To publish and divulge scientific production on subjects of relevance to Public Health.
Universidade de São Paulo. Faculdade de Saúde Pública
Regional variation and factors associated with average expenditure per headache disorder hospitalization in Brazil: a macrocosting analysis in the SUS (2008–2023)
OBJECTIVE: To quantify the total expenditure on hospitalizations due to headache disorders within the Brazilian Unified Health System (SUS) and to identify the sociodemographic, clinical, and regional factors associated with the average expenditure per hospitalization. METHODS: This observational study used SIH-SUS data from 2008 to 2023. Expenditures were inflation-adjusted and categorized by sex, age, and ICD-10 diagnosis. Given the extreme positive asymmetry of the expenditure data, a Generalized Linear Model with a Gamma family and log link function was used to identify adjusted expenditure multipliers. RESULTS: Total expenditure reached BRL 77,643,809.55. The highest volume was concentrated among females (65.7%) and the 19–59 age group (66.1%). The Generalized Linear Model revealed that patients aged 60 years or older had a 21% higher expenditure multiplier (multiplier = 1.21) per event. The South Region showed a structurally 73.7% higher expenditure multiplier (Multiplier = 1.737) per event, even after adjustment for complexity. Vascular headache not elsewhere classified (247.2% higher) and status migrainosus (124.8% higher) were the costliest diagnoses. Crude rate analysis showed the South Region with the highest utilization rate (108.0 hospitalizations per 100,000 inhabitants). CONCLUSION: The high adjusted expenditure multipliers in the South/Southeast and the long median stays in the North/Northeast point to structural inequalities in the cost and timeliness of care provision. Public policies must reinforce specialized outpatient management to reduce high-cost hospitalizations and promote equitable resource allocation.
Copyright (c) 2026 Jesuély Spieckert de Souza, Vanise Grassi, Marcos Otávio Brum Antunes, Mariana Cristina Ribeiro, Vinicius da Silva Lessa de Oliveira, Adriel Brandão, João José Freitas de Carvalho, Frederico Friedrich https://creativecommons.org/licenses/by/4.0
Cross-cultural adaptation andcontent validity of the PGSI into Brazilian Portuguese
OBJECTIVE: This study aimed to cross-culturally adapt the Problem Gambling Severity Index (PGSI) into Brazilian Portuguese and to conduct a preliminary assessment of its content and face validity. METHODS: The adaptation process followed internationally recognized guidelines and included several stages: initial translation, translation synthesis, back-translation, review by a committee of experts, evaluation by an expert panel of 11 specialists, pre-test with participants from the general population, and final revision. The Content Validity Index (CVI), Clarity Index (CI), and Content Validity Ratio (CVR) were calculated based on the experts’ evaluations. As a first step, establishing semantic and content validity is essential before broader psychometric testing can be meaningfully conducted in the target population. RESULTS: The adapted PGSI demonstrated strong content validity, with all items reaching a CVI of 0.90 or higher and an overall mean of 0.98. The CI ranged from 2.63 to 2.90, and the CVR indicated high agreement regarding the essentiality of the items. Face validity testing with 33 participants from the general population revealed that all items were rated as understandable or entirely understandable by most participants (84.9% to 100%). Expert feedback was also used to refine the wording of items, particularly to distinguish between “gaming” and “gambling” in the Brazilian context. CONCLUSION: The Brazilian Portuguese version of the PGSI presented robust preliminary evidence of semantic, conceptual, and cultural adequacy. This version fills a critical methodological gap and provides a culturally appropriate screening and monitoring tool for use in clinical and research settings in Brazil, supporting prevention and public health monitoring of gambling-related harms, including financial impacts. Future studies will evaluate additional psychometric properties further to consolidate its use in clinical and epidemiological contexts. DESCRIPTORS: Gambling. Psychometrics. Cross-Cultural Comparison. Brazil. Translations. Behavioral Addictions.
Copyright (c) 2026 Carla Cavalheiro Moura, Daniel Tornaim Spritzer, Rodrigo Menezes Machado, Rodrigo Nogueira Borghi, Nathalia Seminário Gabioneta, André Monezi de Andrade, Hermano Tavares https://creativecommons.org/licenses/by/4.0
Multimorbidity in the working-age population in Brazil: sociodemographic and behavioral factors
OBJECTIVE: To assess the prevalence of multimorbidity in the Brazilian working-age population and analyze its determinants, with an emphasis on sociodemographic and behavioral aspects. METHODS: A cross-sectional study was conducted using data from the 2019 National Survey of Health, involving employed individuals aged 18 years or older. The outcome was multimorbidity, characterized by the simultaneous presence of two or more chronic noncommunicable diseases, based on a list of 14 conditions. Poisson regression with robust variance was used to assess the association between sociodemographic variables, habits, behaviors, and health/service outcomes. RESULTS: Among the 52,475 employed individuals, 22.6% (95%CI 21.9–23.2) had multimorbidity, which was more prevalent among: women; those aged 30 or older; those with lower levels of education; those who self-identified as white; and urban residents. Participation in public programs for physical activity, episodic heavy drinking, leisure-time screen time, self-rated health as fair/poor or very poor, a doctor’s visit in the past year, and having health insurance were also positively associated with multimorbidity. CONCLUSION: The findings highlight the significant prevalence of multimorbidity among the working-age population in Brazil, with particular emphasis on social and behavioral determinants. These results reinforce the importance of health promotion strategies in multiple contexts, including workplaces, communities, and primary care settings.
Copyright (c) 2026 Tamyres Araújo Andrade Donato, Amanda Cristina de Souza Andrade, Vanessa Moraes Bezerra https://creativecommons.org/licenses/by/4.0
Functional impact of long Covid on work performance and return to work: a cross-sectional study
OBJECTIVE: To evaluate the association between long Covid and socioeconomic, clinical, healthcare, and functional factors with reduced work performance and difficulty returning to work. METHODS: A cross-sectional study of individuals in São Paulo aged ≥ 18 years with long Covid (77.8%), with data collected between April 2023 and June 2024. A systematic random sample of severe and mild Covid-19 cases from March 2020 to January 2022. The severity of Covid-19 was classified according to the U.S. Centers for Disease Control and Prevention (CDC) guidelines. Prevalences were assessed, and a Poisson test was performed to examine the association between reduced work performance and difficulty returning to work and sociodemographic, clinical, healthcare-related, and functional factors considered significant (p ≤ 0.05). Among the participants, 43.9% experienced reduced work performance, and 22.2% had difficulty returning to work. Long Covid is defined as having two or more symptoms that develop and persist for more than four weeks after Covid-19, cannot be explained by an alternative diagnosis, and are assessed using a Likert scale for the intensity of self-reported symptoms (0–10). Participants’ functional status was assessed using scales for basic activities (Katz), instrumental activities (Lawton), functional limitations (WHO-DAS), and sarcopenia (SARC-F). RESULTS: Poorer work performance was associated with advanced age (PR = 2.20; 95%CI 1.27–3.80), as well as being the primary provider (PR = 1.55; 95%CI 1.05–2.29), and having moderate (OR = 2.99; 95%CI 1.60–5.58) or severe (OR = 4.88; 95%CI 2.59–9.19) functional impairment. For difficulty returning to work, the main association observed was severe functional impairment (OR = 4.33; 95%CI 1.58–11.80). CONCLUSION: It is noteworthy that advanced age and, particularly, severe functional impairment were significantly associated with poorer performance and difficulty returning to work in the studied population with long Covid.
