To publish and divulge scientific production on subjects of relevance to Public Health.
Universidade de São Paulo. Faculdade de Saúde Pública
Risk of reintroduction of vaccine-preventable diseases in the state of São Paulo, Brazil
OBJECTIVE: To analyze the risk classification of transmission of vaccine-preventable diseases in the municipalities of the state of São Paulo (SP) and to assess the influence of population size on the risk of transmission of vaccine-preventable diseases (RTDI) before and after the implementation of Microplanning for High-Quality Vaccination Activities. METHODS: This is an epidemiological study with an ecological design, conducted using secondary data on vaccination coverage for nine immunobiologicals recommended in the immunization schedule for children under two years of age. It also examines dropout rates for multi-dose vaccines within the same age group in the state of São Paulo, covering the years 2022 and 2023. Following the calculation of all indicators, municipalities were classified according to their risk of transmission for vaccine-preventable diseases. RESULTS: Analyses of vaccination coverage indicators, dropout rates, homogeneity of vaccination coverage among vaccines for children under two years of age, and the RTDI indicator for children aged one year or younger revealed that, in 2022, the human rotavirus vaccine had the highest proportion of municipalities reaching the coverage target (46%), followed by the meningococcal vaccine (39%). In 2023, the human rotavirus vaccine maintained the highest proportion of municipalities reaching the target (68%), followed by the pneumococcal vaccine (57%). Regarding the RTDI, in large municipalities, high risk fell from 100% to 91.2%, while in medium-sized municipalities there was a reduction from 90.8% to 66.7%, and in small municipalities, from 68.3% to 56%. CONCLUSION: Challenges remain within the state regarding the RTDI classification for vaccination, particularly in medium-sized and large municipalities. The use of immunization indicators at the municipal level can be highly effective for proposing health interventions aimed at increasing vaccination coverage.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
Brazil is already experiencing the brutal impacts of climate change
Brazil is increasingly experiencing severe climate events, including extreme droughts, wildfires, floods, and heatwaves, driven by both excessive rainfall and prolonged dry periods. These disasters have resulted in significant environmental, economic, and social losses, deepening inequality and fuelling public health crises. Climate change is disproportionately affecting vulnerable populations and contributing to the rise of disease outbreaks such as dengue and Oropouche fever. Brazil’s vulnerability stems from its diverse ecosystems, heavy reliance on agriculture and hydropower, and its critical role in global climate dynamics due to widespread deforestation. This paper examines the country’s future challenges and outlines strategies to address extreme weather events, including the development of climate adaptation policies, enhanced deforestation monitoring, and strengthened disaster preparedness. To improve resilience, Brazil must invest in comprehensive risk assessments, the integration of disaster risk indicators, and the establishment of a national climate-disaster reporting system to better anticipate, mitigate, and manage the impacts of extreme climate events.
Copyright (c) 2026 Camila Lorenz, Thais Araújo Cavendish, Thiago Salomão de Azevedo, Michelle Bell, Adelaide Nardocci, Maria de Fátima Andrade, Thiago Nogueira https://creativecommons.org/licenses/by/4.0
Errata: Intersectionality and mental health in university students: a jeopardy index approach
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
Reconciling advantages and difficulties: knowledge and perceptions of eventdriven PrEP among young people
Perceptions and practices of healthcare providers in providing HIV preexposure prophylaxis to trans adolescents and young adults and men who have sex with men
Factors associated with condomless anal sex among adolescent men who have sex with men and transgender women in three Brazilian state capitals: a PrEP1519 study
Errata: Nas intersecções: operacionalizando análise temática interseccional em prevenção ao HIV
Errata: Recent HIV infections and estimated HIV incidence among adolescents from key populations
Economic burden, mortality, and incidence of hospital admissions for cerebrovascular diseases in Brazil from 2017 to 2022: a perspective of the Brazilian Unified Health System
OBJECTIVE: To analyze hospitalizations, mortality, and costs related to cerebrovascular diseases in Brazil from 2017 to 2022 and to evaluate the impact of the COVID-19 pandemic on these numbers. METHODS: Data were collected from the Brazilian Unified Health System Information Technology Department via the Hospital and Mortality Information Systems. The 2010 censuses and the inter-census projections (2017 to 2022) of the Brazilian Institute of Geography and Statistics were searched for population data. The mortality rates and incidence of hospital admissions for cerebrovascular diseases were calculated by dividing the number of deaths and the number of hospital admissions due to cerebrovascular diseases by the total population at risk, multiplied by 100,000 inhabitants, respectively. The results were stratified by age groups, regions of Brazil, sex, and calendar years. Rates were standardized by age, following the direct method from the World Health Organization. RESULTS: Data on mortality from cerebrovascular diseases showed a significant reduction throughout Brazil in general and by sex. The Brazilian Northeast showed a decrease in overall mortality, especially in women, whereas its South showed stationary numbers. Hospitalization rates remain stable, with notable increases in the age groups for younger (from zero to four years of age) and female (from five to nine years of age). Hospitalization costs increased significantly throughout Brazil, with the highest increase in its Northeast, North, Southeast, and Midwest. CONCLUSION: Mortality rates from cerebrovascular diseases decreased in Brazil, showing regional and age group variations and a worrying increase in young men. Despite stable hospitalizations, hospital costs significantly increased, indicating greater complexity of cases and reinforcing the need for more effective prevention and control strategies.
