to report the first results of a total laparoscopic approach in transhiatal esophagectomy and esophageal replacement by an anisoperistaltic gastric tube. PATIENTS AND METHODS: A retrospective review of data from children operated on with a laparoscopic approach for transhiatal esophagectomy and Gavriliu's esophagoplasty between 2011 and 2015 was performed. Surgical techniques were related with variations for 2 cases, 1 case with robotic assistance and 1 with thoracoscopic assistance. RESULTS: Seven patients were operated on. The median weight was 16 kg. Median duration of mechanical ventilation was 2 days. Total esophagectomy was achieved in all cases. Two patients could eat after a barium swallow 7 days after surgery. The most frequent immediate complication (57%) was anastomotic or gastric tube leakage treated successfully in 100% of the cases with self-expanding metallic stent placement. Seventy-one percent of children presented with stenosis, which responded to pneumatic dilatation in 67% of the cases. Redo surgery was required in 43%, either for anastomosis revision or nonfunctioning gastric tube. With an average follow-up of 51 months, 85.7% of children achieved oral feeding. CONCLUSIONS: Total laparoscopic approach for esophagectomy and esophageal replacement by Gavriliu's anisoperistaltic gastric tube is a feasible technique allowing to shorten the postoperative mechanical ventilation duration and save parietal damage often present in these patients requiring multiple surgery. It appears to have a good long-term tolerance, although the immediate postoperative complication rate remains as high as the open technique.

Doctors for Brazil Program: first results / Programa Médicos pelo Brasil: primeiros resultados

Access to medical care is essential for achieving quality Primary Health Care (PHC). In Brazil, access difficulties persist. The Doctors for Brazil Program (PMpB in Portuguese) intends to expand the offer of medical services in places of difficult provision or high vulnerability. It brings as innovations the prioritization of smaller and more isolated cities; the selection of professionals through an isonomic process; training in Family Practice and; the first federal medical career in the PHC, with competitive salaries, progression and financial incentives that value longitudinality and performance. The PMpB is executed by the Agency for the Development of Primary Health Care (Adaps), which allows for more efficient management. The first nine months of the program show promising results, with approximately 23,000 physicians interested in joining the program through its selection process, 97,1% of occupying vacancies and 95,4% of retention. Such results indicate an improvement in the quality of the PMpB in relation to previous policies, as well as the need to continue with its implementation, so that it reaches its full potential of coverage in the PHC of the public health system.

O acesso ao cuidado médico é essencial para o alcance da Atenção Primária à Saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Ele traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em Medicina de Família e Comunidade e; a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa através de seu processo seletivo, 97,1% de ocupação das vagas e 95,4 % de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.