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Delivery of essential pediatric congenital surgical care within Brazil’s universal health coverage system:a national survey of pediatric surgeons

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World Journal of Pediatric Surgery 2023年第3期6卷 136-146页

作者： paul r truche Abbie E Naus Fabio Botelho Julia Ferreira Alexis Bowder Luke Caddell Kathrin Zimmerman Isabella Maria de Freitas Faria Bellisa Caldas Lopes Eduardo Corrêa Costa Fernanda Lage Lima Dantas Augusto J S A Cavalcante Carlos A L B Carvalho Simone Abib David P Mooney Nivaldo Alonso Program in Global Surgery and Social Change Harvard Medical SchoolBostonMassachusettsUSA Department of Surgery Rutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA Department of Pediatric Surgery McGill UniversityMontrealQuébecCanada Department of Surgery Medical College of WisconsinMilwaukeeWisconsinUSA Division of Otolaryngology-Head and Neck Surgery Department of SurgeryUniversity of Wisconsin-Madison School of Medicine and Public HealthMadisonWisconsinUSA School of Medicine UFMGBelo HorizonteMinas GeraisBrazil Department of Pediatric Surgery Instituto de Medicina Integral Professor Fernando FigueiraRecifeBrazil Department of Pediatric Surgery Hospital de Clinicas de Porto AlegrePorto AlegreBrazil Department of Pediatric Surgery Federal University of AcreRio BrancoBrazil Department of Pediatric Surgery Hospital Santa Casa de Belo HorizonteBelo HorizonteBrazil Department of Pediatric Surgery Federal University of Mato GrossoCuiabaBrazil Department of Pediatric Surgery UNIFESPSao PauloBrazil Department of Pediatric Surgery Boston Children's HospitalBostonMassachusettsUSA Department of Plastic Surgery University of São Paulo Institute of Biomedical SciencesSao PauloBrazil

Objective In this study,we assess the delivery of congenital pediatric surgical care under Brazil’s system of universal health coverage and evaluate differences in delivery between public and private *** A cross-sectional national survey of pediatric surgeons in Brazil was *** were asked which of 23 interventions identified through the Disease Control Priorities 3(Surgical Interventions for Congenital Anomalies)they perform and to report barriers faced while providing surgical *** were weighted by state and stratified by sector(public vs private).results A sample of 352 responses was obtained and weighted to represent 1378 practicing pediatric surgeons registered in Brazil during the survey time.73%spend the majority of their time working in the public sector(‘SistemaÚnico de Saúde’and Foundation hospitals),and most of them also work in the private ***,Brazilian pediatric surgeons have the expertise to provide thoracic,abdominal,and urologic *** working mostly in the public sector were more likely to report a lack of access to essential medications(25%vs 9%,pr surgical patients(52%vs 32%,prazilian pediatric surgeons routinely perform thoracic,abdominal,and urologic *** working in government-financed hospitals face barriers related to infrastructure,which may impact Brazilians who rely on Brazil’s universal health coverage *** that support pediatric surgeons working in the public sector may promote the workforce available to provide congenital pediatric surgical care.

关键词： pediatric survey Brazil

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Perspectives on perioperative management of children’s surgical conditions during the COVID-19 pandemic in low-income and middle-income countries:a global survey

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World Journal of Pediatric Surgery 2020年第3期3卷 29-36页

作者： paul truche Alexis Bowder Amber Trujillo Lalla robert Crum Fabio Botelho Henry Elliot rice Bellisa Caldas Lopes Sarah Greenberg Faye Evans John Gerard Meara Emmanuel Adoyi Ameh David Patrick Mooney Program in Global Surgery and Social Change Harvard Medical SchoolBostonMassachusettsUSA Department of Surgery Boston Children's HospitalBostonMassachusettsUSA University of New Mexico School of Medicine AlbuquerqueNew MexicoUSA Hospital das Clinicas da Universidade Federal de Minas Gerais Belo HorizonteMinas GeraisBrazil Division of Pediatric General Surgery Duke Children's Hospital and Health CenterDurhamNorth CarolinaUSA Department of Pediatric Surgery Instituto de Medicina Integral Prof.Fernando FigueiraRecifeBrazil Department of Surgery University of WashingtonSeattleWashingtonUSA Division of Pediatric General&Thoracic Surgery Seattle Children’s HospitalSeattleWashingtonUSA Department of Anesthesiology Critical Care and Pain MedicineBoston Children's HospitalBostonMassachusettsUSA Department of Plastic and Oral Surgery Boston Children's HospitalBostonMassachusettsUSA Division of Paediatric Surgery Department of SurgeryNational HospitalAbujaNigeria

Background Many organizations have issued recommendations to limit elective surgery during the coronavirus disease 2019(COVID-19)*** surveyed providers of children’s surgical care working in low-income and middle-income countries(LMICs)to understand their perspectives on surgical management in the wake of the COVID-19 pandemic and how they were subsequently modifying their surgical care *** A survey of children’s surgery providers in LMICs was *** reported how their perioperative practice had changed in response to *** were also presented with 26 specific procedures and asked which of these procedures they were allowed to perform and which they felt they should be allowed to *** in surgical practice reported by respondents were analyzed *** A total of 132 responses were obtained from 120 unique institutions across 30 LMICs.117/120 institutions(97.5%)had issued formal guidance on delaying or limiting elective children’s surgical *** in LICs were less likely to have issued guidance on elective surgery compared with middle-income facilities(82%in LICs vs 99%in lower middle-income countries and 100%in upper middle-income countries,p=0.036).Although 122(97%)providers believed cases should be limited during a global pandemic,there was no procedure where more than 61%of providers agreed cases should be delayed or *** There is little consensus on which procedures should be limited or delayed among LMIC *** of testing capacity and local,context-specific guidelines may be a better strategy than international consensus,given the disparities in availability of preoperative testing and the lack of consensus towards which procedures should be delayed.

关键词： income survey testing

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