Copyright (c) 2025 Laércio da Silva Paiva, Gabriel Medeiros Correia da Silva, Luana Kitagawa Cunha Soares, Ana Clara Ramon Giannelli, Fernando Rocha Oliveira, Luiz Vinicius de Alcantara Sousa https://creativecommons.org/licenses/by/4.0
Prices paid for primary health care medicines by Brazilian municipalities
OBJECTIVE: The study analyzes the prices paid by Brazilian municipalities for medicines in 2016, 2018, and 2020, comparing municipal human development index, size, region, and purchase modality. METHODS: Economic Ratio indicator, adapted from that proposed for international analyses by the World Health Organization, was used and analyses were performed using data provided by municipalities to the National Database of Pharmaceutical Assistance Actions and Services. RESULTS: The study reveals that the most socially and economically vulnerable municipalities pay more for these medicines, especially in the North and Northeast regions, which can compromise access to and the efficiency of the Unified Health System. Moreover, the article shows that municipalities that purchased in association tend to pay lower prices, suggesting that consortia may be a strategy to mitigate price inequalities. CONCLUSIONS: Based on the results obtained, we propose the adoption of regulatory, economic, and negotiation strategies to reduce these differences and ensure a more equitable distribution of medicines in Brazil.
Ivanessa Thaiane do Nascimento Cavalcanti
Copyright (c) 2025 Silvana Nair Leite, Wendell Rodrigues Oliveira da Silva, Ivanessa Thaiane do Nascimento Cavalcanti , José Roberto Peters, Luis Eduardo Maciel dos Santos Ferreira , Rafael Santos Santana https://creativecommons.org/licenses/by/4.0
Barriers to implementing the WHO Safe Childbirth Checklist in maternity hospitals, Brazil
OBJECTIVE: To identify barriers to the implementation of the World Health Organization Safe Childbirth Checklist in two reference maternity hospitals—one for high-risk and one for routine-risk childbirths—and to develop a causal model applicable to these contexts. METHODS: This qualitative, exploratory study was conducted in two public maternity hospitals that had been using the checklist, since its implementation in 2014. Data were collected through focus groups interviews and brainstorming sessions conducted in 2022 and 2023. Participants included healthcare professionals involved in childbirth care and members of the patient safety center. Content analysis categorized findings based on the five domains of the Consolidated Framework for Implementation Research (CFIR). A causal model was developed using a fishbone diagram to organize results by category. RESULTS: The identified barriers were classified into four of the five CFIR domains. In the Innovation domain, the checklist itself posed challenges due to its design, complexity, and adaptability to existing workflows. In the Inner Setting, barriers included a weak patient safety culture and infrastructure limitations. The Implementation Process domain revealed deficiencies such as inadequate planning, lack of stakeholder involvement, and absence of feedback and assessment mechanisms. Unlike the high-risk maternity hospital, the Outer Setting barrier —lack of policies supporting continuing education—was identified in the routine-risk facility. CONCLUSIONS: Implementation of the checklist in the studied maternity hospitals is hindered by structural, cultural, and adaptation challenges. Limited investment in training represents a significant obstacle, highlighting the need for professional development programs. High staff turnover and the absence of specific protocols further compromise consistent use. Addressing these barriers requires comprehensive strategies to enhance adherence to and integration of the checklist in maternal-newborn care.
Copyright (c) 2025 Zenewton André da Silva Gama, Ewerton William Gomes Brito, Tatyana Maria Silva de Souza Rosendo, Fernanda Pereira Marinho Amaro, Wilton Rodrigues Medeiros, Flôrismeiire de Souza Silva, Marise Reis de Freitas, Rafhael Brito de Almeida Santos, Rose L. Molina, Katherine E. A. Semrau, Lauren Bobanski, Danielle E. Tuller https://creativecommons.org/licenses/by/4.0
Spatio-temporal analysis of the double burden of malnutrition in children from the Brazilian semi-arid region
OBJECTIVE: To analyze the temporal trend of the double burden of malnutrition in the Brazilian semi-arid and non-semi-arid regions, and to assess its spatial distribution in the Brazilian semi-arid region among children aged 5 to 9 years, between 2008 and 2022. METHODS: Ecological time-series study based on public reports, using macrodata of body mass index-for-age and height-for-age from the Sistema de Vigilância Alimentar e Nutricional (SISVAN – Brazilian Food and Nutritional Surveillance System). For temporal analysis of the prevalence of wasting, overweight, stunting, undernutrition, and the double burden of malnutrition in the semi-arid and non-semi-arid regions, Prais-Winsten regression models were used to estimate the annual percentage change (APC%) between 2008 and 2022. To evaluate spatial distribution in the Brazilian semi-arid region, maps showing the temporal evolution of the prevalence of overweight, undernutrition, and the double burden of malnutrition were constructed. RESULTS: Between 2008 and 2022, 48.7 million children aged 5 to 9 years were registered in SISVAN-Web for body mass index-for-age and height-for-age indices. Approximately 28.1% of these lived in the Brazilian semi-arid region. The prevalence of the double burden of malnutrition in the semi-arid region exceeded 20%, with an increasing trend among children aged 7 to 9 years (APC = 0.61%; p < 0.05). Overweight showed a rising trend, while undernutrition decreased across all strata except among the Indigenous population, which remained stable (APC = −1.12%; p > 0.05). APCs in the semi-arid region were higher than in the non-semi-arid region. CONCLUSION: The study highlights a high prevalence of the double burden of malnutrition in the Brazilian semi-arid region, especially among children aged 7 to 9 years. Therefore, it is crucial to promote health actions and malnutrition prevention, strengthening existing policies and prioritizing the most vulnerable populations.
