This study aimed to translate and culturally adapt the Sports Concussion Assessment Tool version 5 (SCAT-5) in Brazilian Portuguese for the follow-up of patients diagnosed with cerebral concussion. The components of the SCAT-5, which includes an assessment of level of consciousness using the Glasgow Coma Scale, were translated from English to Brazilian Portuguese, back-translated, and evaluated by an expert committee. The final version was tested twice, with a 2-week interval between assessments, in 36 athletes admitted to the cerebral concussion outpatient clinic with concussion. Statistical analyses were subsequently performed using prevalence-adjusted and bias-adjusted kappa to assess the degree of agreement between the first and second tests. The athletes were predominantly rugby players (23/36) and female (23/36), and none were in the acute phase of concussion. Their ages ranged from 18 to 45 years, and the median time from the last concussion to assessment was 104 days. A significant difference was observed between the first and second tests for three variables evaluated: "total number of symptoms," "balance test [standing on one foot]" and "total balance score," with an increase in the number of symptoms and a decrease in balance scores between tests, possibly indicating worsening symptoms or increased awareness about symptoms. The agreement between the first and second assessments was deemed moderate only for "irritability" and good or very good for all other variables. The SCAT-5 was successfully translated and culturally adapted for use in Brazilian patients. This tool will contribute to improving and standardizing the healthcare of patients with cerebral concussion in Brazil, improving medical care, and guiding medical staff toward orienting patients to a gradual and adequate return to sports-related activities following concussion.
Population surveys have widely used the Brazilian Food Insecurity Scale (EBIA, acronym in Portuguese) to measure food insecurity in the country. Despite its well-established psychometric properties, few studies have evaluated its measurement invariance between territories, which is essential to ensure the validity of regional comparisons. This study investigated EBIA invariance regarding urban/rural areas, macro-regions, and Brazilian states based on data from the 2013 Brazilian National Household Sample Survey (PNAD, acronym in Portuguese). It analyzed the eight general/adult EBIA items by alignment in three independent partitions of the sample (116,543 households). The results indicated that the EBIA showed invariance between urban and rural areas and partial invariance between regions and between states. These findings reinforce the validity of the EBIA to monitor and compare food insecurity across Brazil. A Escala Brasileira de Insegurança Alimentar (EBIA) tem sido amplamente empregada em inquéritos populacionais para mensurar a insegurança alimentar no Brasil. Embora suas propriedades psicométricas estejam bem estabelecidas, poucos estudos avaliaram sua invariância de mensuração entre diferentes contextos territoriais, o que é essencial para garantir a validade de comparações regionais. Este estudo investigou a invariância da EBIA em relação à situação urbana/rural, macrorregiões e estados do Brasil, com base nos dados da Pesquisa Nacional por Amostra de Domicílios (PNAD) de 2013. Foram analisados os oito itens gerais/de adulto da EBIA, por meio do método de alinhamento, em três partições independentes da amostra, totalizando 116.543 domicílios. Os resultados indicaram que a EBIA apresentou invariância entre áreas urbanas e rurais e invariância parcial entre as regiões e entre estados. Esses achados reforçam a validade do uso da escala para monitorar e comparar a insegurança alimentar em diferentes regiões do país. La Escala Brasileña de Inseguridad Alimentaria (EBIA) se ha utilizado ampliamente en encuestas poblacionales para medir la inseguridad alimentaria en Brasil. Aunque sus propiedades psicométricas están bien establecidas, pocos estudios han evaluado la invariancia de su medición en diferentes contextos territoriales, lo cual es esencial para asegurar la validez de las comparaciones regionales. Este estudio investigó la invariancia del EBIA en relación con la ubicación urbana/rural, las macrorregiones y los estados de Brasil, con base en datos de la Encuesta Nacional por Muestra de Domicilios (PNAD, por sus siglas en portugués) del 2013. Los ocho ítems generales/para adultos de la EBIA se analizaron utilizando el método de alineación en tres particiones independientes de la muestra, que totalizaron 116.543 hogares. Los resultados indicaron que el EBIA mostró invariancia entre áreas urbanas y rurales, e invariancia parcial entre las regiones y entre estados. Estos hallazgos refuerzan la validez del uso de la escala para monitorear y comparar la inseguridad alimentaria en diferentes regiones del país.
