Artigos e Materiais de Revistas Científicas - ODS/01

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Providing support to underprivileged people during the COVID-19 pandemic in Brazil: the role of the Trust Group and women leaders in São Paulo’s favelas
(2023) DOMINGOS, A. L. G.; MITKIEWICZ, J. M.; SALDIVA, P. H. N.
São Paulo was one of the epicenters of the COVID-19 pandemic in Brazil. Amongst underprivileged populations, such as slums residents, the impact of the pandemic was severe. This documentary reports the creation of the Trust Group, made up mostly of women community leaders in São Paulo’s slums, and how their actions inspired public policies in Brazil. Their lessons are examples of governance and solidarity in times of crisis and can serve as models for other cities in Latin America. The documentary describes this history as told by those community leaders. To watch the documentary, kindly visit the following link: https://youtu.be/61elJw0oqCY.
Vocational Rehabilitation and Length of Stay at Work after Work-Related Musculoskeletal Disorders: A Longitudinal Study in Brazil
(2023) MIRANDA, C. B. de; SILVA-JUNIOR, J. S.; GARCIA, K. K. S.; SOUSA, F. N. E. F. de; FISCHER, F. M.
Vocational rehabilitation is an intervention to enhance the return to work and improve quality of life. The aim of this study was to evaluate sociodemographic and occupational factors associated with the length of stay at work among workers with work-related musculoskeletal disorders (WRMDs) who had undergone rehabilitation through the Brazilian public social security system. This was a longitudinal study among 680 workers with histories of disability due to WRMDs who returned to the formal job market after vocational rehabilitation between 2014 and 2018. Survival analysis was performed to identify the factors influencing permanence in work. Job dismissal occurred for 29.26% of the workers. The average duration of employment after returning to the formal job position was 56 months. The following factors were associated with shorter length of employment: living in the southeastern region (HR: 2.78; 95% CI 1.12–6.91) or southern region (HR: 2.68; 95% CI 1.04–6.90) of Brazil; working in transportation, storage or postal services (HR: 2.57; 95% CI 1.07–6.17); or working in financial activities, insurance or related services (HR: 2.70; 95% CI 1.05–6.89). These findings may contribute to the discussion about prevention of disability and interventions to ensure health care for workers with WRMD disabilities who undergo rehabilitation.
Analysis of education level in access and use of health care services, ISA-Capital, São Paulo, Brazil, 2003 and 2015
(2023) SANTOS, Edige Felipe de Sousa; LOUVISON, Marilia Cristina Prado; OLIVEIRA, Elaine Cristina Torres; MONTEIRO, Camila Nascimento; BARROS, Marilisa Berti de Azevedo; GOLDBAUM, Moises; CESAR, Chester Luiz Galvao
The great socioeconomic inequality that prevails in Brazil and the existence of a national health system with universal coverage places the need to monitor the evolution and social inequities regarding access to these services. This study aims to analyze the changes in the prevalence of health care use and the extent of social inequality in the demand, use and, access, resolution of health problems, satisfaction, and health care use of Brazilian Unified National Health System (SUS) according to education levels in the population living in the urban area of the Municipality of Sao Paulo, in 2003 and 2015. We analyzed data from two population-based household health surveys (Health Survey in Sao Paulo City - ISA-Capital) from 2003 and 2015. Dependent variables related to health care use in the two weeks preceding the survey and due to diseases included demand, access, satisfaction, problem resolution, and the public or private nature of the service. Prevalence was estimated using level of education and prevalence ratios (PR) by the Poisson regression. In the period, the demand for health care, access, resolution, and use of public health care increased from 2003 to 2015. Inequities in public health care use changed from 2003 to 2015 according to level of education. We found no social inequities in health care use in the municipality of Sao Paulo regarding demand, access, satisfaction, and resolution according to levels of education. Results show progress in the use and resolution of health care services, as well as the strong concentration of the use of SUS by the population with lower education. Results indicate the progress that SUS has made, but also show persistent challenges in the use and access to services.