Copyright (c) 2025 Helen Hermana Miranda Hermsdorff, Maisa Póvoa de Oliveira, Cíntia Pereira Donateli , Daniela Mayumi Usuda Prado Rocha https://creativecommons.org/licenses/by/4.0
Purchase of food from the new staple food basket in low-income Brazilian households
OBJECTIVE: To describe the purchase of foods included in the new staple food basket by low-income households in Brazil, from 2017 to 2018. METHODS: Data on household food purchases were obtained from the 2017–2018 Household Budget Survey, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Data from 13,706 low-income households (< ½ minimum wage per capita) were analyzed. Foods were identified based on an ordinance issued by the Ministry of Social Development and Fight Against Hunger, which specifies the composition of the new staple food basket. Estimates were expressed as a percentage of caloric intake. RESULTS: Foods introduced into the new staple food basket accounted for 84.1% of the total calories purchased by low-income households in Brazil, from 2017 to 2018, with significant participation in rural areas (88.0%) and in the North (88.2%) and Northeast (85.9%) regions. Among food groups, cereals (33.5%), sugars and oils/fats (21.3%), and meats and eggs (11.6%) presented the highest contributions. Rice, corn, and other grains contributed 19.7%, whereas beans accounted for 4.7% of calories. Poultry meat and beef were the most purchased foods in the meat and egg group, representing 5.0% and 4.0% of calories, respectively. Fruits contributed 1.9% and vegetables 0.7% of calories. We observed no major differences in food purchase regarding the race/skin color of the head of the household. CONCLUSION: Analysis shows that in the 2017–2018 period, the foods included in the new staple food basket became the basis of low-income households’ diet, reinforcing the cultural viability of its implementation.
Copyright (c) 2025 Marcos Anderson Lucas da Silva, Lucas Braga Rodrigues, Samuel Almeida Brito, Luisa Gazola Lage, Maria Laura da Costa Louzada https://creativecommons.org/licenses/by/4.0
Percepção da vizinhança e sintomas depressivos: estudo nacional ELSI-Brasil, 2015–2016
OBJECTIVE: To investigate the association between depressive symptoms and neighborhood perception among older adults living in urban areas. METHODS: This cross-sectional study included 7,115 individuals (≥ 50 years) from the baseline (2015–2016) of the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil – Brazilian Longitudinal Study of Aging) who lived in urban areas and had self-reported responses (no proxy respondents), with complete data on the outcome. The outcome was assessed using the 8-item Center for Epidemiologic Studies–Depression Scale (CES-D-8) (cutoff ≥ 4), and the exposure variable was neighborhood perception related to participants’ area of residence. Univariable and multivariable Poisson regression analyses were performed, with each exposure variable adjusted for sociodemographic characteristics and health conditions. RESULTS: The prevalence of depressive symptoms was 34.9%, being 43.8% among women and 24.5% among men. In the multivariable analysis, urban mobility issues, noise pollution, physical disorder, violence, lack of neighborhood pleasantness, low social cohesion, and perceived insecurity were significantly associated with a higher prevalence of depressive symptoms in the overall sample and among women. Among men, all variables except perceived insecurity were also significantly associated with higher prevalence of depressive symptoms. CONCLUSION: The findings highlight the importance of intersectoral action across health, urban mobility, public safety, and urban planning policies to promote mental health among older adults living in urban areas.
Copyright (c) 2025 Pablo Cardozo Roccon, Amanda Cristina de Souza Andrade, Débora Moraes Coelho, Bruno de Souza Moreira , Luciana de Souza Braga, Maria Fernanda Lima-Costa, Waleska Teixeira Caiaffa https://creativecommons.org/licenses/by/4.0
Yellow fever mortality in Brazil: an age-period-cohort study
OBJECTIVE: To analyze yellow fever mortality trends in Brazil, focusing on sexes differences and using an age-period-cohort model. METHODS: This ecological study analyzed yellow fever mortality data in Brazil from 1980 to 2019 sourced from Datasus. Population estimates were retrieved from the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality data, including age, year of death, and cause (ICD-9: 060; ICD-10: A95), were analyzed using an age period cohort model. A Poisson distribution was assumed for mortality counts, and analyses were conducted using Holford’s method and its adaptations on R. RESULTS: The results show that the incidence rate peaked at younger ages, such as 30 years (0.010/100,000 individuals, 95%CI: 0.008/100,000 to 0.013/100,000), followed by a gradual declining trend with increasing age, reaching 0.007/100,000 individuals (95%CI: 0.005/100,000 to 0.010/100,000) at 50 years onward. Regarding period, a substantial increase in the adjusted hazard ratio occurred over time, especially in 2015 (13.923 [95%CI: 11.095 to 17.471]), suggesting a significant elevation when compared with previous periods. Cohort analysis showed a trend of increasing risk until 1960 (RR = 1.000), followed by a marked reduction for more recent cohorts, such as 2010: RR = 0.056 (95%CI: 0.028 to 0.112). Vaccination analysis showed alternating periods of significant increases and decreases in vaccination rates. CONCLUSIONS: Younger individuals showed higher mortality rates, with a gradual decline with advancing age. Period effects highlighted a pronounced resurgence in recent years, particularly during the 2015 epidemic, underscoring the influence of temporal factors such as outbreaks and vaccination campaigns. Cohort analysis showed a progressive decline in mortality risk among more recent birth cohorts, likely reflecting the impact of expanded immunization programs and improved public health measures. The proposed yellow fever vaccination trends in Brazil may explain some of the observed patterns.