The objectives were to evaluate the differences in the nutritional profile between 2015/2016 and 2019/2021 and to estimate the number of Brazilians (≥ 50 years) with nutritional profile inadequacies. This is a cross-sectional study that used data from participants in waves 1 (2015/2016; n = 8,724) and 2 (2019/2021; n = 7,729) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Anthropometric parameters included body mass index and waist circumference (WC) and weekly food consumption of fruits, vegetables, fish, poultry, and red meat in both waves. Seven criteria for nutritional profile inadequacy were analyzed. There was an increase in the prevalence of high WC [70.0% (95%CI 68.5-71.5) and 75.5% (95%CI 72.8-78.0)] and fruit consumption in 3-4 days of the week [16.5% (95%CI 15.4-17.6) and 23.0% (95%CI 20.1-26.1)] between waves 1 and 2, respectively. The prevalence estimates of underweight and overweight (around 2% and 70%, respectively) remained stable during this period. It was estimated that, in 2022, around 29 million Brazilians aged ≥ 50 years had ≥ 4 inadequate criteria of the nutritional profile. It is concluded that the nutritional profile of the participants showed slight changes during the period. Public Health actions are necessary to improve this population's anthropometric parameters and food consumption. Os objetivos foram avaliar as diferenças do perfil nutricional entre 2015/2016 e 2019/2021 e estimar o número de brasileiros (≥ 50 anos) com inadequações do perfil nutricional. Trata-se de um estudo transversal que utilizou dados de participantes das ondas 1 (2015/2016; n = 8.724) e 2 (2019/2021; n = 7.729) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). Os parâmetros antropométricos incluíram índice de massa corporal e circunferência da cintura (CC) e consumo alimentar semanal de frutas, hortaliças, peixes, aves e carnes vermelhas nas duas ondas. Foram analisados sete critérios de inadequação do perfil nutricional. Houve aumento na prevalência de CC elevada [70,0% (IC95% 68,5-71,5) e 75,5% (IC95% 72,8-78,0)] e do consumo de frutas em 3-4 dias da semana [16,5% (IC95% 15,4-17,6) e 23,0% (IC95% 20,1-26,1)] entre as ondas 1 e 2, respectivamente. As prevalências de baixo peso e excesso de peso (em torno de 2% e 70%, respectivamente) se mantiveram estáveis nesse período. Estimou-se que, em 2022, cerca de 29 milhões de brasileiros com ≥ 50 anos tinham ≥ 4 critérios inadequados do perfil nutricional. Conclui-se que o perfil nutricional dos participantes apresentou mudanças discretas no período. Ações de saúde pública são necessárias para melhorar os parâmetros antropométricos e o consumo alimentar dessa população. Los objetivos fueron evaluar las diferencias en el perfil nutricional entre 2015/2016 y 2019/2021 y estimar el número de brasileños (≥ 50 años) con insuficiencias del perfil nutricional. Este estudio transversal utilizó datos de las ondas 1 (2015/2016; n = 8.724) y 2 (2019/2021; n = 7.729) del Estudio Longitudinal de Salud del Anciano Brasileño (ELSI-Brasil). Se analizaron parámetros antropométricos como índice de masa corporal, circunferencia de la cintura (CC) y consumo semanal de frutas, verduras, pescado, aves y carnes rojas en ambas oleadas. Se analizaron siete criterios de insuficiencia nutricional. Se observó un aumento en la prevalencia de CC alta [70,0% (IC95% 68,5-71,5) y 75,5% (IC95% 72,8-78,0)] y en el consumo de frutas 3-4 días a la semana [16,5% (IC95% 15,4-17,6) y 23,0% (IC95% 20,1-26,1)] entre las ondas 1 y 2, respectivamente. Las prevalencias de bajo peso y sobrepeso (alrededor del 2% y 70%, respectivamente) se mantuvieron estables. Se estimó que, en 2022, unos 29 millones de brasileños ≥ 50 años presentaban ≥ 4 criterios inadecuados del perfil nutricional. Se concluye que el perfil nutricional mostró ligeros cambios durante el período. Se requieren acciones de Salud Pública para mejorar los parámetros antropométricos y el consumo de alimentos en esta población.
Robotic surgery has become popular in recent decades and is already used in practically all surgical specialties. The increasing use of robotic systems has raised concerns about the safety of patients operated on by surgeons on a learning curve. This demand resulted in a standardized curriculum for training new surgeons. Public hospitals in Brazil possesses robotic systems, making surgical technology available to public healthcare. The relationship between funding and the healthcare model is one of the biggest obstacles to the deployment of expensive new treatments, such as the robotic system. In this prospective study, eighty patients were operated by robotic system, in a Brazilian public hospital, from March 2025 to January 2026, by eight apprentice surgeons. Data concerning demographics, intraoperative information (operation time, and post-operative findings were collected. Patients who underwent surgery were predominantly male (n = 48, 60%), with a mean age of 51 years (SD = 15; range: 19-81 years). The procedures performed were 39 inguinal hernioplasties (48.75%), followed by 31 cholecystectomies (38.75%) and other procedures accounted for 11 cases. Complications observed included seroma (n = 7), median 30 ml and without any approach required, urinary retention (n = 2), one infection of surgical site, one case of prolonged pain after hernioplasty and one conversion to open surgery due to complex inguinoscrotal hernia. Part of the financing came from the apprentice surgeon (70% of total cost), part came from the private initiative (20%), embodied in the robotic enterprise system and finally, funding from public healthcare. The median total cost for 5 inguinal hernioplasties and 5 cholecystectomies was 150000,00 reais, Brazilian currency.