Copyright (c) 2026 Fabio Cavalcanti Freitas, Vivian Cintra Sousa, Daniella de Melo, Diêgo Araújo de Moraes Ramos, Gabriela Sayuri Ochiai, Daniel Kolisch, Julia Costa Guimarães, Larissa Gomes da Silva, Erika Christina Gouveia e Silva, José Eduardo Pompeu, Ana Carolina Basso Schmitt https://creativecommons.org/licenses/by/4.0
Indicators of complementary feeding and social vulnerability in the Brazilian Amazon
OBJECTIVE: To analyze Complementary Feeding Quality Indicators according to socioeconomic characteristics in Cruzeiro do Sul, Acre, Western Brazilian Amazon. METHODS: This is a cross-sectional analysis nested within the MINA - Brazil birth cohort (n = 971), using data from the 1-year (n = 774) and 2-year (n = 854) follow-up visits. Dietary intake was assessed using a 24-hour recall to construct the Complementary Feeding Quality Indicators, adapted from World Health Organization recommendations: minimum dietary diversity, meat and/or egg consumption, ultra-processed food consumption, and zero fruit and vegetable consumption . Socioeconomic, neonatal, and morbidity variables were analyzed according to a hierarchical conceptual model (distal, intermediate, and proximal levels). Prevalence ratios (PR) were estimated using Poisson regression with robust variance and multiple adjustment; variables were selected based on theoretical assumptions or an association with p < 0.10 at each level. RESULTS: Regarding meat and egg consumption, 79.0% of 1-year-old children and 89.9% of 2-year-old children consumed at least one food item from this group the previous day. High frequencies of ultra-processed food consumption were observed in the first (89.1%) and second (94.6%) years of life. The minimum dietary diversity indicator in the first year was less frequent among children from families with lower wealth indices (lowest tertile: PR = 0.74; 95%CI 0.63–0.86) and whose mothers were not engaged in paid work (PR = 0.87; 95%CI 0.80–0.95). Zero fruits and vegetables consumption was more prevalent among children from families with lower wealth indices (lowest tertilel: PR = 4.89; 95%CI 2.90–8.24). CONCLUSION: The results highlight the influence of socioeconomic factors on children’s dietary patterns, reinforcing the importance of intersectoral strategies to promote food and nutritional security.
Copyright (c) 2026 Steffany Martins Moreira, Isabel Giacomini, Lalucha Mazzucchetti, Marly Augusto Cardoso https://creativecommons.org/licenses/by/4.0
Patterns of medication use among individuals with Covid-19 in Brazil: Epicovid 2.0
OBJECTIVE: To describe the patterns of medication use among individuals with Covid-19 to treat the disease in Brazil, according to area of residence, demographic and socioeconomic characteristics, religion, and level of trust in scientists. METHODS: Epicovid 2.0 National Survey (2024) in 133 municipalities. The analysis included participants who reported having had an episode of Covid-19. The use of antibiotics, azithromycin, antipyretics, chloroquine, and ivermectin was assessed, in addition to the composite outcomes: use of chloroquine and/or ivermectin; chloroquine, ivermectin, and/or azithromycin (CIA); and use of any medication. The frequency of use and 95% confidence intervals were estimated, considering the complex sampling design and sample weighting RESULTS: The frequency of use of any medication to treat Covid-19 was 63.0% (95%CI 60.0–65.9). Antipyretics were the most commonly used (53.7%), followed by antibiotics (36.2%) and azithromycin (27.2%). The isolated use of ivermectin was reported by 23.6% and that of chloroquine by 12.1%; the use of ivermectin and/or chloroquine reached 27.8% and that of CIA, 39.0%. Overall, medication use was more frequent in the North, Northeast, and Central-West regions and among women. Use was concentrated among adults aged 40–59, people with low educational attainment, and those with lower incomes. Self-identified black and brown individuals reported higher use of chloroquine. Use of chloroquine, ivermectin, and combinations of these medications was more common among evangelicals (0.05 < p < 0.1) and among people who consulted doctors (p < 0.001). Participants who reported distrusting scientists reported higher use of chloroquine and chloroquine/ivermectin compared to those who reported trusting scientists. CONCLUSION: Four out of ten people who reported episodes of Covid-19 consumed medications not recommended by science to treat the disease. Medication use tended to be more frequent among women, in the northern half of Brazil, among evangelicals, and among people with lower income and education levels. These groups should be prioritized in future campaigns on the appropriate use of medications.
Visceral leishmaniasis in a peri-urban area of São Paulo associated with Nyssomyia whitmani
OBJECTIVE: To investigate an outbreak of canine visceral leishmaniasis and the circulation of Leishmania in phlebotomine species in a peri-urban area in the municipality of São Paulo. METHODS: Twelve dogs were assessed for Leishmania infection and sandflies were collected using Shannon and CDC light traps. The presence of the parasite in the captured female sandflies was analyzed by molecular method. RESULTS: Of the dogs analyzed, four were seropositive both in the rapid serological test and by ELISA for Le. infantum. Among the 8,354 phlebotomines captured, Nyssomyia whitmani predominated in the area (98.2%) and DNA from Le. infantum and Le. braziliensis was detected in females of this species, indicating potential participation in the transmission cycle of the visceral leishmaniasis agent. CONCLUSION: The findings of this study demonstrate the occurrence of an outbreak of canine visceral leishmaniasis in the Perus district, in the municipality of São Paulo, characterized by the presence of dogs infected with Le. infantum and potential transmission associated with the phlebotomine Ny. whitmani. It also reinforces the importance of entomological surveillance of susceptible vectors and the integration of information in a one health approach, with a view to the early detection of potential transmission foci.
Using artificial intelligence to analyze violence against women in São Paulo
OBJECTIVE: To propose the Health Research Standard Process for Artificial Intelligence framework, adapted from the Cross-Industry Standard Process for Data Mining approach, and apply it using time series and artificial intelligence techniques to analyze data from the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) on violence against women in São Paulo, exploring sociodemographic, spatial, and predictive dimensions. METHODS: The methodology was adapted to health research, replacing the original Business Understanding stage with Research Understanding by incorporating essential technical-scientific elements. We analyzed 80,148 reports of violence against women aged between 20 and 59 living in the city of São Paulo between 2013 and 2023. The analyses included descriptive statistics, calculation of prevalence ratios, decomposition and predictive modeling of time series capturing trends and seasonality, and geospatial analysis of notifications. RESULTS: We observed temporal patterns and sociodemographic characteristics of the victims, with increasing trends in reports of physical, psychological, and sexual violence after 2015 and seasonal behavior. Among the associations, there was a 32% increase in the prevalence of sexual violence when the aggressor was under the influence of alcohol and a 2.47 times greater risk of sexual violence among pregnant women. The geospatial distribution revealed concentrations of notifications in peripheral areas of the municipality, such as the south, east, and central zones. Predictive modeling indicated that the upward trend will persist over the next 24 months, with estimated rates reaching up to 12 cases per 100,000 inhabitants. CONCLUSION: The applicability of the Health Research Standard Process for Artificial Intelligence was effective as a model for data analysis and the development of predictive algorithms in public health. It was possible to propose a replicable methodological matrix for future research and evidence-based interventions.