Copyright (c) 2025 Lucas Casagrande Passoni Lopes https://creativecommons.org/licenses/by/4.0
Overall survival of neoadjuvant versus adjuvant systemic treatment for breast cancer in Brazil
OBJECTIVE: Compare the overall survival of women with non-metastatic breast cancer who received neoadjuvant systemic therapy followed by surgery versus those who underwent surgery followed by adjuvant systemic therapy. METHODS: A nationwide retrospective cohort study was conducted using real-world data from 2008 to 2015 available on the Brazilian Unified Health System (SUS). Women aged ≥ 18 years with breast cancer undergoing surgery or neoadjuvant systemic therapy as their first treatment between 2008 and 2010 were included. Cohorts were matched using propensity score matching in a 1:1 ratio and assessed 5-year overall survival using Kaplan-Meier, compared by log-rank test and hazard ratios (HR) using Cox proportional HR model. RESULTS: A total of 23,331 women began treatment for breast cancer in SUS with neoadjuvant systemic therapy (n = 6,040) and surgery (n = 17,291). In the matched cohorts (n = 6,040 in both groups), more deaths occurred among those who received neoadjuvant systemic therapy compared with surgery as first treatment (37.3% and 19.6%, respectively; p < 0.001). Overall survival after five years was 0.641 in neoadjuvant systemic therapy and 0.816 in the surgery group (p < 0.001). For both groups, older patients (≥ 70 years) living in northern and midwestern Brazil, in municipalities with low and medium HDI, and self-declared as Black presented the lowest overall survival probabilities. Use of hormone therapy after surgery and conservative surgery instead of mastectomy were associated with higher survival. HR was 5.13 (95%CI: 2.95–8.88) in stage I, 1.57 (95%CI: 1.27–1.95) in stage II, and 1.38 (95%CI: 1.26–1.50) in stage III. CONCLUSION: Women who underwent surgery as first treatment had a significantly higher 5-year overall survival compared with those who received neoadjuvant systemic therapy. Socioeconomic and demographic factors influenced survival outcomes.
Copyright (c) 2025 Carolina Zampirolli Dias, Carolina Campos Vieira de Sousa, Thais Piazza, Ilka Afonso Reis, Augusto Afonso Guerra Junior, Mariangela Leal Cherchiglia https://creativecommons.org/licenses/by/4.0
Dissatisfaction with SUS pharmaceutical services and nonadherence to medication use
OBJECTIVE: To analyze the association between user dissatisfaction with the pharmaceutical services provided by the Brazilian Unified Health System (SUS) and nonadherence to medication use by patients with chronic non-communicable diseases. Correspondence: Poliana Vieira da Silva Menolli Universidade Estadual do Oeste do Paraná Centro de Ciências Médicas e Farmacêuticas Rua Universitária, 1.619 85819-110 Cascavel, PR, Brazil Email: poliana.menolli@unioeste.br Received: Jul 9, 2024 Approved: Feb 25, 2025 How to cite: Menolli PVS, Girotto E. Dissatisfaction with SUS pharmaceutical services and nonadherence to medication use. Rev. Saude Publica. 2025;59:e36. https://doi.org/10.11606/s15188787.2025059006463 Associate Editor: Paulo Frazão Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided that the original author and source are credited. METHODS: A cross-sectional study with data from the service evaluation component of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos in Brazil, conducted from July to December 2014. In-person interviews were analyzed with SUS users aged 18 or over who had used medications for hypertension, diabetes, and dyslipidemia and had visited SUS pharmacies in the three months prior to the survey. The dependent variable was medication nonadherence, assessed through three measures: nonadherence due to lack of medication, nonadherence in the past seven days and declared nonadherence. The independent variable was dissatisfaction with the dimensions of pharmaceutical services (timeliness, availability, and accommodation), measured using item response theory. Logistic regression was performed to calculate crude and adjusted odds ratios (OR). RESULTS: A total of 2,448 users were evaluated. Nonadherence due to lack of medication was 31.6%; in the past seven days was 11.5%; and declared nonadherence 13.0%. Lack of access and forgetfulness were the main reasons for nonadherence in the past seven days. In the adjusted analysis, dissatisfaction with the “timeliness” dimension was associated with nonadherence in the past seven days (OR = 1.489; 95%CI: 1.023–2.168) and the “accommodation” dimension was associated with declared nonadherence (OR = 3.132; 95%CI: 2.266–4.329). CONCLUSION: Dissatisfied users were more likely to be nonadherent to medication use across all service dimensions, and dissatisfaction with the availability and accommodation of pharmaceutical services was associated with nonadherence.