the constitution and use of personal databases for various purposes has increased in recent years, amplified by technological advancements. Recent regulations seek to keep pace with these advances and ensure the protection of individual's privacy and dignity. The objective was to assess the impact of the Brazilian General Data Protection Law (LGPD) and Resolution 738/2024 of the Brazilian National Health Council on research with participants in Brazil. documentary research, using analysis of national and international regulations, laws and guidelines to describe the preand post-LGPD regulatory framework. the law and Resolution 738/2024 represent important milestones for data protection and specific requirements for its use in research, in addition to reinforcing ethical observance and the need of informed consent. these changes represent operational challenges, as well as dilemmas in balancing the importance of data use in health, education, and science, and the limits of individual protection.
This cross-sectional study identified mental health profiles among Brazilian adolescents and examined their associations with domain-specific physical activity (leisure time, school, and active commuting) and television (TV) viewing time. Data were obtained from 144,046 adolescents in the 2019 Brazilian National Survey of School Health (PeNSE, acronym in Portuguese). Self-reported indicators included the frequency of five emotional states, weekly minutes of physical activity in leisure time, physical education, and commuting, and daily TV hours. Latent class analysis classified adolescents based on their mental health profiles, and multinomial logistic regression estimated associations between physical activity domains and TV viewing time with mental health classes, adjusting for covariates. Six mental health profiles were identified: (1) school-related concern; (2) anxious and stressed; (3) subthreshold internalizing; (4) anxious, sad, and angry; (5) low symptom; (6) severe internalizing. Adolescents who engaged in physical activity in their leisure time and at school were more likely to belong to the low symptom class, while those who engaged in physical activity during commuting were more likely to be in class 6 (severe internalizing). Adolescents who watched two to four hours of TV per day were more likely to belong to class 1 (school-related concern), class 4 (anxious, sad, and angry), and class 5 (low symptom), whereas those who watched TV more than four hours/day were less likely to belong to class 3 (subthreshold internalizing) and class 6 (severe internalizing). These findings underscore that both the context and quantity of physical activity and TV time are differentially related to adolescent mental health profiles, implying the need for targeted surveillance and interventions.
To analyze socioeconomic inequalities in the use of oral health services among Brazilian adults aged 35-44 years between 2003 and 2023, according to level of education, income, and type of service used. This is a cross-sectional study on data from the National Survey of Oral Health (SB Brasil) 2003, 2010, and 2023. Weighted prevalences of the use of oral health services in the previous year were estimated, and absolute (Slope Index of Inequality - SII) and relative (Relative Index of Inequality - RII) measures of inequality were calculated according to level of education and income. Multiple logistic regression models were used to assess the association between socioeconomic indicators and service use. Between 2003 and 2023, the proportion of adults who used oral health services in the previous year increased from 38.7 to 51.6%. The RII for level of education decreased from 2.16 to 1.39, and the SII, from 0.30 to 0.20, indicating a reduction in educational inequalities, statistically significant among public service users (RII=1.08; SII=0.07 in 2023). Income-related inequalities remained unchanged. According to adjusted models, there was a significant interaction between level of education and type of service, with a steeper gradient in the private sector and a more homogeneous pattern in the public sector. From 2003 to 2023, the use of oral health services increased, and educational inequalities declined among users of public services, reflecting progress in the consolidation of the National Oral Health Policy and in the expansion of public access. However, economic disparities persist, underscoring the need for redistributive policies that integrate equity and sustainability in the financing of the Brazilian Unified Health System.
Hypothermic machine perfusion (MP) improves outcomes in kidney transplantation, but evidence from low- and middle-income countries (LMICs) and public health settings is limited. This study evaluated clinical and operational performances of MP in the first and largest Brazilian renal perfusion service. This single-center study was conducted at a Brazilian public hospital. Operational performance was evaluated through a qualitative observational analysis using a 20-item questionnaire applied to 7 transplant surgeons and perfusion nurses, based on national medical device assessment guidelines. Clinical outcomes were assessed in a longitudinal cohort of 212 deceased-donor kidney transplant recipients. Kidneys preserved with MP after an initial period of static cold storage (MP group, n = 100) were compared with those preserved exclusively with static cold storage (SCS group, n = 112). Outcomes included delayed graft function (DGF), dialysis requirement, length of hospital stay, and one-year graft and patient survival. Final data collection and analysis were completed in September 2025. Operational evaluation was preponderantly favorable, supporting the sustainable use of MP, which was associated with a lower incidence of DGF compared with SCS (25% vs 46.5%; p = .002) and independently associated with lower odds of DGF (OR = 0,38; CI 95%: 0,21-0,69). MP recipients required fewer dialysis sessions and had shorter hospital stays. Graft function, rejection rates, and one-year graft and patient survival were similar between groups. In a real-life LMIC public health setting, MP was operationally sustainable and reduced DGF after kidney transplantation, supporting its use in resource-constrained transplant programs.