Vaccine hesitancy in Brazil: post-pandemic challenges and the use of artificial intelligence
Vaccine hesitancy is a global public health challenge, and its characteristics change according to the social and epidemiological context. This commentary seeks to stimulate debate on the dynamic nature of the definition and determinants of vaccine hesitancy, especially in the wake of the Covid-19 pandemic and the population’s increased access to new forms of information-seeking, such as artificial intelligence. Scientific production on childhood vaccine hesitancy in Brazil before 2016 was focused on high-income families. After 2016, there was an increase in production on vaccine hesitancy, considering the World Health Organization’s 2014 determinants model. After the start of the pandemic, there was a significant increase in studies on disinformation and the politicization of the vaccine. Currently, the use of generative artificial intelligence, which is increasingly common in the search for information on vaccines, is being considered.
Communication strategies in childhood vaccine hesitancy: a scoping review
OBJECTIVE: To analyze how communicative configurations are addressed in empirical studies on childhood vaccine hesitancy, with an emphasis on the strategies and communication channels used, as well as on how these elements influence parents’ and caregivers’ decisions. METHODS: A scoping review was conducted across five databases (Scopus, Web of Science, PubMed, SciELO, and LILACS) on childhood vaccine hesitancy and communication strategies, including articles published between 2015 and 2017 in English, Portuguese, Spanish, and French. Empirical studies on childhood vaccination were included, with children’s age as defined by the study authors. Data extracted independently by five researchers were analyzed through thematic synthesis, based on a coding matrix that categorized findings into core themes. The analysis was theoretically guided by Hepp and Hasebrink’s concept of communicative configurations. RESULTS: Twenty-two studies were analyzed, mostly conducted in the United States (n = 9), primarily involving parents/caregivers and healthcare professionals. Social media emerged as a central medium, with an ambivalent role: as a source of misinformation, but also a channel for pro-vaccine messages. Strategies featuring clear scientific messages, the MOTIVE tool, and analyses of anti-vaccine discourses were promising in increasing vaccination intention. Trust-based relationships between physicians and families and message tailoring were identified as fundamental. CONCLUSION: Health communication is essential for addressing childhood vaccine hesitancy. The reviewed studies indicate that integrated strategies combining evidence-based public policies with personalized and culturally sensitive communication are key to promoting vaccine uptake and increasing confidence in vaccines.
Hearing loss and postural balance performance in adults and the elderly in ELSA-Brazil
OBJECTIVE: To investigate the association between hearing loss and postural balance in adults and the elderly participating in the Estudo Longitudinal da Saúde do Adulto (ELSA-Brazil - Longitudinal Study of Adult Health). METHODS: Cross-sectional study with data from the fourth wave (2020–2025) of ELSA-Brazil, in the center of São Paulo. Sociodemographic, clinical, and audiological variables were analyzed. Hearing loss was defined by the average of the tonal thresholds (> 25 dBHL) in different criteria: PTA (0.5 kHz-2kHz), speech-frequency PTA (0.5 kHz-4kHz), and high-frequency PTA (3 kHz-8kHz), considering the better and the worst hearing ear. Balance was assessed using the modified Romberg test, in four progressive conditions (eyes open on a firm surface, eyes closed on a firm surface, eyes open on a soft surface, and eyes closed on a soft surface), with a binary classification (pass/fail). The outcome was performance in the balance test. RESULTS: A total of 540 participants were assessed, mostly women, self-declared white, mean age of 63.1 years, mean Body Mass Index (BMI) of 28.4 kg/m², with higher education and income between R$ 1,245.00 and R$ 3,319.00. The rate of balance failure was 13.3%. The prevalence of hearing loss ranged from 13.7% to 59.8%, depending on the criteria used. There was an association between hearing loss and worse performance in the balance test, especially for high-frequency PTA. In the logistic regression models, there was a significant association between the explanatory variable age and failure in the balance test. After excluding the age variable, there was an association for hearing loss, BMI, schooling, and income. CONCLUSION: There was an association between hearing loss and poorer balance performance. The highest proportion of failures was for the hearing loss criterion that included high frequencies. Age was the most relevant explanatory variable in balance test performance, in addition to hearing loss, schooling, income, and BMI, emphasizing the need for a multifactorial view of this function.
Fernanda Yasmin Odila Maestri Miguel Padilha
Food environment in Brazil: food deserts and food swamps in large urban cities
OBJECTIVE: To assess the availability of healthy and unhealthy food establishments in Brazil and, thereby, map food deserts and food swamps. To analyze maps of food deserts and food swamps in conjunction with indicators of social inequality. METHODS: Data from the Relação Anual de Informações Sociais (RAIS, 2022), integrated with consumption profiles from the Pesquisa de Orçamentos Familiares (POF, 2017–2018), were used to classify establishments according to the Dietary Guidelines for the Brazilian Population. At the municipal level, the density of establishments with healthy and unhealthy profiles was estimated for Brazilian municipalities. At the intramunicipal level, food deserts and food swamps were identified in urban municipalities with more than 300,000 inhabitants, by cross-referencing the results with income indicators from the Cadastro Único. RESULTS: At the municipal level, it was observed that the North and Northeast regions concentrate most municipalities with low densities of healthy establishments, while the South and Southeast have higher densities of unhealthy establishments. At the intramunicipal level, approximately 25 million people reside in food deserts, corresponding to 32.3% of the population of the 91 municipalities analyzed, and approximately 15 million live in food swamps (19% of the population). Among individuals in the Cadastro Único with a per capita income below half the minimum wage, 38% live in food deserts and 10% in food swamps. CONCLUSION: The results highlight the overlap between socioeconomic vulnerability and adverse food environments, reinforcing the urgency of public policies aimed at regulating the food environment, strengthening public food supply infrastructure, and promoting territorial equity in access to healthy foods.