Copyright (c) 2025 Poliana Vieira da Silva Menolli, Edmarlon Girotto https://creativecommons.org/licenses/by/4.0
Locomotion difficulty and need for home care: a cross-sectional study
OBJECTIVE: To investigate home visits by physicians or nurses for consultations and procedures and associated factors in families with people with mobility difficulties and need for home care. METHODS: A cross-sectional study was carried out with data from Ciclo III do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (Cycle III of the National Program for Access and Quality Improvement in Primary Care) from September 2017 to June 2018, interviewing over 140,000 users in 28,939 basic health units in 5,312 municipalities. This study analyzed home visits to individuals with mobility difficulties and the need for home care according to internal and external factors via a Poisson regression. RESULTS: Of all primary healthcare service users, 7.8% stated that someone in their home had mobility difficulties and needed home care. About 70% received home visits. The highest prevalence of home visits, after adjusted analysis, occurred in the Brazilian Northeast. The greater the social vulnerability, the lower the prevalence of home visits in the case of mobility difficulties. Municipalities with 100% coverage from the family health strategy showed a higher prevalence of home visits than those with coverage below 50%. CONCLUSION: External factors, such as income and social vulnerability index (which have a greater relation with macrosocial determinants), continue to point toward inequalities in care; whereas internal factors, such as family health coverage, community health agent coverage in all micro-areas, and the possibility of receiving care without prior appointments indicated better results. This study reinforces the importance of public policies that encourage complete family health teams to provide comprehensive care to the population.
Copyright (c) 2025 Rogério da Silva Linhares, Elaine Thumé, Maria Laura Vidal Carrett, Everton José Fantinel, Maria Aurora Dropa Chrestani Cesar, Elaine Tomasi https://creativecommons.org/licenses/by/4.0
Post-COVID-19 syndrome and health-related quality of life after hospital discharge
OBJECTIVE: To analyze the association between the presence of post-COVID-19 syndrome after six months and health-related quality of life 6 and 12 months after hospital discharge. METHOD: An ambidirectional cohort study was conducted with individuals discharged from three of the main hospitals in Cuiabá (in the state of Mato Grosso) between October 2021 and March 2022. After collecting data from medical records, individuals were interviewed via telephone 6 months (n = 189) and 12 months (n = 159) after hospital discharge, evaluating the presence of at least one persistent post-COVID-19 symptom at 6 months (post-COVID-19 syndrome) and health-related quality of life (EQ-5D-3L) at 6 and 12 months, as well as specific dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The association was assessed via Poisson regression with robust variance, adjusted for sociodemographic, health, and hospitalization characteristics. RESULTS: Of the individuals assessed, 88.4% answered that they had COVID-19 symptoms in the interview after 6 months. At 6 and 12 months after hospital discharge, 55.0% and 74.2% of individuals, respectively, had some impairment in quality of life. In the multiple model, post-COVID-19 syndrome remained associated with having any quality of life issue (RR = 2.43; 95%CI: 1.06–5.57) and specifically with the anxiety/depression domain (RR = 2.74; 95%CI: 1.08–7.01) at 6 months after discharge. The association was no longer significant after 12 months. CONCLUSION: These results show the long-term negative repercussions of post-COVID-19 syndrome on cognitive, emotional, and physical functions, exposing the negative impact on the quality of life of those affected.
Copyright (c) 2025 Roseany Patricia Silva Rocha, Amanda Cristina de Souza Andrade, Ana Paula Muraro https://creativecommons.org/licenses/by/4.0
Temporal trends and regional clusters of tuberculosis-HIV coinfection outcomes in Brazil
OBJECTIVE: To investigate the temporal trends and regional clusters of tuberculosis treatment outcomes among people with HIV in Brazil, as well as their relationship with socioeconomic and programmatic indicators. METHODS: Ecological study with data from people living with HIV who initiated and completed tuberculosis treatment from 2015 to 2021 in Brazil. We described the semiannual trends of cure, treatment interruption, and death rates in Brazilian states using joinpoint regression models. Cluster analyses stratified by three population sizes were conducted using the k-means method to identify clusters in 510 immediate geographic regions. Socioeconomic and programmatic indicators related to treatment interruption and death were included in multivariate negative binomial regression models. RESULTS: A total of 54,362 tuberculosis treatments in people with HIV were analyzed, with cure rates of 55.51%, interruption rates of 23.33%, and death rates of 21.16% for the period. Nationally, cure rates remained stable, while treatment interruption increased by 2.54% per semester (ranging from 1.59% to 3.70%) and death increased by 9.31% (ranging from 7.41% to 17.24%). The states of Ceará and Amapá showed the worst trends for treatment interruption and death. Regions with greater income inequality, higher percentages of workers with only primary education, higher household density, and broader private health coverage had higher rates of treatment interruption and death. Conversely, regions with higher expected years of schooling and hospitalizations for primary care-sensitive conditions had lower probabilities of these outcomes. CONCLUSION: Nationally, despite stable cure rates, tuberculosis treatment interruption and death among people with HIV increased. Regional disparities in the relationship between socioeconomic and programmatic indicators and outcomes suggest inequities in access to and adherence to tuberculosis treatment across Brazil.