To evaluate the psychometric properties of a self-administered oral health literacy (OHL) questionnaire for adolescents, titled the Brazilian Oral Health Literacy-Youngs Questionnaire (BOHL-YQ). The study included adolescents aged 15 to 19 years enrolled in public schools in the municipality of Araruna, Paraíba, Brazil. Data on demographic, socioeconomic characteristics, and oral health-related behaviors were collected from 360 participants. The internal consistency of the BOHL-YQ was evaluated. To examine the dimensional structure of the instrument, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Convergent validity was investigated through associations between BOHL-YQ scores and demographic, socioeconomic, and oral health-related behavioral variables. A total of 348 questionnaires were analyzed. One item showed inadequate loading in the EFA of the 15-item version. The EFA of the 14-item version demonstrated good internal consistency (Cronbach's alpha=0.71; McDonald's omega=0.72), a Kaiser-Meyer-Olkin value of 0.77, and adequate fit for two domains: Cognitive and Comprehension/Decision-Making. The CFA indicated the model explained 84% of the variance. Higher OHL scores were found among female adolescents (p=0.006), urban residents (p<0.001), and those whose mothers had >9 years of schooling (p=0.014), did not receive government benefits (p<0.001), had a dental visit within the last year (p<0.001), and in private dental services (p=0.043). In this context, the BOHL-YQ demonstrated good internal consistency and convergent validity, indicating that it is a valid and easily applicable instrument for measuring oral health literacy among Brazilian adolescents.
To analyze the association between the co-occurrence of health risk behaviors and the presence of depression in Brazilians. This was a cross-sectional study using data from the 2023 population-based telephone survey Vigitel. Depression was assessed by self-reported medical diagnosis. The co-occurrence of health risk behaviors was measured based on the sum of five behaviors: consumption of ultra-processed foods (UPF), physical inactivity, sedentary behavior, smoking, and binge drinking. This variable was subsequently categorized as "none," "one," "two," or "three or more" behaviors. Descriptive analyses, Pearson's χ2 test, and univariate and multiple logistic regression adjusted for sex, age, marital status, and level of education were carried out. A total of 21,690 individuals participated in the survey, of whom 12.3% had depression, and approximately 79.8% reported at least one health risk behavior. Consumption of UPF (OR 1.35; 95%CI 1.08-1.68), physical inactivity (OR 1.29; 95%CI 1.04-1.60), and smoking (OR 1.76; 95%CI 1.36-2.27) were associated with depression. Individuals with two health risk behaviors had 1.36 times higher odds of depression (OR 1.36; 95%CI 1.08-1.73), while those with three or more had twice the odds (OR 2.01; 95%CI 1.49-2.71), compared to those with none. Individuals with the co-occurrence of two or more health risk behaviors are more likely to have depression. These findings highlight the importance of integrated strategies for mental health promotion and the prevention of unhealthy behaviors in the Brazilian population.
To describe clinical and molecular aspects of a cohort of Brazilian individuals with neurofibromatosis type 1, a neurocutaneous disorder associated with a predisposition to tumors and inter- and intrafamilial variable expressivity. We conducted a retrospective study of 50 patients from 30 unrelated families, with features of Neurofibromatosis type 1, who underwent clinical evaluation and whole genome sequencing. Patient ages ranged from 9 months to 62 years (mean 21.7 years). The most frequent manifestations were café-au-lait (100%), lentiginous macules (94%), Lisch nodules (62%), cutaneous (62%), and plexiform (38%) neurofibromas. Other findings included neurodevelopmental disorders (14%), congenital pseudarthrosis of the tibia (4%), optic pathway glioma (4%), and sphenoid wing dysplasia (2%). Eight individuals presented with tumors other than neurofibromas, including two with malignant peripheral nerve sheath tumors, two with breast cancer, and one each with a dysembryoplastic neuroepithelial tumor, cholangiocarcinoma, pilocytic astrocytoma, and basal cell carcinoma. All probands, except one, tested positive for pathogenic or likely pathogenic variants, of which three (11.1%) were novel (c.3372del, c.7299del, and c.7457_7457+2del), three were recurrent within this series (c.3826C>T, c.5902C>T, and c.6855C>A), and the others were private. Two families (6.6%) presented incidental findings, one in BRCA1 and the other in TMEM127. Three individuals (6.5%) had a second molecular diagnosis: one each with spinocerebellar ataxia type 19, primary ciliary dyskinesia type 3, and XYY syndrome. This study presents the largest cohort of Brazilian individuals with neurofibromatosis type 1 to utilize whole-genome sequencing, identifying three novel germline NF1 variants and two previously unreported double diagnoses.