One health approach to toxocariasis in quilombola communities of southern Brazil
(2023) SANTAREM, Vamilton Alvares; PANAZZOLO, Giovanni Kalempa; KMETIUK, Louise Bach; DOMINGUES, Orlei Jose; FERREIRA, Isabella Braghin; SOUZA FILHO, Roberto Teixeira de; FARINHAS, Joao Henrique; DOLINE, Fernando Rodrigo; LESCANO, Susana Angelica Zevallos; BIONDO, Leandro Meneguelli; GIUFFRIDA, Rogerio; BIONDO, Alexander Welker; FAVERO, Giovani Marino
Background Toxocariasis has been listed among the most neglected parasitic diseases worldwide, with approximately one fifth of the global population exposed, particularly those living under poverty. In Brazil, communities of descendants of enslaved blacks (quilombola) have historically had some of the highest rates of vulnerability and poverty, characterized by lack of health assistance, poor quality of life, and nutritional insecurity.Methods A cross-sectional sampling of quilombola individuals living in four communities of southern Brazil, as well as their dogs and the soil, was carried out from December 2021 to March 2022. Sociodemographic and other information such as water source, alimentary habits, and dog and cat ownership were gathered using a semi-structured questionnaire for assessing toxocariasis risk factors. Human serum samples were tested by ELISA for anti-Toxocara spp. IgG antibody detection was carried out on dog feces and hair, and soil samples were surveyed for presence of Toxocara spp. eggs.Results Overall, 172/208 individuals (82.7%, 95% CI = 77.0-87.2) were seropositive, the highest seroprevalence rate to date in Brazil. Male gender (P = 0.029), educational level (P = 0.026), and drinking water source (P = 0.043) were associated with seropositivity by univariate analysis. Final logistic regression revealed increased odds (P = 0.017, OR = 7.6, 95% CI = 1.5-42.7) to have seropositivity in individuals > 50 years old (< 10 years old). As expected, individuals with soil contact were more likely seropositive (P = 0.038, OR = 4.4, 95% CI = 1.1-18.8). Although retrieved in only 5/96 (5.2%) dog feces, Toxocara spp. eggs were found in 18/60 (30.0%) soil samples.Conclusions The high vulnerability and seroprevalence observed in quilombola communities clearly demand a One Health approach for detection, monitoring, and prevention of infection by Toxocara spp. in both human and dog populations.
A web-based educational therapy intervention associated with physical exercise to promote health in fibromyalgia in Brazil: the Amigos De Fibro (Fibro Friends) study protocol
(2023) ANTUNES, Mateus Dias; LOURES, Felipe Cayres Nogueira da Rocha; SOUZA, Ingred Merllin Batista de; CRUZ, Ariela Torres; JANUARIO, Priscila de Oliveira; PINHEIRO, Mara Maria Lisboa Santana; SCHMITT, Ana Carolina Basso; FRUTOS-BERNAL, Elisa; MARTIN-NOGUERAS, Ana Maria; MARQUES, Amelia Pasqual
Background Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study ""Amigos de Fibro (Fibro Friends)"" is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil.Methods A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention.Discussion The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology.
Improving Outcomes of Patients with Acute Coronary Disease in Real Life: The Case of Applying in Practice What We Already Know from Clinical Studies
(2023) GARZON, Stefano; LEMOS, Pedro A.
Two decades of socioeconomic inequalities in the prevalence of untreated dental caries in early childhood: Results from three birth cohorts in southern Brazil
(2023) KARAM, Sarah Arangurem; COSTA, Francine dos Santos; PERES, Karen G.; PERES, Marco A.; BARROS, Fernando C.; BERTOLDI, Andrea D.; SANTOS, Ina S.; TOVO, Luciana; MATIJASEVICH, Alicia; MENEZES, Ana M.; GONCALVES, Helen; CORREA, Marcos Britto; DEMARCO, Flavio Fernando
Objectives To estimate the socioeconomic disparities in untreated dental caries in early childhood according to socioeconomic characteristics in three birth cohorts in Southern Brazil. Methods The socioeconomic data to this study were collected at the 48-month follow-up and oral health studies of 1993, 2004 and 2015 Pelotas birth cohort studies. The outcome was untreated dental caries in children aged 6 (1993 cohort), 5 (2004 cohort) and 4 years (2015 cohort), dichotomized into absence/presence. Analyses were stratified by maternal skin colour/race, maternal education and family income. For statistical purposes, the prevalence difference, relative risk and absolute and relative indices of health inequality (Slope Index of Inequality-SII and Concentration Index-CIX) were used. Results The prevalence of untreated dental caries in primary dentition was 63.4%, 45.5% and 15.6%, in 1993, 2004 and 2015 cohorts, respectively. The prevalence of untreated dental caries was concentrated in the poorest quintile and lower maternal education group in both absolute (SII) and relative (CIX) measures of inequality, being characterized as a pro-poor event. A higher risk of untreated caries was found in the poorest quintile of family income compared with the richest quintile in the 1993 cohort (RR 1.44 [95% CI 1.05; 1.98]). That risk was higher considering the 2004 Cohort (RR 1.78 [95% CI 1.42; 2.23]) and 2015 cohort (RR 4.20 [95% CI 2.97; 5.94]) data. Conclusions Over the course of two decades, a higher prevalence of untreated dental caries is concentrated among the most socioeconomically deprived children.
