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Low- and middle-income countries (LMICs) bear a heavier burden of neurosurgical diseases than high-income countries. Brazil, a growing middle-income country, holds promise as a health care market. However, there exists a lack of information to characterize the state of neurosurgical practice and access to care in Brazil. This study aimed to characterize neurosurgical practice in Brazil and identify barriers to care. A collaborative survey was developed with Brazilian neurosurgeons and distributed by the Brazilian Society of Neurosurgery. The survey gathered demographic information, practice characteristics, case volume, referral patterns, income sources, and assessed barriers using a Likert scale. Descriptive statistics were employed for data analysis. One-hundred and forty-nine neurosurgeons participated (response rate: 17.5%), representing various states in Brazil. Neurosurgeons practiced in more than 4 different hospital systems on average, with most consultations and procedures occurring in public hospitals. Common procedures included tumor surgeries, general neurosurgery, spine surgeries, trauma surgeries, and hydrocephalus management. Equipment shortage and systemic issues were identified as major barriers to care. Neurosurgical practice in Brazil exhibits diverse age distribution, widespread distribution across states, and involvement in both public and private hospitals. Survey insights shed light on neurosurgical workload and neurosurgical practice characterization. Lack of equipment and inadequate postoperative resources pose significant barriers to care. The findings highlight the need for investments in equipment, critical care facilities, and improved health care system coordination to enhance access to neurosurgical care in Brazil. [ABSTRACT FROM AUTHOR]

Background and Objective: This study aimed to assess the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) in five selected low and middle-income countries to provide appropriate evidence for other related studies., Materials and Methods: In this multinational population-based cross-sectional survey between August 2019 and April 2021, validated questionnaires were used to assess LUTS in adults over 18 years from Iran, Egypt, Bangladesh, Brazil, and Cameroon., Results: A total of 1477 participants from five countries completed the questionnaires. The mean age of participants was 43.5 ± 15.7 years. 37.1% reported at least one episode of UI per week. UUI prevalence in different countries analysis showed that the commonest prevalence was reported in Cameron (40.0%; n = 30), while the lowest was 15.0% (n = 31) in Brazil. Stress UI was common in Iran (38.7%; n = 338), and Bangladesh had the lowest rate (7.8%; n = 16). Urinary urgency was the common LUTS among participants (59.9%, n = 818 out of 1477 participants). Nocturia was the other prevalent symptom among cases (50.6%; 748 out of 1477 cases), and this symptom had a higher rate in elderly populations. Men reported voiding and postmicturition symptoms more frequently than women. Storage symptoms except for nocturia, including frequency, urgency, and UI were common in women while voiding symptoms, including straining, and intermittency were reported more frequently in men than women., Conclusion: A high prevalence of urinary symptoms was reported in low to middle-income countries., (© 2024 Wiley Periodicals LLC.)

Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with children with ASD (3–17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, type of health care system used, and the parents/caregivers' education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors. [ABSTRACT FROM AUTHOR]

Background: The main barriers to the broad implementation of pediatric minimally invasive surgery (MIS) are technological, technical, and epistemological barriers, as well as the rarity of certain pathologies. These issues are presumed to be more significant in low- and middle-income countries. This study aimed to identify and analyze the factors limiting the diffusion and implementation of pediatric MIS in Brazil., Methods: A nationwide cross-sectional survey was conducted via an online questionnaire in Brazil from January 2022 to July 2022. The sample was taken by convenience from the population of pediatric surgeons in Brazil. A total of 187 surgeons were included. The collected data were divided into three sections to evaluate technological, technical, and epistemological limitations to pediatric MIS implementation., Results: Although 85% of the participants had previous training, a lack of adequate training was identified as a significant limiting factor, particularly among those who had taken only short courses (42.3% vs. 64.3%, p = 0.033). Only 14% of the participants reported performing MIS for major pediatric procedures. With respect to intracorporeal suturing, 38.1% of the surgeons with extensive training considered it a limiting factor compared with 60.7% (p = 0.029) of those without prior training. Among those without previous training, 61% cited a lack of financial support or encouragement from their department as the reason. Additionally, 65% of the surgeons considered the lack of basic instruments a limiting factor. Although 95% of the participants agreed that simulation training is indispensable, pediatric surgery fellowship programs in Brazil do not include a standardized curriculum or mandatory training in MIS, and only 47% reported providing training space for their current fellows., Conclusion: A combination of technological, technical, and epistemological barriers hinders the implementation of pediatric MIS. Despite its limitations, this study serves as a foundational guide for future analysis and overcoming the identified barriers., (© 2024. The Author(s).)