This essay presents a political-philosophical reflection on the need to reconstruct health practices in order to make them more effective and sensitive in identifying and responding to the needs of diverse individuals and populations. To this end, it draws on the experience of health sector reforms in Brazil and the development of the Brazilian Public Health System, focusing in particular on the relevance of three conceptual constructs associated with this process: comprehensiveness, vulnerability, and care. Inspired by philosophical hermeneutics (Gadamer, Ricoeur), the discussion emphasizes the importance of a broader and more integrated understanding of health needs; the use of social markers of difference as indicators of vulnerabilities that require differentiated responses from health services and policies; and the value of a dialogical approach to health practices that is existentially sensitive and informed by multiple forms of knowledge, enabling productive integration of technical efficacy with practical success.
Unlike remedies from ancient systems like Chinese traditional medicine and Ayurveda, records of the traditional uses of Brazilian plants are scattered and lack interpretation. Dataplamt was created to recover this knowledge and make it readily available, and already contains data on 3,464 species recovered from 114 texts written prior to 1950; it spans 170 medicinal categories, with 28 addressing infectious or parasitic diseases. It also includes native plant names, confirming their ancestral roots. The Dataplamt database makes it possible to identify resilient traditional uses, which are important for developing traditional herbal products, and also contributes to the bioeconomy and spreading information about Brazil's plants to the general population. Diferentemente das medicinas milenares como a chinesa e a ayurveda, registros sobre usos tradicionais das plantas brasileiras encontram-se dispersos e sem interpretação. A Dataplamt foi criada com o objetivo de recuperar e disponibilizar essas informações e já contém dados sobre 3.464 espécies, recuperadas de 114 livros, produzidos até 1950. São indicadas como medicinais 170 categorias, sendo a maior parte (28) contra doenças infectoparasitárias. Nomes originais das plantas são também recuperados, confirmando ancestralidade. A Dataplamt permite identificar usos tradicionais resilientes, importantes para o desenvolvimento de produtos fitoterápicos tradicionais. Contribui também para a bioeconomia e a divulgação junto à população das plantas da biodiversidade brasileira.
The historical submersion of the State Career Plan agenda within the Brazilian Unified Health System (SUS) is directly linked to the diffusion of managerial principles structured by New Public Management. This article aims to document the theoretical reasons and practical effects of the weakening of labour rights in the construction of SUS. Drawing on data related to the process of precarious labour relations and outsourcing, as well as the increasing municipalization of health management, we identify three key areas where labour management is central to the historical challenges faced by SUS: the pressure of personnel expenses on municipal budgets; the expansion of the public-private hybrid model in public administration; and the limitations in implementing a Regionalized Health Care Network. In conclusion, we argue that the ideology and practices of 'management culture' undermine the central role of labour management in the realization of SUS. Strengthening the State Career Program for workers hinges on this critique of managerialism, from which it will be possible to restore the dignity of labour in public health. A submersão histórica da agenda da Carreira de Estado no Sistema Único de Saúde (SUS) está diretamente relacionada com a difusão dos princípios teóricos gerencialistas estruturados pela Nova Gestão Pública. A partir dessa problematização, o presente artigo procura fundamentar as razões teóricas e os efeitos práticos da fragilização dos direitos do trabalho na construção do SUS. Considerando dados que documentam o processo de precarização e terceirização dos vínculos de trabalho e a crescente municipalização da gestão na saúde, apontamos em três dimensões a centralidade da gestão do trabalho para impasses históricos do SUS: a pressão das despesas com pessoal sobre o orçamento municipal; a expansão do hibridismo público-privado na administração pública; a limitação da implementação de uma Rede Regionalizada de Atenção à Saúde. A título de conclusão, apontamos que o ideário e a prática da “cultura management” rebaixam a centralidade da gestão do trabalho na realização do SUS. O fortalecimento do Programa da Carreira de Estado para as trabalhadoras e trabalhadores depende dessa crítica ao gerencialismo, do qual se tornará possível recuperar a dignidade do trabalho na saúde pública. La sumersión histórica de la agenda de la Carrera de Estado en el Sistema Único de Salud (SUS) está directamente relacionada con la difusión de los principios teóricos gerencialistas estructurados por la Nueva Gestión Pública. A partir de esta problematización, el presente artículo busca fundamentar las razones teóricas y los efectos prácticos del debilitamiento de los derechos laborales en la construcción del SUS. Considerando datos que documentan el proceso de precarización y tercerización de los vínculos laborales, así como la creciente municipalización de la gestión en salud, señalamos, en tres dimensiones, la centralidad de la gestión del trabajo para los impases históricos del SUS: la presión del gasto en personal sobre el presupuesto municipal; la expansión del hibridismo público-privado en la administración pública; y la limitación de la implementación de una Red Regionalizada de Atención a la Salud. A modo de conclusión, sostenemos que el ideario y la práctica de la “cultura management” reducen la centralidad de la gestión del trabajo en la materialización del SUS. El fortalecimiento del Programa de la Carrera de Estado para las trabajadoras y los trabajadores depende de esta crítica al gerencialismo, a partir de la cual será posible recuperar la dignidad del trabajo en la salud pública.