A higher number of SARS-COV-2 infections in quilombola communities than in the local population in Brazil
(2023) MARTINS, Aline Fagundes; SOUZA, Daniela Raguer Valadao de; REZENDE NETO, Jose Melquiades de; SANTOS, Aryanne Araujo; INVENCAO, Grazielly Bispo da; MATOS, Igor Leonardo Santos; SANTOS, Kezia Alves dos; JESUS, Pamela Chaves de; SILVA, Francilene Amaral da; ALMEIDA, Fernando Henrique Oliveira de; VALE, Fernando Yuri Nery do; FONSECA, Dennyson Leandro M.; SCHIMKE, Lena F. F.; MATOS, Saulo Santos; OLIVEIRA, Brenda Morais; FERREIRA, Cyntia Silva; DIAS, Bruna de Paula; SANTOS, Samara Mayra Soares Alves dos; BARBOSA, Camila Cavadas; BARRETO, Ikaro Daniel de Carvalho; MORENO, Ana Karolina Mendes; GONCALVES, Ricardo Lemes; SILVA, Breno de Mello; CABRAL-MARQUES, Otavio; BORGES, Lysandro Pinto
The historical and social vulnerability of quilombola communities in Brazil can make them especially fragile in the face of COVID-19, considering that several individuals have precarious health systems and inadequate access to water. This work aimed to characterize the frequency of SARS-COV-2 infections and the presence of IgM and IgG SARS-CoV-2 antibodies in quilombola populations and their relationship with the presence of risk factors or preexisting chronic diseases in the quilombola communities. We analyzed the sociodemographic and clinical characteristics, serological status, comorbidities, and symptoms of 1,994 individuals (478 males and 1,536 females) from 18 Brazilian municipalities in the State of Sergipe of quilombola communities, which were evaluated at different epidemiological weeks, starting at the 32nd (August 6th) and ending at the 40th (October 3rd) epidemiological week. More than 70% of studied families live in rural areas and they have an extreme poverty social status. Although we found a higher number of SARS-COV-2 infections in quilombola communities than in the local population, their SARS-CoV-2 reactivity and IgM and IgG positivity varied across the communities investigated. Arterial hypertension was the most risk factor, being found in 27.8% of the individuals (9.5% in stage 1, 10.8% in stage 2, and 7.5% in stage 3). The most common COVID-19 symptoms and comorbidities were headache, runny nose, flu, and dyslipidemia. However, most individuals were asymptomatic (79.9%). Our data indicate that mass testing must be incorporated into public policy to improve the health care system available to quilombola populations during a future pandemic or epidemic.