Copyright (c) 2025 Lucas Vinícius de Lima, Gabriel Pavinati, Yenny Lorena Valdivia-Rojas, José Nildo de Barros Silva Júnior, Ana Paula Sayuri Sato, Fredi Alexander Diaz-Quijano, Victor Santana Santos, Gabriela Tavares Magnabosco https://creativecommons.org/licenses/by/4.0
Zika virus does not alter locomotor activity of Aedes albopictus (Diptera: Culicidae)
OBJECTIVE: To investigate the effect of Zika virus on the locomotor activity of a Brazilian population of Aedes albopictus under laboratory conditions. METHODS: Females of Aedes albopictus were infected with Zika virus orally or by intrathoracic injection. The locomotor activity was monitored using a Drosophila activity monitor under controlled conditions of 25°C and a 12h light/dark cycle. The infection status was determined using reverse transcription followed by real-time polymerase chain reaction (RT-qPCR). Statistical analyses were conducted using generalized linear mixed models (GLMMs). RESULTS: The locomotor activities of Zika virus-infected and uninfected Aedes albopictus females were diurnal and bimodal, with peaks at lights on and off. The infection did not significantly alter the total activity, diurnal and nocturnal, or the light-on and light-off peaks of infected females compared with uninfected females, regardless of the method of infection (intrathoracic injection or orally). CONCLUSION: This finding indicates that Zika virus infection does not affect the daily activity pattern of this species under laboratory conditions, which reinforces the importance of this species as a competent and adaptable vector in urban and rural areas, confirming the importance of ongoing surveillance and control strategies.
Copyright (c) 2025 Tamara Nunes Lima-Camara , Pâmela dos Santos Andrade, Vivian Petersen, Antônio Ralph Medeiros-Sousa, Anderson Vicente de Paula, Paulo Roberto Urbinatti, Rosa Maria Marques de Sá Almeida https://creativecommons.org/licenses/by/4.0
Auriculotherapy in primary care: profile of graduates from a large-scale course
OBJECTIVES: To present the profile of graduates from a blended learning course in auriculotherapy and their perception of user acceptance and clinical outcomes of this integrative and complementary health practice, currently the most widely implemented in the Brazilian Unified Health System. The course is offered free of charge to primary health care professionals. METHOD: A digital questionnaire was sent in 2023 by email to all graduates to date (n = 13,581), addressing their professional profile, their perception of user acceptance and the clinical outcomes of auriculotherapy. Data were analyzed using descriptive statistics. RESULTS: A total of 5,461 professionals responded (41.34% of graduates from nine editions of the course, each with multiple classes of around 50 to 100 students). Most were women (87.82%), nurses (33.55%), physical therapists (11.59%), psychologists (5.40%), pharmacists (9.65%), nutritionists (8.05%), dentists (7.57%), and physicians (5.57%); aged 30 to 49 years (77.7%); working in primary health care (80.44%); without prior experience in integrative and complementary health practice (73.58%). After the course, 56.31% reported practicing auriculotherapy. User acceptance was reported as high or very high by 73.6% and as moderate by 22.14% of practitioners. Clinical outcomes were reported as very good or good by 79.72% and as moderate by 18.35%. of practitioners. CONCLUSION: The graduates of the auriculotherapy course who responded to the survey are mostly women, family health professionals and members of multi-professional teams working in primary health care, who report higher user acceptance and perceive good clinical outcomes from the use of auriculotherapy.
Copyright (c) 2025 Charles Dalcanale Tesser , Lúcio José Botelho (in memoriam), Melissa Costa Santos, Emiliana Domingues Cunha da Silva, Ari Ojeda Ocampo Moré, Fátima Terezinha Pelachini Farias, Lilian Elizabeth Diesel https://creativecommons.org/licenses/by/4.0
Effect of dietary and lifestyle intervention in pregnant women: randomized clinical trial
OBJECTIVE: To evaluate the intra- and between-group (control and intervention) effect of counseling during pregnancy on pregnant women’s food consumption and physical activity. METHODS: This randomized, parallel, two-arm clinical trial was carried out in primary health care in a Brazilian municipality from 2018 to 2021. Adult pregnant women with pre-gestational overweight (n = 350) were randomly assigned to the control or intervention groups. The intervention consisted of three counseling sessions based on the NOVA food classification system and encouragement toward physical activity. Then, 24-hour dietary records were obtained, and physical activity was assessed using a structured questionnaire. The Wilcoxon test was used for intra-group differences between assessments and the Mann-Whitney test, for differences between groups. RESULTS: Women in the control group consumed less minimally and unprocessed foods (%E) (Δ = −4.08; -13.58 to 4.34; p = 0.006) and more ultra-processed foods (%E) (Δ = 3.74; −5.86 to 12.86; p = 0.009), with no difference between groups. The intervention group showed an increase in commuting-related physical activity (min/week) between assessments (Δ = 9.00; −30.00 to 70.00; p = 0.02), with no difference between groups. The other parameters showed no differences. CONCLUSIONS: The intervention failed to affect outcomes. However, intragroup changes showed that the control consumed less minimally and unprocessed foods and more ultra-processed foods and the intervention group increased their commuting-related physical activities.