This study aimed to determine the prevalence of food insecurity in Marajoara quilombola communities and its associated factors. A cross-sectional, community-based, family-approach study was carried out with 434 families in Salvaterra, Marajó Island, Pará, Brazil, from June to July 2021. A household survey was carried out with a standardized questionnaire on sociodemographic data and the Brazilian Food Insecurity Scale. A multivariate logistic regression was used to analyze associated factors. Most quilombola families (88.9%) lied in food insecurity, 33.1% (n = 144) of whom in severe insecurity; 21.4% (n = 93), in moderate insecurity; and 34.3% (n = 149), in mild insecurity. The regression model showed that receiving no pension doubles the chance of mild food insecurity and multiplies moderate+severe insecurity by 5 times. Per capita family income below 1/5 or even 1/3 of the minimum wage increase the chance of moderate+severe insecurity by 9 and 9 times, respectively. Households in the B/C economic classification were 21% less likely to have moderate+severe insecurity than those with the D/E classification. Food insecurity had a high prevalence in quilombola families, with a preponderance of moderate+severe insecurity. Family income and its components configured the main factors associated with food insecurity. O objetivo deste estudo foi determinar a prevalência de insegurança alimentar de comunidades quilombolas marajoaras e os fatores associados. Estudo transversal de base comunitária e abordagem familiar com 434 famílias, localizadas no Município de Salvaterra, Ilha de Marajó, Pará, Brasil, de junho a julho de 2021. Realizou-se inquérito domiciliar com questionário padronizado sobre dados sociodemográficos e o questionário da Escala Brasileira de Insegurança Alimentar. Para analisar os fatores associados foi utilizada a regressão logística multivariada. A maioria das famílias (88,9%) quilombolas estava em insegurança alimentar, 33,1% (n = 144) em insegurança grave, 21,4% (n = 93) em insegurança moderada e 34,3% (n = 149) em insegurança leve. O modelo de regressão mostrou que não receber aposentadoria dobrou a chance de insegurança alimentar leve e multiplica 5 vezes a insegurança moderada+grave. A renda familiar per capita de menos de 1/5 ou até 1/3 do salário mínimo elevou em 9 e 4 vezes a chance de insegurança moderada+grave, respectivamente. Famílias na classificação econômica B/C tiveram 21% menos chances de apresentar insegurança moderada+grave em relação às com classificação D/E. A insegurança alimentar apresentou alta prevalência em famílias quilombolas, preponderando insegurança moderada+grave. A renda familiar e seus componentes foram o principal fator associado à insegurança alimentar. El objetivo de este estudio fue determinar la prevalencia de la inseguridad alimentaria en las comunidades quilombolas de Marajó y los factores asociados. Se trata de un estudio transversal, de base comunitaria y con un enfoque familiar, con 434 familias ubicadas en el municipio de Salvaterra, Isla de Marajó, Pará, Brasil, de junio a julio del 2021. Se realizó una encuesta domiciliaria utilizando un cuestionario estandarizado sobre datos sociodemográficos y el cuestionario de la Escala Brasileña de Inseguridad Alimentaria. Se utilizó la regresión logística multivariante para analizar los factores asociados. La mayoría de las familias quilombolas (88,9%) sufría inseguridad alimentaria, de las cuales el 33,1% (n = 144) experimentaba inseguridad severa, el 21,4% (n = 93) inseguridad moderada y el 34,3% (n = 149) inseguridad leve. El modelo de regresión demostró que no recibir jubilación duplicaba la probabilidad de sufrir inseguridad alimentaria leve y multiplicaba por 5 la probabilidad de sufrir inseguridad moderada+severa. Un ingreso familiar per cápita inferior a 1/5 o hasta 1/3 del salario mínimo aumentó la probabilidad de inseguridad alimentaria moderada+severa en 9 y 4 veces, respectivamente. Las familias de la categoría económica B/C tuvieron un 21% menos de probabilidades de experimentar inseguridad moderada+severa en comparación con las de la categoría D/E. La inseguridad alimentaria tuvo una alta prevalencia entre las familias quilombolas, predominando la inseguridad de moderada+severa. Los ingresos familiares y sus componentes fueron el principal factor asociado a la inseguridad alimentaria.