Consumption of ultra-processed foods in Brazil: distribution and temporal evolution 2008-2018
(2023) LOUZADA, Maria Laura da Costa; CRUZ, Gabriela Lopes da; SILVA, Karina Augusta Aparecida Nogueira; GRASSI, Ana Giulia Forjaz; ANDRADE, Giovanna Calixto; RAUBER, Fernanda; LEVY, Renata Bertazzi; MONTEIRO, Carlos Augusto
Disparities in HIV continuum of care in the paediatric population: A real-life study in Brazil
(2023) FERREIRA, Alexandre Alberto Cunha Mendes; PINHO, Rosana Goncalves Goncalves; AQUINO, Lais Martins de; PERINI, Filipe de Barros; FONSECA, Fernanda Fernandes; TRESSE, Alexsana Sposito; PEREIRA, Gerson Fernando Mendes; I, Vivian Avelino-Silva; PASCOM, Ana Roberta
Introduction Paediatric HIV follow-up is challenging, and treatment indicators are markedly far from Joint United Nations Programme on HIV/AIDS (UNAIDS) goals. In this study, we describe the 2019 Brazilian HIV cascade according to age categories and sociodemographic variables and address temporal trends between 2009 and 2019. Methods We obtained data from the Brazilian Ministry of Health monitoring database. Cascade outcomes included retention in care, antiretroviral use, and viral suppression. We assessed the effect of age on timely initiation of antiretroviral treatment (ART; initiation with CD4(+) T-cell count >= 350 cells/mm(3) or a first ART dispensation <= 30 days after the first CD4(+) T-cell measurement) and detectable HIV viral load (>50 copies/mL) in univariable and multivariable analysis adjusted for sex, race, and social vulnerability index (SVI). Temporal trends in timely ART initiation and viral suppression were evaluated graphically. Results Among 771 774 people living with HIV, those in the youngest age categories had poorer indicators in the care cascade. Those in younger age groups, those with higher SVI, and those declaring Black and native Brazilian race/ethnicity had higher odds of having detectable viral load and delayed ART initiation. Although children living with HIV tend to start ART with higher CD4(+) T-cell counts, time-series analysis suggests that improvements in treatment indicators seen in the adult population are not observed in the paediatric population. Conclusion Our results highlight the challenges faced by children and adolescents living with HIV in achieving UNAIDS goals. Lower access to ART among children is a central barrier to improved paediatric care.
Modification of temperature-related human mortality by area-level socioeconomic and demographic characteristics in Latin American cities
(2023) BAKHTSIYARAVA, Maryia; SCHINASI, Leah H.; SANCHEZ, Brisa N.; DRONOVA, Iryna; KEPHART, Josiah L.; JU, Yang; GOUVEIA, Nelson; CAIAFFA, Waleska Teixeira; O'NEILL, Marie S.; YAMADA, Goro; ARUNACHALAM, Sarav; DIEZ-ROUX, Ana V.; RODRIGUEZ, Daniel A.
Background: In Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality. Objectives: Explore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities. Methods: The dependent variables quantify city-specific associations between temperature and mortality: heatand cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 degrees C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level. Results: We find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality. Discussion: Evidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.
Analysing the impact of modifiable risk factors on cardiovascular disease mortality in Brazil
(2022) GASPAR, Renato Simoes; REZENDE, Leandro F. M.; LAURINDO, Francisco Rafael Martins
ObjectivesWe have examined the impact of changes in modifiable risk factors on CVD mortality in 26 Brazilian states from 2005 to 2017. MethodsData were acquired from the Global Burden of Diseases study (GBD) and official sources of the Brazilian government, totalling 312 state-year observations. Population attributable fractions (PAFs) were calculated to determine the number of deaths attributed to changes in each risk factor. Fixed-effects multivariable linear regression models were performed, adjusting for income, income inequality, poverty and access to healthcare. ResultsBetween 2005 and 2017, CVD deaths reduced by 21.42%, accompanied by a decrease in smoking (-33%) and increases in hyperglycaemia (+9.5%), obesity (+31%) and dyslipidaemia (+5.2%). Reduction in smoking prevented or postponed almost 20,000 CVD deaths in this period, while increased hyperglycaemia exposure resulted in more than 6,000 CVD deaths. The association between hyperglycaemia and CVD mortality was 5 to 10 times higher than those found for other risk factors, especially in women (11; 95%CI 7 to 14, deaths per 1-point increase in hyperglycaemia exposure). Importantly, the association between hyperglycaemia and CVD mortality was independent of socioeconomic status and access to healthcare, while associations for other risk factors after the same adjustments. ConclusionReduction in smoking was the risk factor that led to the highest number of CVD deaths prevented or postponed, while hyperglycaemia showed the most deleterious association with CVD mortality. Health policies should aim to directly reduce the prevalence of hyperglycaemia to mitigate the population burden of CVD in Brazil in the future.