Differences in the microenvironment for leisure physical activity and commuting in São Paulo
OBJECTIVE: To describe the characteristics of the built environment at the micro-scale and to examine differences according to residential area and social and demographic variables among adults in São Paulo, Brazil. METHODS: This is a cross-sectional study involving 1,434 adults from the ISA–Physical Activity and Environment cohort. Environmental characteristics were assessed using the Microscale Audit of Pedestrian Streetscapes (MAPS Global) method based on Google Earth images along 400–700-meter routes centered on the participants’ georeferenced addresses. For the analysis, Mann-Whitney U tests were used for two independent groups and Kruskal-Wallis tests for three or more groups, followed by Dunn’s post-hoc test, to assess differences in mean scores by health coordination unit, sex, age, educational level, and skin color. RESULTS: The surroundings of residences in the Central-West region had the highest overall scores (p < 0.001). Individuals with higher education levels, who self-identified as White or Asian, and those aged 60 years or older resided in areas with better scores for aesthetics, social aspects, presence of trees, canopy cover, sidewalks, intersections, and overall environmental score (p < 0.001). In contrast, people with lower educational attainment and those who self-identified as Black or Brown lived in areas with poorer sidewalk conditions (p < 0.001). CONCLUSION: It is concluded that micro-scale conditions were better in the vicinity of residences in central regions and for individuals with higher education, White or Asian skin color, and older age, highlighting the need for public policies aimed at more equitable and inclusive urban planning.
Access to specialized outpatient care: an analysis of regulation in Brazilian settings
OBJECTIVE: To analyze how different subnational governments, based on common national guidelines, have developed their own models for regulating access to specialized care, with varying degrees of innovation, institutionalization, and integration of telehealth. METHOD: A descriptive and exploratory study with a qualitative approach that comparatively analyzes the implementation of regulations governing access to specialized care. Data were collected through document analysis, literature review, and, in some cases, interviews with key stakeholders, consolidated into detailed descriptions of each scenario to form the research corpus. Analysis was conducted using the Consolidated Framework for Implementation Research (CFIR). Experiences were selected from the municipalities of Curitiba (PR), Belo Horizonte (MG), Porto Alegre (RS), and São Paulo (SP), as well as the states of Ceará, Santa Catarina, Rio Grande do Sul, and the Federal District. RESULTS: The eight Brazilian experiences with outpatient regulation are characterized by diversity in organizational models, degrees of institutionalization of teleconsultation, and integration across levels of care. The adoption of technologies, access regulation protocols, and computerized systems varied across locations, influenced by structural, regulatory, and contextual factors. When integrated, teleconsultation improved the quality of referrals and increased problem-solving capacity in primary care, but its implementation remains uneven across the country. CONCLUSION: The implementation of access regulation to specialized care in the Unified Health System varied according to institutional, organizational, and technological capacities. Weaknesses were identified in the integration of health information systems in the organization and delivery of specialized care, with structural inequalities; in governance, with low standardization of protocols; limited integration between Primary Health Care and specialized care; and professional resistance to change. Regions with better outcomes integrated teleconsultation into outpatient regulation; clinical and access protocols adopted health information systems integrated with analytical intelligence resources and institutionalized regulatory guidelines. The CFIR highlighted the influence of contexts, actors, and processes, reinforcing the importance of national guidelines for improving local organizations.
Copyright (c) 2026 Thais Barros Zanette da Silva, Jozinélio Severino Teixeira, Carlos Amilcar Salgado, Luciano de Paula Camilo, Claudilene Sousa Fortaleza, Fábio Ferreira Amorim, Leila Bernarda Donato Göttems https://creativecommons.org/licenses/by/4.0
Comparison of two methods for assessing weight gain in Brazilian pregnant women
OBJECTIVE: To compare two methods for assessing gestational weight gain (GWG) among overweight adult pregnant women receiving care in Primary Health Care. METHODS: This is a secondary analysis of a randomized controlled clinical trial conducted between 2018 and 2021 involving 260 overweight pregnant women receiving prenatal care at primary health care centers in the municipality of Ribeirão Preto, São Paulo. Participants were assigned to two groups: intervention (received individualized nutritional counseling— GI) or control (received only standard prenatal nutritional guidance—GC). Prenatal weight gain (PWG) was classified according to the U.S. guidelines of the National Academy of Medicine (NAM) and in accordance with Brazilian growth curve recommendations. To assess agreement between the methods, the kappa coefficient was used, and for the classification of weight gain (adequate, insufficient, or excessive), the criteria adopted by each method were used. Logistic regression models were employed to analyze the association between the groups (IG and GC) and the two methods used in the assessment of PWG. RESULTS: Moderate agreement was observed between the methods, with a pattern of disagreement indicating possible underestimation of GPG by the NAM guidelines. Pregnant women in the GI had a higher likelihood of insufficient GPG according to the Brazilian method (OR = 2.87; 95%CI 0.88–9.25) and a lower likelihood of excessive weight gain according to the US method (OR = 0.63; 95%CI 0.34–1.17), compared to women in the GC, although neither finding was statistically significant. CONCLUSION: The Brazilian curves proved to be more appropriate for classifying GPG in overweight Brazilian pregnant women, better reflecting weight monitoring during prenatal care. Their adoption may facilitate the early identification of GPG inadequacies and, consequently, contribute to improving the quality of prenatal care.
Copyright (c) 2026 Natalia Posses Carreira, Daiane Leite da Roza, Daniela Saes Sartorelli, Maria Carolina de Lima, Lívia Castro Crivellenti https://creativecommons.org/licenses/by/4.0
Intimate partner violence and associated factors among adult women: a population-based study
OBJECTIVE: The study investigated the lifetime prevalence of intimate partner violence among women aged 20 to 69 years residing in the urban area of São Leopoldo (RS) and associated factors. METHODS: This was a population-based cross-sectional study in which 1,113 women were interviewed. The outcome was self-reported lifetime intimate partner violence, and sociodemographic, physical and mental health, and behavioral variables were assessed. A stratified analysis by age group was performed. RESULTS: The prevalence of intimate partner violence in the sample was 17.9% (95%CI 15.6–20.1). In the adjusted analysis, the outcome was associated with lower socioeconomic status, a history of sexually transmitted infections, and the presence of common mental disorders. In the stratified analysis, women aged 20–39 years had a 13.7% (95%CI 10.5–16.8) lifetime prevalence of intimate partner violence, with nearly three times the likelihood among those with common mental disorders. Among women aged 40 years or older, the prevalence was 20.7% (95%CI 17.6–23.8), with those in the lowest socioeconomic class, who were single, divorced, or widowed, who self-reported sexually transmitted infections, and who had common mental disorders being more likely to experience the outcome. Secondary intersectional analyses revealed a higher prevalence of intimate partner violence among Black or Brown women with low educational attainment (PR = 1.67; 95%CI 1.14–2.45) and White women with low educational attainment (PR = 1.58; 95%CI 1.14–2.19), compared to white women with higher educational attainment. CONCLUSIONS: The study demonstrated a high lifetime prevalence of intimate partner violence, reinforcing the need for public policies that improve women’s socioeconomic conditions, as well as integrated gender-based violence prevention programs that incorporate mental health care in the support provided to victims.