To analyze Complementary Feeding Quality Indicators according to socioeconomic characteristics in Cruzeiro do Sul, Acre, Western Brazilian Amazon. 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. 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). 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.
Most of the current evidence on valvular heart disease (VHD) comes from high-income countries. Access to treatment and the impact of VHD on quality of life may vary substantially across nations, largely due to socioeconomic differences. This study aimed to estimate the burden of VHD and its association with mortality in a middle-income country. We included participants from the ELSA-Brasil cohort who underwent transthoracic echocardiography at baseline (3,267 participants; 1,539 males; mean age 60.6 ± 8.8 years) across six Brazilian states. Participants were categorized into three groups-no VHD, trace/mild VHD, and moderate/severe VHD-and their characteristics and associated factors were analyzed. P-values < 0.05 were considered statistically significant. Among all participants, 2.4% had moderate/severe VHD (including 7 participants with prosthetic valves), and 43.6% had trace/mild VHD. The most prevalent moderate/severe VHD was mitral regurgitation, followed by aortic and tricuspid regurgitation, with 56 participants (86%) presenting isolated valvular regurgitation. Moderate/severe VHD was more common in older individuals and was associated with a higher prevalence of most cardiovascular comorbidities, but with lower obesity rates. It was also associated with greater cardiac remodeling and reduced systolic function, with phenotypic variations depending on the affected valve. Moderate/severe VHD was linked to increased 10-year mortality (HR: 3.7; 95% CI [2.17-6.31]), independent of age, sex, and hypertension. VHD is common among community-dwelling adults in this middle-income country and increases with age. Participants with moderate/severe VHD exhibited a greater burden of comorbidities, more pronounced cardiac remodeling, worse systolic function, and substantially reduced long-term survival. A maior parte das evidências atuais sobre doença valvar cardíaca (DVC) vem de países de alta renda. O acesso ao tratamento e o impacto da DVC na qualidade de vida podem variar substancialmente entre países, principalmente devido a diferenças socioeconômicas. Este estudo teve como objetivo estimar a carga de DVC e sua associação com mortalidade em um país de renda média. Incluímos participantes da coorte ELSA-Brasil que realizaram ecocardiograma transtorácico na linha de base (3.267 participantes; 1.539 homens; idade média de 60,6 ± 8,8 anos) em seis estados brasileiros. Os participantes foram categorizados em três grupos – sem DVC, DVC mínima/leve e DVC moderada/grave – e suas características e fatores associados foram analisados. Valores de p < 0,05 foram considerados estatisticamente significativos. Entre todos os participantes, 2,4% apresentavam DVC moderada/grave (incluindo sete participantes com prótese valvar) e 43,6% apresentavam DVC mínima/leve. A DVC moderada/grave mais prevalente foi a regurgitação mitral, seguida pelas regurgitações aórtica e tricúspide, com 56 participantes (86%) apresentando regurgitação valvar isolada. A DVC moderada/grave foi mais comum em indivíduos mais velhos e esteve associada a maior prevalência da maioria das comorbidades cardiovasculares, porém a menores taxas de obesidade. Também se associou a maior remodelamento cardíaco e pior função sistólica, com variações fenotípicas conforme a valva acometida. A DVC moderada/grave esteve associada a maior mortalidade em 10 anos (HR: 3,7; IC 95% [2,17–6,31]), independentemente de idade, sexo e hipertensão. A DVC é comum entre adultos em uma coorte comunitária de um país de renda média e aumenta com a idade. Participantes com DVC moderada/grave apresentaram maior carga de comorbidades, remodelamento cardíaco mais acentuado, pior função sistólica e redução substancial da sobrevida em longo prazo.