I Can't Take This Shitty Quarantine Anymore: Sexual Behavior and PrEP Use Among Young Men Who Have Sex with Men and Transgender Women in Brazil During the COVID-19 Pandemic
(2023) FERRAZ, Dulce; ROSSI, Thais Aranha; ZUCCHI, Eliana Miura; DEUS, Luiz Fabio Alves de; MABIRE, Xavier; FERGUSON, Laura; MAGNO, Laio; GRANGEIRO, Alexandre; PREAU, Marie; BOTELHO, Fernanda Cangussu; RODRIGUES, Ayra; STEELE, Sabrina; DOURADO, Ines
This study analyzes how the COVID-19 pandemic affected sexual behavior and use of HIV prevention methods among young transgender women (YTGW) and young gay, bisexual and other men who have sex with men (YGBMSM) participating in an HIV pre-exposure prophylaxis (PrEP) demonstration study in Brazil. Online interviews with 39 participants aged 15-22 years old were conducted between September and November 2020 and analyzed based on social constructionism and human rights-based approaches to health. The pandemic disrupted interviewees' routines, negatively affecting their life conditions. Among those who did not have a steady partner, social distance measures led to temporary interruption of sexual encounters and increased sexting and solo sex. Conversely, for those who had a steady relationship such measures contributed to increasing sexual practices and intimacy. Participants who had sexual encounters during the pandemic reported having continued to use PrEP. However, home confinement with family, lack of privacy, loss of daily routines and changes in housing impaired PrEP adherence and attendance at follow-up consultations. These results highlight the importance of maintaining HIV-service delivery for these groups during a public health crisis, as well as to address the structural drivers of the epidemic with comprehensive HIV prevention policies and by ensuring access of YGBMSM and YTGW to social protection policies.
Utilisation and costs of mental health-related service use among adolescents
(2022) ZIEBOLD, Carolina; SILVA-RIBEIRO, Wagner; KING, Derek; MCDAID, David; HOFFMANN, Mauricio Scopel; ROMEO, Renee; PAN, Pedro Mario; MIGUEL, Euripedes Constantino; BRESSAN, Rodrigo Affonseca; ROHDE, Luis Augusto; SALUM, Giovanni Abrahao; MARI, Jair de Jesus; EVANS-LACKO, Sara
Background The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Methods Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Results Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95% CI = 1.44-4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27-3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69-5.36, p<0.001]), higher impact of symptoms on adolescent's life (OR = 1.32, 95%CI = 1.19-1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05-1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (beta = 0.25, 95%CI = 0.12-0.39, p<0.001), lower parental stigma (beta = 0.12, 95%CI = 0.02-0.23, p = 0.020) and white ethnicity (beta = 0.55, 95%CI = 0.04-1.07, p = 0.036). Conclusion The impact of mental health problems on adolescents' daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.
Factors associated with inequalities in social conditions in the health of elderly white, brown and black people in the city of Sao Paulo, Brazil
(2023) MOURA, Roudom Ferreira; CESAR, Chester Luiz Galvao; GOLDBAUM, Moises; OKAMURA, Mirna Namie; ANTUNES, Jose Leopoldo Ferreira
The scope of this study is to identify determining factors of disparities in social con-ditions in the health of non-institutionalized elderly people in the city of Sao Paulo, from the standpoint of self-declaration of skin color. It is a cross-sectional study with a representative sample of 1,017 elderly participants in the ""2015 Heal-th Survey of the Municipality of Sao Paulo"". The analysis used crude and adjusted Poisson regres-sion models, reporting the prevalence ratio and 95% confidence intervals as a measure of associa-tion between the variables. In the adjusted analy-sis, brown and black skin color was positively associated with worse schooling, negative self-as-sessment of health status, health insurance and access to public health services. On the one hand, black skin color was no longer associated with the lowest income, however, it was associated with arterial hypertension. On the other hand, brown skin color was associated with low income, but not with arterial hypertension. Elderly black and brown people had worse health conditions, less access to private health services and socioecono-mic resources. These results are compatible with the hypothesis of structural racism in Sao Paulo's society and may inform social health policies ai-med at promoting health and social justice. zados saude
Association of urban inequality and income segregation with COVID-19 mortality in Brazil
(2022) SOUSA FILHO, J. Firmino de; SILVA, Uriel M.; LIMA, Larissa L.; PAIVA, Aureliano S. S.; SANTOS, Gervasio F. H.; ANDRADE, Roberto F. S.; GOUVEIA, Nelson; SILVEIRA, Ismael H.; FRICHE, Amelia A. de Lima; BARRETO, Mauricio L.; CAIAFFA, Waleska Teixeira
Socioeconomic factors have exacerbated the impact of COVID-19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID-19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID-19 mortality in large urban centers in Brazil. We compiled weekly COVID-19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID-19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID-19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID-19, as supported by the observed associations in this study.