Copyright (c) 2026 Camila Simon, Juvenal Soares Dias da Costa, Maria Teresa Anselmo Olinto, Fernanda Souza de Bairros, Tonantzin Ribeiro Gonçalves https://creativecommons.org/licenses/by/4.0
Machine learning and cancer survival: analysis of the Registro Hospitalar de Câncer do Estado de São Paulo
OBJECTIVE: To compare the performance of different Survival Machine Learning (SML) algorithms in predicting the survival of cancer patients. METHODS: Data from the Registro Hospitalar de Câncer do Estado de São Paulo (São Paulo State Cancer Registry Hospital) were used, covering the five most incident types of cancer (breast, prostate, lung, colorectal and cervix). Six algorithms were evaluated: Gradient Boosting Survival (GBS), Random Survival Forest (RSF), Support Vector Machine Survival (SVM-Survival), XGBoost Cox, XGBoost Accelerated Failure Time (AFT), and LightGBM. Performance was measured by the Concordance Index (C-Index), C-Index IPCW and Integrated Brier Score (IBS) metrics. RESULTS: The XGBoost AFT model showed the best C-Index results for breast (0.7845), lung (0.7368), colorectal (0.7618), and cervix (0.7726), while GBS was superior for prostate (0.7574). Clinical staging was consistently the most important variable, according to the explainability analysis. CONCLUSION: The SML algorithms showed good predictive performance, regardless of cancer type, sample size and censoring proportion. These models show potential for subsidizing cancer planning and supporting strategic decisions in the organization of cancer care networks.
Copyright (c) 2026 Fernando Henrique de Albuquerque Maia, Lucas Buk Cardoso, Simone Aldrey Angelo, Yasmin Pacheco Gil Bonilha, Adeylson Guimarães Ribeiro, Maria Paula Curado, Gisele Aparecida Fernandes, Alexandre Dias Porto Chiavegatto Filho, Vanderlei Cunha Parro, Tatiana Natasha Toporcov https://creativecommons.org/licenses/by/4.0
Hydrological disasters and health losses: an index-based analysis for Brazil
OBJECTIVE: To develop and apply composite indices to assess immediate losses caused by hydrological disasters in Brazil between 2000 and 2023, with a focus on human losses and damages to health infrastructure. METHODS: Data were obtained from the Integrated Disaster Information System, which consolidates national records of hydrological disasters. Seven indicators were selected for the Human Loss Index and four for the Health Infrastructure Loss Index. Indicators were normalized using Min-Max procedures and weighted through a combined Analytic Hierarchy Process and entropy method. The General Severity Index was calculated as the arithmetic mean of Human Loss Index and Health Infrastructure Loss Index, stratified into four levels of severity. Spatial and temporal analyses were conducted to identify critical regions and municipalities. RESULTS: The findings reveal significant heterogeneity in disaster impacts across time and space. Human losses exhibited greater variability than health infrastructure losses, with notable peaks in 2006, 2011, 2015, and 2019. Infrastructure damages were less frequent but highly disruptive, especially in 2012, 2019, and 2023. Municipalities in the Amazon region, particularly Japurá and Atalaia do Norte, registered the highest combined indices, reflecting compounded vulnerabilities from geographic isolation, fragile infrastructure, and socioeconomic inequalities. High General Severity Index scores were concentrated in the North, while human losses were more widely distributed, including along the densely populated southeastern coast. Results confirm that small and socioeconomically vulnerable municipalities are disproportionately affected, with limited institutional capacity to respond. CONCLUSIONS: Hydrological disasters in Brazil are strongly mediated by social inequalities, deficient urban planning, and weak preventive policies. Human and infrastructure losses disproportionately affect vulnerable populations, particularly in the North, where access to health services is precarious. The findings emphasize the need for territorially integrated strategies that combine climate adaptation, poverty reduction, and investments in resilient public health infrastructure.
Copyright (c) 2026 Gisele Paixão Pereira, José Firmino de Sousa Filho, Thomás Rocha Ferreira, Paulo Victor Maciel da Costa, Andrêa Jacqueline Forte Ferreira, Julia Moreira Pescarini, Joanna Miguez Nery Guimarães, Sofia Rafaela Maito Velasco, Danielson Jorge Delgado Neves, Jean Souza dos Reis, Kecia Cristina Miranda da Silva, Gervásio Ferreira dos Santos, Rita de Cássia Ribeiro Silva, Roberto Fernandes Silva Andrade, Maurício Lima Barreto https://creativecommons.org/licenses/by/4.0
Progress, challenges, and lessons for climate resilient and low carbon health systems in Latin America and the Caribbean: an exploratory mixed-methods study
OBJECTIVE: To assess progress, challenges, and enabling factors for building climate-resilient and low-carbon health systems across Latin America and the Caribbean, a region facing accelerating climate-sensitive health burdens amidst persistent health system fragilities. METHODS: We conducted an explanatory, sequential, mixed-methods study integrating quantitative analysis of the Pan American Health Organisation Climate Change and Health surveys from 2021/2022 (n = 24 countries) and 2023/2024 (n = 27 countries) with semi-structured interviews involving four countries demonstrating progress (Argentina, Chile, Jamaica, Peru). Quantitative data were analysed descriptively across three sub-regions (Caribbean, Central America, South America). Qualitative data underwent two-stage coding (deductive and inductive) with three-researcher consensus to identify barriers, enablers, and lessons learned. RESULTS: By 2023/2024, 93% of countries had designated climate-health focal points (71% in 2021/2022). However, implementation gaps persist: less than 50% of countries had integrated climate change into national health reports; 22–40% developed national climate-health strategies; and vulnerability assessments rarely informed policy. Access to international climate finance remained inequitable. Whilst 60–74% developed disaster preparedness plans, only 30–44% implemented public health communication campaigns. Training focused on environmental health personnel, with doctors, nurses, and planning staff minimally engaged. Qualitative analysis revealed interconnected barriers: climate change perceived as distant rather than urgent, competing priorities overwhelming decision-makers, institutional silos, and misalignment between available training and local needs. Key enablers included linking climate action to established health priorities, institutionalising responsibilities through formal mechanisms, multi-stakeholder engagement, and committed individuals with diplomatic skills navigating cross-sectoral dynamics. CONCLUSION: Latin America and the Caribbean countries are establishing foundations for climate-resilient and low-carbon health systems, but translating governance progress into sustained implementation requires addressing systemic barriers through institutionalisation beyond political cycles, tailored capacity building, and innovative financing mechanisms. These findings inform guidance for health systems strengthening amidst accelerating climate change.