The dynamics of the health workforce is a complex challenge for the Unified Health System, given the significant regional differences in Brazil. Considering the need to produce information on the HWF for system management, the aim of this article was to analyse the growth and distribution of higher education professions in Health Centre/Basic Health Unit-type establishments in Brazil and its regions between 2013 and 2023. It is a descriptive study using the online database of the Department of Informatics of the Ministry of Health (DATASUS). Over a decade (2013-2023), there was a 53% increase in the number of professionals working in primary care units in Brazil, more significantly from 2019 to 2023. The total population ratio of professionals in Brazil and in each region increased in the three periods observed, with the Brazilian rate of higher education professionals in primary care being 170.16 per 100,000 inhabitants in 2023, compared to 117.58 in 2013. In all the periods evaluated, the S and SE regions had a higher population ratio than the CO, NE and especially N regions. The study shows that there was growth in the different occupations. However, density differences in the allocation of professionals remain a challenge in primary care. A dinâmica da força de trabalho em saúde (FTS) é um desafio complexo para o Sistema Único de Saúde, dada as significativas diferenças regionais no Brasil. Considerando a necessidade de produção de informações sobre a FTS para a gestão do sistema, o objetivo desse artigo foi analisar o crescimento e a distribuição das profissões de nível superior nos estabelecimentos tipo Centro de Saúde/Unidade Básica de Saúde no Brasil e suas regiões, entre 2013 e 2023. É um estudo descritivo utilizando o banco de dados online do Departamento de Informática do Ministério da Saúde (DATASUS). Em uma década (2013-2023), houve crescimento de 53% na ocupação por profissionais de nível superior nas unidades de atenção básica no Brasil, mais expressivamente de 2019 a 2023. A razão populacional total de profissionais no Brasil e em cada região aumenta nos três períodos observados, sendo a taxa brasileira de profissionais de nível superior na atenção básica de 170,16 para cada 100.000 habitantes em 2023, em comparação à taxa de 117,58 em 2013. Em todos os períodos avaliados, as regiões S e SE apresentaram razão populacional maior que as das regiões CO, NE e, especialmente N. O estudo demonstra que houve crescimento nas diferentes ocupações. No entanto, as diferenças de densidade na alocação de profissionais permanecem um desafio na AB. La dinámica de la fuerza de trabajo en salud es un desafío complejo para el Sistema Único de Salud, dadas las significativas diferencias regionales en Brasil. Considerando la necesidad de producir información sobre la FTS para la gestión del sistema, el objetivo de este artículo fue analizar el crecimiento y la distribución de las profesiones de educación superior en los establecimientos del tipo Centro de Salud/Unidad Básica de Salud en Brasil y sus regiones entre 2013 y 2023. Se trata de un estudio descriptivo que utiliza la base de datos en línea del Departamento de Informática del Ministerio de Salud (DATASUS). En una década (2013-2023), hubo un aumento del 53% en el número de profesionales que trabajan en unidades de atención primaria en Brasil, más significativamente de 2019 a 2023. La proporción de profesionales en Brasil y en cada región aumentó en los tres períodos observados, siendo la tasa brasileña de profesionales de educación superior en atención primaria de 170,16 por 100.000 habitantes en 2023, frente a 117,58 en 2013. En todos los períodos evaluados, las regiones S y SE presentaron una tasa de población superior a las regiones CO, NE y, especialmente, N. El estudio muestra que hubo crecimiento en las diferentes ocupaciones. Sin embargo, las diferencias de densidad en la asignación de profesionales siguen siendo un reto en la atención primaria.
To investigate preliminary evidence of validity based on relations to external variables for the Brazilian version of the Screening Pediatric Patients for Reading Difficulties Test (SPRouT). Following approval by the Research Ethics Committee, 27 children aged four to eight years were individually assessed using the SPRouT and standardized instruments measuring intelligence and phonological processing skills. Analyses included Spearman correlations (controlling for intelligence) and simple linear regressions to examine the predictive capacity of the SPRouT. Moderate to strong negative correlations were observed between SPRouT scores and measures of phonological awareness, phonological working memory, and rapid naming. The total SPRouT score explained between 23% and 32% of the variance in phonological measures, with medium to large effect sizes. Findings provide initial evidence of convergent validity for the SPRouT, as it demonstrated associations with skills related to reading development. Regression analyses also suggest its predictive potential, although longitudinal studies and clinical samples are needed to confirm this property. The SPRouT represents a promising tool for screening reading difficulties, and further psychometric investigations with larger and more diverse samples are recommended. Investigar evidências preliminares de validade baseada na relação com variáveis externas da versão brasileira do Screening Pediatric Patients for Reading Difficulties Test (SPRouT). Após aprovação pelo Comitê de Ética, 27 crianças de quatro a oito anos foram avaliadas individualmente com o SPRouT e com instrumentos padronizados que medem inteligência e habilidades de processamento fonológico. As análises incluíram correlações de Spearman, controlando o efeito da inteligência, e regressões lineares simples para verificar a capacidade preditiva do SPRouT. Foram observadas correlações negativas moderadas a fortes entre os escores do SPRouT e medidas de consciência fonológica, memória de trabalho fonológica e nomeação automática rápida. O escore total do SPRouT explicou de 23% a 32% da variância nas medidas fonológicas, com efeitos de magnitude média a alta. Os achados fornecem evidências iniciais de validade convergente para o SPRouT, ao demonstrar associações com habilidades relacionadas ao desenvolvimento da leitura. As análises de regressão sugerem seu potencial preditivo, embora estudos longitudinais e com amostras clínicas sejam necessários para confirmar essa propriedade. O SPRouT representa uma ferramenta promissora para a triagem de dificuldades de leitura, recomendando-se a ampliação das investigações psicométricas com amostras maiores e mais diversificadas.
暂无摘要（点击查看详情）