ABSTRACT We compared the prevalence of of non-injecting drug use (NIDU) and Self-Rated Health (SRH) among individuals self-reporting as HIV-positive (PLWHA), HIV-negative and unknown at the III Brazilian Household Survey on Substance Use. Overall, 16,273 individuals, 12-65 years old, were interviewed in 2015. Prevalence and Standard Error (SE) were estimated considering the complex sample design and weight calibration. Chi-square tests with Rao-Scott adjustment were used to test independence between NIDU, SRH and HIV status. PLWHA presented higher frequencies of 12-month use for most substances than those reporting to be HIV-negative: alcohol use prevalence was 49.5% (SE 12.8) vs. 43.1% (SE 0.7), p  = 0.34; tobacco 45.3% (SE 12.7) vs. 15.3% (SE 0.4), p  < 0.01; amphetamines 1.7% (SE 1.7) vs. 0.3% (SE 0.1), p  = 0.51; cannabis 10.5%(SE 6.7) vs. 2.5%(0.2), p  = 0.06; powder cocaine 3.6% (SE 3.0) vs. 0.9% (SE 0.1), p  = 0.45; crack-cocaine 5.3% (SE 3.2) vs. 0.3% (SE 0.1), p  < 0.01; inhalants 3.6% (SE 3.0) vs. 0.2% (SE 0), p  = 0.03; ketamine 1.7%(SE 1.7) vs. 0.1% (SE 0), p  = 0.23; and opioids 1.7% (SE 1.7) vs. 1.4% (SE 0.2), p  = 0.93. PLWHA also reported worse SRH. Our results and the scarcity of integrated substance use and HIV treatments call for innovative, cost-effective approaches to tackle these public health challenges.

Background: Around 20-30% of alcohol use in low and middle-income countries is estimated to come from unrecorded sources, but little is known about the characteristics of its consumers. The aim of this study was to obtain information about users of unrecorded alcohol and describe factors associated with its frequent use., Method: A cross-sectional study, using Respondent Driven Sampling (RDS), was conducted in Rio de Janeiro, Brazil in 2010. Individuals aged 18-65 who reported binge drinking in the last 12 months were recruited to participate in a structured interview. Three sources of unrecorded alcohol use were assessed: home-made/unrecorded; perfumes/lotions; and "medicinal" products (compounds made of herbs and local spirits)., Results: 343 individuals were recruited and 303 were interviewed. The sample comprised mostly of men (n=256) from low socioeconomic strata, with a mean age of 38.8 (±12). Most individuals (71.8%) reported to have used more than one variety of unrecorded alcohol, which was found to be associated with: being older than 31 (OR 2.21; CI 95% 1.05-4.80), an AUDIT score >20 (OR 11.21; CI 95% 4.56-30.96), having used crack/cocaine (OR 2.29; CI 95% 1.02-5.21), and having received treatment for alcohol addiction in the last 12 months (OR 3.64; CI 95% 1.25-13.49)., Conclusion: Most unrecorded alcohol users were disadvantaged polysubstance users. Assessing unrecorded alcohol use has important clinical implications and should be screened for among crack/powder cocaine and alcohol-dependent patients., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Driving under the influence of multiple substances is a public health concern, but there is little epidemiological data about their combined use and putative impact on driving in low and middle-income countries where traffic crashes have been clustering in recent years. The aim of this study is to estimate the prevalence of alcohol and drug use - as well as their associated factors - among drivers in the context of alcohol outlets (AOs)., Methods: A probability three-stage sample survey was conducted in Porto Alegre, Brazil. Individuals who were leaving AO were screened, with the selection of 683 drivers who met the inclusion criteria. Drivers answered a structured interview, were breathalyzed, and had their saliva collected for drug screening. Prevalences were assessed using domain estimation and logistic regression models assessed covariates associated with substance use., Findings: Benzodiazepines 3.9% (SE 2.13) and cocaine 3.8% (SE 1.3) were the most frequently detected drugs in saliva. Among drivers who were going to drive, 11% had at least one drug identified by the saliva drug screening, 0.4% two, and 0.1% three drugs in addition to alcohol. In multivariable analyses, having a blood alcohol concentration (BAC)>0.06% was found to be associated with a 3.64 times (CI 95% 1.79-7.39) higher chance of drug detection, compared with interviewees with lower BACs., Conclusions: To drive under the influence of multiple substances is likely to be found in this setting, highlighting an association between harmful patterns of consume of alcohol and the misuse of other substances., (Copyright © 2013 Elsevier Ltd. All rights reserved.)