Copyright (c) 2025 Daniela Saes Sartorelli, Maria Carolina de Lima, Natalia Posses Carreira https://creativecommons.org/licenses/by/4.0
Health profile and metal exposure over three years in a child cohort study, Bruminha Project
OBJECTIVE: To describe the health profile and patterns of exposure to mining waste over the period of three years in a cohort of children living in areas affected by the collapse of a mining tailings dam in Brumadinho, Minas Gerais State, Brazil, in 2019. METHODS: This prospective cohort study included all children aged 0 to six years residing in four selected locations: three in the disaster zone (Parque da Cachoeira, Córrego do Feijão, and Tejuco – exposed areas) and one located 10 km away (Aranha – non-exposed area). Assessments included anthropometric growth, neuromotor and cognitive development, and respiratory conditions. Urine samples were collected and analyzed for lead, arsenic, cadmium, mercury, and manganese using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: The average percentage of children assessed in the period was 80% of the projected population. There was an increase in the percentage of children with urinary arsenic levels above the reference value over the three-year period (2021 = 42%; 2022 = 44%; 2023 = 57%), as well as in detection rates of lead (88.9%) and mercury (63.9%) in 2021, both reached 100% in 2023. T he median urinary arsenic concentration increased from 2021 (9.35 μg/g; IQR = 5.45–13.9) to 2023 (10.8 μg/g; IQR = 7.0–15.3) in the total sample of children (p = 0.064), with a statistically significant increase among those living in exposed areas (p = 0.015; Parque da Cachoeira). Over the three-year period, there was a decrease in the percentage of neurodevelopmental alterations and overweight/obesity, and an increase in reports of respiratory alterations in the total population, although these changes were not related to metal exposure. CONCLUSION: The findings indicate ongoing exposure of the metals analyzed in the study population; however, no associated health effects have been identified thus far. It is essential that the Brazilian Unified Health System be structured according to specificities of the productive processes in each territory.
Copyright (c) 2025 Carmen Ildes Rodrigues Fróes Asmus, Maíra Lopes Mazoto, Nataly Damasceno de Figueiredo, Herling Gregorio Aguilar Alonzo, Renan Duarte dos Santos Saraiva , Aline de Souza Espindola Santos , Ana Paula Natividade de Oliveira, Ivisson Carneiro Medeiros da Silva, Michele Alves Costa , Leiliane Coelho André, Sérgio Viana Peixoto, Volney de Magalhães Câmara https://creativecommons.org/licenses/by/4.0
Analysis of the post-incorporation period of health technologies incorporated into the SUS, from 2012 to 2022
OBJECTIVE: To analyze the time elapsed in the post-incorporation process of procedures, orthoses, prostheses, and special materials, with a focus on compliance with the legal deadline of 180 days established for the provision of the technology. METHODS: The analysis was conducted with procedures and orthoses, prostheses, and special materials recommended for incorporation by the National Commission for the Incorporation of Technologies from 2012 to 2022, and the technology identification code created in the Management System for the Table of Procedures, Medicines, Orthoses, Prostheses and Special Materials of the Brazilian Unified Health System, after incorporation. For the technologies identified, we calculated the median periods (Q1–Q3) of the days elapsed during the incorporation and post-incorporation periods. In addition, the proportion of technologies offered according to the legal deadline was verified, and the influence of variables on the post-incorporation period was analyzed. RESULTS: Among 41 reports on procedures, orthoses, prostheses, and special selected materials, 79 technologies were analyzed. The coding period, defined as the benchmark for the supply of the technology, had a median of 204 (57–425) days. This period was longer than 180 days in 64% of the technologies assessed. Variables such as the organization group to which the technology belongs, indication of the need to adapt for implementation in the incorporation report, and delay in the evaluation period for incorporation seem to influence the period for providing the technology. CONCLUSIONS: The effective provision of technologies incorporated into the health system in Brazil has not occurred within the expected period of 180 days in most cases, which limits their accessibility to the population. Anticipating the need for adaptation before implementation, even during incorporation, seems to be a way of reducing the post-incorporation period.
Copyright (c) 2025 Nayê Balzan Schneider, Ana Paula Beck Da Silva Etges, Carisi Anne Polanczyk https://creativecommons.org/licenses/by/4.0
Association of Previne Brasil Program with prenatal care and maternal-child mortality
OBJECTIVE: To investigate the impact of prenatal care on the reduction of maternal-child mortality in Brazilian municipalities following the new primary health care financing model, the Previne Brasil program. METHODS: This study comprised a nationwide cross-sectional observational analysis, utilizing secondary data from Departamento de Informática do Sistema Único de Saúde (Datasus – Information Technology Department of the Unified Health System), Sistema de Informação sobre Mortalidade (SIM – Mortality Information System), Sistema de Informação sobre Nascidos Vivos (Sinasc – Live Birth Information System), Sistema de Informação em Saúde para a Atenção Básica (Sisab – Primary Health Care Information System), and Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics). Medians of maternal mortality, infant mortality, and prenatal care rates were calculated for Brazilian municipalities from 2016 to 2022. Logistic regression analyses were conducted to assess associations between independent variables (primary care coverage, population size, Gross Domestic Product, and Gini index) and outcomes (variations in maternal and infant mortality rates). Both crude and adjusted odds ratios were estimated, with a significance level of 5%. RESULTS: Prenatal care rates increased by 86.7%, while maternal mortality rates decreased by 30.9%, with no association between them. Region, primary care coverage, municipal Gross Domestic Product, and population size were associated with variations in maternal mortality rates. The Southern region had a higher likelihood of reducing maternal mortality. No association was found between increased prenatal care rates and reduced infant mortality. Regional location, primary care coverage, population size, and the Gini index were associated with variations in infant mortality rates, with greater reductions observed in more populous municipalities and in the Northeast, Southeast, and Midwest. CONCLUSION: The Previne Brasil program led to an increase in prenatal care consultations in Brazilian municipalities but did not significantly impact the reduction of maternal-child mortality.