Copyright (c) 2026 Yasna Palmeiro-Silva, Camila Llerena-Cayo, Sebastian Bauhoff, Kristie L. Ebi, Catharina Giudice, Cristian A. Herrera, Jeremy J. Hess, Zuhelen Padilla, Karen Alicia Polson, Zoila Vela-Clavo, Daniel Forsin Buss, Stella M. Hartinger https://creativecommons.org/licenses/by/4.0
Age at menarche and general and abdominal obesity in older Brazilian women: ELSI-Brazil
OBJECTIVE: To examine the association between age at menarche and general and/or abdominal obesity in Brazilian women aged ≥ 50 years. METHODS: Cross-sectional study conducted with data from the second wave of the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros — ELSI (ELSI-Brazil, 2019–2021), in a nationally representative sample of community-dwelling individuals aged ≥ 50 years. Self-reported age at menarche was categorized as ≤ 12 years, 13–15 years, and ≥ 16 years. General obesity was defined as a body mass index of ≥ 30 kg/m2, and abdominal obesity as a waist circumference of ≥ 88 cm. The variables were combined into “general or abdominal obesity” and “general and abdominal obesity”. Multinomial logistic regression adjusted for sociodemographic and lifestyle characteristics was used. RESULTS: Among the 4,229 participants, 41.1% (95% confidence interval —95%CI 37.9–44.3) reported menarche at ≤ 12 years and 9.3% (95%CI 8.0–10.9) at ≥ 16 years. The prevalence of general or abdominal obesity was 36.6% (95%CI 33.7–39.5), while the prevalence of general and abdominal obesity was 35.0% (95%CI 32.5–37.7). After adjustments, women with age at menarche of ≤ 12 and 13–15 years had, respectively, 84% (odds ratio — OR = 1.84; 95%CI 1.14–2.98) and 64% (OR = 1.64; 95%CI 1.04–2.57) greater odds of general and abdominal obesity compared with those with menarche at ≥ 16 years. There was no significant association between age at menarche and general or abdominal obesity. CONCLUSION: Menarche before age 16 is associated with a higher odds of general and abdominal obesity combined, but not in isolation, suggesting its potential as a relevant marker for the formulation of public policies aimed at preventing obesity in girls from school age onwards.
Copyright (c) 2026 Nair Tavares Milhem Ygnatios, Juliana Vaz de Melo Mambrini, Juliana Lustosa Torres, Núbia Carelli Pereira de Avelar, Ana Lúcia Danielewicz, Rosana Carolina Souza Duarte de Matos, Luciana de Souza Braga, Maria Fernanda Lima-Costa, Bruno de Souza Moreira https://creativecommons.org/licenses/by/4.0
Association between food knowledge and adherence to the Brazilian Food Guide
OBJECTIVE: To investigate the association between food knowledge according to the level of food processing and adherence to the recommendations of the Dietary Guidelines for the Brazilian Population. METHODS: This study was carried out with a subsample of the NutriNet-Brazil cohort based on quotas (n = 1,053). Adherence to the Guide was assessed using a scale of dietary practices (24 items), which generates a score ranging from 0 to 72. To assess knowledge, participants indicated on a scale of 1 to 10 how healthy they considered each item on a list of 12 foods in four categories (fruit, meat, dairy products and grains), including three groups from the Nova food classification: fresh or minimally processed (G1); processed (G3); and ultra-processed (G4). To generate the score (0 to 8), two points were assigned in each category when option G1 was evaluated as healthier than G3, and both as healthier than G4. In the analysis, sample weighting was used to bring the distribution of the sample closer to the profile of the Brazilian population. T he association between the knowledge score and adherence to the Guide was tested using linear regression with adjustment for sociodemographic, socioeconomic and behavioral variables. RESULTS: The mean score for adherence to the Guide was 43.1 (SD = 9.29) and the mean score for knowledge was 5.4 (SD = 1.2). In the crude model, for every one point increase in knowledge, adherence to the Guide increased by an average of 0.8 points (p = 0.002). The association remained significant in the adjusted model, but the coefficient was reduced to 0.6 (p = 0.020) with the inclusion of socioeconomic variables in the model. CONCLUSION: Greater knowledge to recognize ultra-processed foods as less healthy is associated with greater adherence to the dietary practices recommended by the Dietary Guidelines for the Brazilian Population, reinforcing the importance of disseminating the recommendations.
Copyright (c) 2026 Kamila Tiemann Gabe, Patricia Constante Jaime https://creativecommons.org/licenses/by/4.0
Cost of a healthy and sustainable basic food basket in Brazil between 2009 and 2024
OBJECTIVE: To evaluate the evolution of the cost of a proposed healthy and sustainable basic food basket, nationally and for metropolitan regions, between 2009 and 2024. METHODS: Food purchase data (quantities and amounts paid) from the 2008–2009 and 2017–2018 Pesquisas de Orçamentos Familiares (POF - Household Budget Surveys) were used. T he food groups that make up the baskets were based on the Eat-Lancet planetary diet and official regulatory instruments. The Broad Consumer Price Index for foods and food groups was used to update the monthly prices of the items consumed by the Brazilian population in the context of the POFs that make up the proposed basic food basket. The accumulated inflation over the period was discounted to compare monetary values over time, calculating the real value of the basic food baskets. RESULTS: The real cost of the proposed national basic food basket remained relatively stable between 2009 and 2012, showing a subsequent upward trend until early 2017, including more significant growth between 2018 and 2024. A similar pattern was observed in the basic food baskets of the metropolitan regions. The cost (adult/month) represented on average 26% of the minimum wage in force in each year of the analysis period and 19% of the national average per capita income between 2010 and 2023. The share of food groups in the cost of the proposed basket remained stable over the period. CONCLUSION: There has been an increase in the real cost of the proposed healthy and sustainable basic food basket at national and regional level, particularly since 2018. Moreover, the value of the healthy and sustainable basic food basket showed an upward trend in relation to the average per capita income of the population, especially since 2018.
Copyright (c) 2026 Eliseu Verly Junior, Dirce Maria Lobo Marchioni, Semíramis Martins Álvares Domene, Isabela de Albuquerque Ribeiro, Flávia Mori Sarti https://creativecommons.org/licenses/by/4.0
Profile of food and beverage street vendors around private schools in Brazil
OBJECTIVE: To describe the socioeconomic profile and activity of street vendors, as well as the profile of food sales, according to industrial processing, in the vicinity of private schools in Brazilian state capitals. METHODS: Cross-sectional study with street vendors in the immediate vicinity of a national probability sample of Brazilian private schools. Elementary and/or high schools participating in the Food Marketing in Brazilian Schools Study were included. A previously validated questionnaire was applied to characterize workers, infrastructure and food availability. Food was classified according to the NOVA system. Comparisons between macro-regions (North, Northeast, Central-West, Southeast, and South) and sizes of point of sale (smallest: 1–3 items; intermediate: 4–13 items; largest: ≥ 14 items) were evaluated using the Kruskal-Wallis test. RESULTS: The informal food and beverage trade in the immediate vicinity of 2,180 private schools was mapped, totaling 699 street vendors. There was a predominance of men (57.8%), black people (68.8%), those with completed secondary education (35.8%), and those who worked informally (91.4%), in carts and stalls, due to a lack of opportunity in the formal market (52.5%). T he median number of ultra-processed items was about twice that of in natura, minimally processed, or processed foods and preparations based on them (2.17; 95%CI 1.90–2.45). Larger outlets concentrated more ultra-processed foods in all regions, except in the Northeast, where this predominance already occurred in intermediate-sized outlets (3.32; 95%CI 2.88–3.75). The lowest ratio of ultra-processed foods was observed in the South (0.21; 95%CI 0.05–0.37) and the highest in the Northeast (3.32; 95%CI 2.88–3.75). CONCLUSION: Street vending around Brazilian private schools reflects structural inequalities and expands commercially in the supply of ultra-processed foods to children and adolescents. We recommend its inclusion as an inseparable component in the evaluation of the school food environment, to support policies that reconcile income generation and the promotion of healthy eating.