Decision Criteria for Partial Nationalization of Pharmaceutical Supply Chain: A Scoping Review
(2023) MARRONE, Patricia Veras; MATHIAS, Fabio Rampazzo; BERNARDO, Wanderley Marques; ORLANDINI, Marina Feliciano; SERAFIM, Maria Carolina Andrade; SCOTON, Maria Lidia Rebello Pinho Dias; LOPES, Juliano Marcal; PEREIRA, Sergio Luiz; DIAS, Eduardo Mario
(1) Background: Any disturbance in the pharmaceutical supply chain (PSC) can disrupt the supply of medicines and affect the efficiency of health systems. Due to shortages in the global pharma supply chain over the past few years and the complex nature of free trade and its limitations when confronted by a major global health and humanitarian crisis, many countries have taken steps to mitigate the risks of disruption, including, for example, recommending the adoption of a plus one diversification approach, increasing safety stock, and nationalizing the medical supply chains. (2) Objective: To scope findings in the academic literature related to decision criteria to guide national policy decisions for the ""Partial Nationalization of Pharmaceutical Supply Chain"" (PNPSC) from the viewpoints of the three main stakeholders: industry, payers (government and health insurance), and patients. (3) Methods: These consist of a scoping review of the peer-reviewed literature. (4) Results: A total of 115 studies were included. For local manufacturing decisions, five criteria and 15 sub-criteria were identified. Weighting, decision-making, risk assessment, and forecasting were the main data analysis tools applied; (5) Conclusions: The findings could serve as a baseline for constructing PNPSC frameworks after careful adaptation to the local context.
Challenges to food safety for children and adolescents in Brazil
(2022) GONCALVES JUNIOR, Jucier; AMORIM, Liromaria Maria de; LIMA, Nadia Nara Rolim; ROLIM NETO, Modesto Leite
COVID-19 and HIV among children and adolescents: Current inequalities
(2022) SILVA, Francisco Samuel Marcelino; MACHADO, Savio Samuel Feitosa; MOREIRA, Jorge Lucas de Sousa; ARAUJO, Jaime Emanuel Brito; ARAUJO, Tallys Iury de; DIONIZIO, Barbara Silveira; VIEIRA, Nelio Barreto; PEREIRA, Yara Talita Gomes; ARAUJOTEIXEIRA, Saulo; LIMA, Danielly Goncalves Sombra; ROLIM NETO, Modesto Leite
Evidence-Based Practices in a Social Project: Promotion of Executive Functions in Children from Northeastern Brazil
(2022) BRITO, Gabriel; LEON, Camila; RIBEIRO, Camila; TREVISAN, Bruna; DIAS, Natalia; SEABRA, Alessandra
Evidence points to the possibility of promoting executive functions (EF) through school interventions. Little is known, however, about the effectiveness of this type of intervention in situations of social vulnerability. This study investigated the effectiveness of an EF intervention program applied with a sample of preschool children, in a situation of socioeconomic vulnerability, assisted by a non-governmental organization (NGO) in northeastern Brazil. Participants were 46 children (mean age = 4.67 years; SD = 0.71), divided into experimental (EG = 25) and control (CG = 21) groups. The children were assessed before and after the intervention regarding measures of EF and behavior indices. The intervention was applied over 3 months by two professionals from the NGO. There was no group x moment interaction effect on the performance measure used, however, fewer difficulties were observed posttest in the EG in relation to the CG, according to the informant-based measures. From the parents' reports, difficulties in inhibitory control (IC) decreased in the EG. From the parents' and teachers' reports, difficulties in hyperactivity, conduct problems and behavior problems (BP) total indices also decreased in the EG. A simple mediation model suggested that gains in IC mediated the intervention impact on gains in BP as observed by the parents. Interventions in EF for socioeconomically vulnerable children can minimize the deleterious effects of poverty on neurocognitive development. This study shows the applicability and effects of this type of intervention in an educational context, within the scope of a community assistance social project, bringing neuropsychology and social requirements closer together.

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