Copyright (c) 2025 Caio Vieira de Barros Arato, Luciane Miranda Guerra , Livia Fernandes Probst, Antonio Carlos Pereira https://creativecommons.org/licenses/by/4.0
Efficacy of auricular acupuncture on sleep quality among individuals with depression: a clinical trial
OBJECTIVE: To evaluate the efficacy of auricular acupuncture in reducing insomnia symptoms among individuals with depression compared with non-specific auricular acupuncture, at four weeks, six weeks, and three months after the intervention began. METHODS: A randomized, blinded clinical trial assessed sleep quality using the Pittsburgh Sleep Quality Index in 74 adults equally divided into two groups: specific auricular acupuncture and non-specific auricular acupuncture. Both groups underwent 12 auricular acupuncture sessions performed twice a week. RESULTS: After three months, the intention-to-treat analysis found no statistically significant difference in achieving good sleep quality between groups (33.3% versus 26.1%, p > 0.05). However, a trend toward statistical significance occurred after 4 weeks, with 50% of participants in the experimental group and 24.1% in the control group achieving good sleep quality (p = 0.057). CONCLUSIONS: We observed no statistically significant difference in sleep quality between individuals with depressive symptoms undergoing specific auricular acupuncture compared with non-specific after three months. However, a significant trend (p = 0.057) confirmed by the per-protocol analysis (p = 0.038) indicated that participants receiving specific auricular acupuncture had a 69% higher chance of achieving good sleep quality after four weeks. These findings should be interpreted with caution, as they did not reach statistical significance; rather, they reflect a trend toward significant improvement and are subject to the study’s limitations.
Copyright (c) 2025 Ana Elise Machado Ribeiro Silotto, Artur Heps, Daniel Maurício Oliveira Rodrigues, Pedro Henrique de Mesquita Pacheco, Nathalia Martins Pereira Sanches, Mariana Cabral Schveitzer, Paulo Rossi Menezes, Alexandre Faisal-Cury https://creativecommons.org/licenses/by/4.0
Food insecurity in urban and rural areas of Brazil during the COVID-19 pandemic
OBJECTIVE: To analyze the impact of the COVID-19 pandemic on food insecurity (FI) among families living in rural and urban areas of Brazil. METHODS: Cross-sectional and descriptive study based on the analysis of two nationally representative surveys conducted using probabilistic sampling by clusters in urban and rural areas of Brazil (2020 and 2022). FI was measured using the Brazilian Food Insecurity Scale. The households were classified as food secure, mild FI, or moderate/severe FI. Prevalence and 95% confidence intervals (95%CI) and analyses were performed in Stata 16 considering the respective sample weights (svy). Variations between the two surveys were analyzed by urban and rural area, and associations with gender and race/skin color. RESULTS: The majority of households were located in urban areas (2020: 85.6% [n = 1,662]; 2022: 85.5% [n = 10,365]) compared to rural areas (2020: 14.5% [n = 518]; 2022: 85.5% [n = 2,382]). with regard to the characteristics of the household reference person, schooling level, being a formal worker and the per capita family income were higher among families from urban areas. Between 2020 and 2022, the proportion of severe levels of FI increased significantly more in households from rural areas. Despite the higher FI in rural areas, a variation of +54% was noted in urban areas, where the prevalence of moderate/severe FI increased from 19.4% (2020) to approximately 30% (2022). There were greater proportions of FI in households headed by men in urban areas (+75.1%) and mixed race/black people (+55.9%), while households headed by white people saw an improvement in FS. CONCLUSION: The FI increased unequally between the rural and urban areas of Brazil during the COVID-19 pandemic. The results of this study reinforce the need to plan equitable public policies that debate the different vulnerability profiles aggravated by disparities as a way of guaranteeing food and nutritional security in post pandemic in Brazil.
Copyright (c) 2025 Eloah Costa de Sant Anna Ribeiro, Aline Alves Ferreira, Rosana Salles-Costa https://creativecommons.org/licenses/by/4.0
Characteristics of retracted biomedical research papers from Latin American institutions
OBJECTIVE: To characterize retractions of biomedical research papers that had a least one author affiliated with a Latin American (LATAM) institution. METHODS: We conducted a cross-sectional study of research papers published in scientific journals focusing on the field of biomedical research and identified by means of the Retraction Watch database. The retracted articles identified were required to have at least one author whose institutional affiliation was a LATAM country. Data were collected on the authors’ countries and institutional affiliations, the reason for retraction, dates of publication and retraction, indexing, journal quartile and impact factor. Reasons for retraction were categorized into three major groups, i.e., scientific misconduct, error, and not specified. RESULTS: According to Retraction Watch, 181 papers were retracted across 1987–2024 which fulfilled the inclusion criteria. Guatemala, Bolivia, Peru, Panama, Ecuador, Colombia, and Argentina were the countries that had a retraction rate above 1 per 10 thousand papers throughout the study period. The principal reason for retraction was scientific misconduct (63.0%) followed by honest error (21.5%). The main causes of retraction due to scientific misconduct were ethical and legal problems (33.1%), followed by fabrication/falsification (20.2%). CONCLUSION: The number of retractions in some LATAM countries, mainly due to scientific misconduct, highlights the need to strengthen ethical practices in research. Future initiatives should focus on developing and evaluating effective strategies to prevent misconduct and promote scientific integrity.
Copyright (c) 2025 Jorge Andres Ramos-Castaneda, Cristina Candal-Pedreira, Mónica Pérez-Ríos, Ana Teijeiro, Alberto Ruano-Ravina, Guadalupe García https://creativecommons.org/licenses/by/4.0