Copyright (c) 2026 Sabrina Gomes Ferreira Clark, Larissa Loures Mendes, Juliana Souza Oliveira, Luiza Delazari Borges, Letícia Ferreira Tavares, Paulo César Pereira de Castro Júnior, Letícia de Oliveira Cardoso, Raquel Canuto https://creativecommons.org/licenses/by/4.0
Factors associated with the cost of child and adolescent mental health crisis care in Brazil
OBJECTIVE: To identify the sociodemographic and clinical variables that influenced the daily costs of children and adolescents who stayed overnight in Type III Centro de Atenção Psicossocial Infantojuvenil (CAPSij - Child and Adolescent Psychosocial Care Center) or in hospital reference or emergency and urgent care from the perspective of society in the year 2023. METHODS: This is a retrospective cost analysis. Direct and indirect costs were collected. A mixed technique was used to measure costs, prioritizing the micro-costing approach and the bottom-up method for valuation. Factors influencing costs were evaluated using univariate statistical models. RESULTS: The study included 399 users. The average total cost was R$ 6,704.38 (US$ 1,149.99) and the average daily cost was R$ 1,097.97 (US$ 188.33). There was statistical significance in the correlation between daily cost and age, race, diagnostic subgroup, referral to the service, and reason for seeking care. The variable with the greatest positive variation in daily cost was seeking care for drug use (R$ 125.82; US$ 21.58), while the variable with the greatest negative variation in daily cost was being referred by another service (R$ 139.86; US$ 23.99). CONCLUSIONS: To make more efficient use of available resources, it is up to the child and adolescent mental health care network to invest in the early care of children and adolescents, especially those who are most vulnerable and who may have problems with drug use, and to increasingly encourage coordination between services.
Copyright (c) 2026 Nathalia Nakano Telles, Heloísa Garcia Claro, José Carlos Marques de Carvalho, Márcia Aparecida Ferreira de Oliveira https://creativecommons.org/licenses/by/4.0
Evaluation of the implementation of an intervention aimed at expanding Covid-19 testing, case telemonitoring and surveillance actions in Primary Health Care
OBJECTIVE: To evaluate the degree of implementation of an intervention aimed at expanding testing, isolation, quarantine, and telemonitoring of Covid-19 cases (TQT-Covid-Strategy) in primary healthcare units within an administrative health region of a municipality in Northeastern Brazil. METHODS: A decision matrix was used with dimensions and criteria derived from a logical model developed based on literature review and technical guidelines of the World Health Organization, the Brazilian Ministry of Health, and the host municipality of the administrative health region. Interviews were conducted with 121 key informants. RESULTS: The degree of implementation in the 17 health units surveyed (12 Family Health Units and five Health Centers) varied according to the final classification, dimensions, and criteria. Overall, most units were considered as having the intervention partially implemented, with the highest rated dimension being “accessibility to testing,” implemented in 82.3% of the units, followed by the use of the “digital platform,” partially implemented in 15 units. The dimension with the lowest score percentage was “monitoring cases and surveillance strategies”. CONCLUSIONS: The intervention led to significant improvements in access to testing, supported by the adoption of communication strategies that enhanced the population’s adherence. Contextual, operational, technical, and acceptance factors among health professionals and users represented important challenges to implementation. To ensure sustainability and dissemination of this strategy, investments are required to strengthen Primary Health Care, including improvement in infrastructure, expansion of the health workforce, and professionals training.
Copyright (c) 2026 Gerluce Alves Pontes da Silva, Thais Regis Aranha Rossi, Sisse Figueiredo de Santana, Alcione Brasileiro Oliveira, Ana Maria Freire de Souza Lima, Trícia Silva Santos, Izabel Cristina Neves Ramos, Carolina Pedroza de Carvalho Garcia, Laio Magno, Inês Dourado, Lígia Maria Vieira da Silva https://creativecommons.org/licenses/by/4.0
Precarious work and Covid-19: repercussions on the health of primary health care workers
OBJECTIVE: To analyze how the Covid-19 pandemic influenced the working conditions and health of primary health care professionals in a health district of a capital city in Northeast Brazil. METHODS: This was a qualitative study using the theoretical framework of the health work process, part of the formative research of the project "Expansion of testing, quarantine, e-health and telemonitoring strategies in the fight against Covid-19 in Brazil" (TQT Project). Data were collected between December 2021 and March 2022 in a health district of a capital city in Northeast Brazil to support the implementation of the aforementioned project. Twenty-two interviews and three focus groups with 19 participants, all health care professionals from the health district under study, were analyzed for their content. RESULTS: The pandemic context caused repercussions on working conditions and health, with the effects of precarious working conditions and the implementation of protective measures being highlighted as key elements in the dimension of working conditions. Mental suffering, the impact of gender issues, and post-Covid-19 conditions were identified as the main elements contributing to the illness of the professionals.CONCLUSION: The evidence set gathered in this study indicates that various stressors emerge or worsen intensely and inseparably among health care professionals, clearly demonstrating the relationship between the pandemic and the health-disease process of these workers. Therefore, it is imperative to reverse the situation of illness among workers in the post-pandemic period to mitigate its effects in the medium and long term.
Copyright (c) 2026 Ticiane Teixeira de Mendonça, Sandra Garrido de Barros, Thais Regis Aranha Rossi, Ana Clara de Rebouças de Carvalho, Denise Nogueira Cruz, Laio Magno, Ines Dourado https://creativecommons.org/licenses/by/4.0
Mental health during the COVID-19 pandemic: reports from health professionals in Rio de Janeiro
OBJECTIVE: To explore the perception of Health Professionals (HP) who worked in Primary Health Care (PHC) between 2020 and 2022, in the Manguinhos neighborhood of Rio de Janeiro, regarding the risk and protective factors for their mental health during the management of the COVID-19 pandemic. METHODS: This is a qualitative study integrated into a broader investigation on testing strategies, quarantine, digital health, and telemonitoring in areas of high socioeconomic vulnerability in Brazil. Three focus groups were conducted with community health agents and ten semistructured interviews with higher education professionals. The data were collected between November 2022 and March 2023. The analysis was conducted based on the psychodynamics of work, and the procedures followed the content analysis technique. RESULTS: The study identified several factors that contributed to high levels of stress and anxiety among health professionals who worked in family health units during the COVID-19 pandemic. The main reported factor was the constant fear of death. Additionally, work overload, lack of adequate Personal Protective Equipment (PPE), feelings of decision-making incapacity, and absence of mental health support exacerbated the impact on the professionals' health. Among community health agents, the perception of exclusion concerning the HP category was particularly noted. CONCLUSION: The COVID-19 pandemic revealed the urgent need to prioritize the mental health of health professionals from the onset of any health crisis. Preparing for future emergencies requires proactive actions, such as equitable distribution of workload, adequate provision of PPE, and free and accessible access to specialized mental health treatment for health professionals.
Copyright (c) 2026 Débora Castanheira, Carla Pereira, Thiago Silva Torres, Daniele Novaes, Gessica Ferreira, Thiago Jacobino, Thais Regis Aranha, Valdilea Gonçalves Veloso https://creativecommons.org/licenses/by/4.0
Analysis of the monitoring of the expansion of Covid-19 testing and surveillance in a municipality
OBJECTIVE: To analyze the monitoring of an intervention for expanding testing, isolation, quarantine, and telemonitoring of Covid-19 (TQT-Covid-Strategy) in an administrative health region of a municipality in Northeastern Brazil. METHODS: This is an evaluative study, whose object of analysis were data produced in the monitoring of a health intervention (TQT-Covid-Strategy), for six months, in 17 health units, namely 12 Family Health Units and five Health Centers. Monitoring matrices created through field reports, workshops with professionals and managers, and permanent education activities were analyzed. Monitoring took place in the three components of the TQT-Covid-Strategy intervention: expansion of accessibility to testing, monitoring of cases and surveillance strategies, and digital platform. The actions in each component were considered adequate (A), partially adequate (P), and inadequate (I) in relation to the activities determined in the action plan and in the protocol of the TQT-Covid-Strategy. RESULTS: The component of the expansion of accessibility to testing was considered adequate, while the monitoring of cases and surveillance strategies presented partially adequate or inadequate results in many units. As for the digital platform component, there was predominantly adequate performance in relation to registration and access to test results and case reporting. However, the use of other surveillance-related resources, such as contact tracing, was inadequate. CONCLUSIONS: Boosting the institutionalization of monitoring can be an important instrument for the implementation and improvement of health interventions. The regular presence of enablers and a widely disseminated protocol, in addition to community health agents, enhanced the intervention. However, partially adequate or inadequate results reinforced the importance of qualification of the work process in primary health care regarding surveillance actions and the use of information and communication technologies.
Copyright (c) 2026 Alcione Brasileiro Oliveira, Ana Maria Freire de Souza Lima, Thais Regis Aranha Rossi, Gerluce Alves Pontes da Silva, Sisse Figueiredo de Santana, Trícia Silva Santos, Izabel Cristina Neves Ramos, Sintique Priscila Alves Lopes, Nathalia Almeida Suzart, Laio Magno, Lígia Maria Vieira da Silva https://creativecommons.org/licenses/by/4.0
Home isolation capacity after Covid-19 diagnosis in vulnerable communities of two Brazilian cities: TQT Covid-19 Study
OBJECTIVE: To investigate factors associated with self-reported capacity to comply with home isolation after Covid-19 diagnosis in vulnerable communities in two Brazilian cities. METHODS: Cross-sectional study, with data from a study on the implementation of an intervention based on strategies of testing, isolation, quarantine, and telemonitoring (TQT) of Covid-19 in Primary Health Care in vulnerable neighborhoods (TQT Covid-19 Study). Demographic, socioeconomic, and behavioral data were used to perform descriptive and logistic regression analyses, aiming to evaluate the factors associated with home isolation capacity. RESULTS: The sample consisted of 324 participants, most of them women (72.5%) and who self-reported to be Black or mixed-race (85.2%). Regarding level of education, 20.1% had up to elementary school degree; 42% had high school degree; and 37.9% had higher education or graduate degree. The density of people per room was high in 57.1% of households. In the multivariate analysis, high household density (≥ 0.5 residents/room) was significantly associated with reduced isolation capacity (ORa = 0.41; 95%CI 0.20–0.82). Other sociodemographic and behavioral variables, including age, sex, race/skin color, level of education, history of Covid-19 infection, access to health services, and preventive behaviors, did not present a statistically significant association. CONCLUSION: According to the study, housing conditions, especially high household density, can be a determinant for adherence to home isolation. Thus, innovative prevention strategies should combine educational and structural actions that consider the household context of vulnerable families.
Copyright (c) 2026 Audêncio Victor, Fabiane Soares, Diana Zeballos, Thais Aranha Rossi, Joilson Nascimento Paim, Thiago Silva Torres, Debora Castanheira, Valdiléia Gonçalves Veloso, Inês Dourado, Laio Magno https://creativecommons.org/licenses/by/4.0
Demand creation for testing and Covid-19 surveillance indicators in the Covid-19 Testing, Isolation, Quarantine, and Telemonitoring Study
OBJECTIVE: To analyze the demand creation strategies for Covid-19 testing and to describe surveillance indicators for testing, quarantine, contact tracing, and telemonitoring in primary health care services. METHODS: This cross-sectional study used data from the Covid-19 Testing, Isolation, Quarantine, and Telemonitoring (TQT Covid-19) study, conducted from July 2022 to July 2023. Primary healthcare service units in Rio de Janeiro and Salvador were selected to apply an intervention to develop demand creation strategies for testing uptake. Demand creation strategies were grouped into online strategies, traditional means, primary health care service units, community, and active search. Logistic regression was performed to determine the characteristics of the population reached by each strategy. The following Covid-19 surveillance indicators were estimated for testing and prevention (testing rate, positivity rate, monthly incidence, and full vaccination rate); for telemonitoring (monitoring rate, severity, referrals, and mortality); for quarantine (quarantine conditions); and for contact tracing (proportion of contacts traced and refusals of testing). RESULTS: The intervention reached 12,401 individuals, and 11,843 tests were performed. Demand creation strategies that reached more individuals for testing were primary health care service units (37.0%) and active search (25.9%). The positivity rate during the study period was 27.2% in Salvador and 11.5% in Rio de Janeiro. A total of 14.1% of cases were monitored, and most were asymptomatic (42.5%) or mild (52.3%). No deaths were reported among monitored cases. The proportion of fully vaccinated individuals was 91.8%. Contact tracing identified 25.1% of reported contacts, and 41.5% declined testing. CONCLUSIONS: The intervention facilitated expanded testing. Primary health care service units and active search were the strategies that reached more individuals for testing. Telemonitoring and contact tracing were the most challenging components to implement in primary health care services units and, given their importance, should be strengthened for future pandemics. These findings underscore the relevance of surveillance for assessing public health measures, identifying gaps, and supporting data-driven decision-making to improve epidemic management.
Copyright (c) 2026 Diana Zeballos, Fabiane Soares, Laio Magno, Thais Aranha Rossi, Gabriel Alves de Sampaio Morais, Carina Carvalho dos Santos, Joice Neves Reis, Guilherme Barreto Campos, Lucas Miranda Marques, Alexandre Grangeiro, Debora Castanheira, Thiago Silva Torres, Valdilea Gonçalves Veloso, Ines Dourado https://creativecommons.org/licenses/by/4.0