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Objective: To analyze the impact of the COVID-19 pandemic on food insecurity (FI) among families living in rural and urban areas of Brazil.

Methods: Cross-sectional and descriptive study based on the analysis of two nationally representative surveys conducted using probabilistic sampling by clusters in urban and rural areas of Brazil (2020 and 2022). FI was measured using the Brazilian Food Insecurity Scale. The households were classified as food secure, mild FI, or moderate/severe FI. Prevalence and 95% confidence intervals (95%CI) and analyses were performed in Stata 16 considering the respective sample weights (svy). Variations between the two surveys were analyzed by urban and rural area, and associations with gender and race/skin color.

Results: The majority of households were located in urban areas (2020: 85.6% [n = 1,662]; 2022: 85.5% [n = 10,365]) compared to rural areas (2020: 14.5% [n = 518]; 2022: 85.5% [n = 2,382]). with regard to the characteristics of the household reference person, schooling level, being a formal worker and the per capita family income were higher among families from urban areas. Between 2020 and 2022, the proportion of severe levels of FI increased significantly more in households from rural areas. Despite the higher FI in rural areas, a variation of +54% was noted in urban areas, where the prevalence of moderate/severe FI increased from 19.4% (2020) to approximately 30% (2022). There were greater proportions of FI in households headed by men in urban areas (+75.1%) and mixed race/black people (+55.9%), while households headed by white people saw an improvement in FS.

Conclusion: The FI increased unequally between the rural and urban areas of Brazil during the COVID-19 pandemic. The results of this study reinforce the need to plan equitable public policies that debate the different vulnerability profiles aggravated by disparities as a way of guaranteeing food and nutritional security in post pandemic in Brazil.

Objective: To evaluate quality of life, sarcopenia and proteinuria, six and 12 months after infection with mild and moderate COVID-19.

Methods: We evaluated 253 individuals with mild (n = 119) and moderate (n = 134) clinical presentation for COVID-19 (reverse transcription-polymerase chain reaction-RT-PCR) after six (T6) and 12 (T12) months from the date of acute infection (T0). Quality of life, pain, risk for sarcopenia, muscle strength and proteinuria were assessed by the Short Form Health Survey 36 (SF-36) questionnaire; visual analogue scale (VAS); the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F); hand grip and sit-up and the urinalysis strip, respectively.

Results: The average age was 44 ± 10 and 43 ± 12 years; female 68 and 59% for the mild and moderate groups, respectively. Seventy-five percent or more of patients were vaccinated with at least two doses before acquiring COVID-19 infection. Individuals with a moderate clinical presentation in relation to mild cases were hypertensive (23 and 6%, p < 0.001) and had diabetes mellitus (9 and 2%; p = 0.01) at the time of COVID-19 acute infection. The moderate group at T6 presented lower functional capacity (SF36: 46 ± 20 vs. 61 ± 24); more pain (SF36: 45 ± 29 vs. 67 ± 32 and VAS: 55 vs. 32%); greater dysfunctionality for daily activities (Duke Activity Status Index-DASI: 40 ± 11 vs. 45 ± 10); lower limb muscle strength (sit-up: 9 ± 2 vs. 11 ± 2); higher risk for sarcopenia (SARC-F: 6 ± 4 vs. 4 ± 3) and higher proteinuria ≥ 1"+": 59 vs. 42%) compared to the mild group. After 12 months, the moderate group remained with greater pain (SF36+VAS) and more dysfunctionality in daily activities (DASI) compared to the mild group.

Conclusion: Comparing T12 to T6, we observed that the mild group had worse functional capacity; more pain (SF36+VAS); lower upper limb strength and higher proteinuria ≥ 1"+": 63 vs. 42%). We observed a negative correlation between SARC-F score and sit-up; functional capacity (SF36).

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Objective: This study aimed to characterize swallowing and investigate the association between self-reported coughing and/or choking during meals and the risk of dysphagia in frail elderly individuals receiving healthcare at a specialized center in São Paulo, Brazil.

Methods: This cross-sectional observational study included elderly individuals attending an Elderly Health Reference Unit (URSI) from July 2017 to December 2023. Data from all patients referred to the URSI were collected, excluding only those with incomplete medical records. The study proceeded in two phases: the first phase involved physical, functional, and social assessments, while the second phase included speech and swallowing evaluations. Participants were categorized into groups based on self-reported mealtime symptoms. Descriptive and inferential analyses compared these groups using the Mann-Whitney U test for quantitative data and Pearson's χ2 test for qualitative data. Risk analysis employed multiple logistic regression with forward stepwise selection.

Results: The study comprised 1,027 elderly individuals (mean age 78 years; 68.2% women; 64.2% self-identified as white). Approximately half reported frequent choking during meals. Sex, Multidimensional Assessment of the Elderly in Primary Care classification and score, polypharmacy, chronic diseases, falls, urinary incontinence, osteoporosis, cardiac disease, last dental visit, speech difficulty, change in food consistency, hearing loss, and hearing aid use were associated with mealtime symptoms. Speech alterations increased bronchoaspiration risk by 16%, memory complaints by 11%, and xerostomia and food consistency changes by 8%.

Conclusion: Speech alterations, changes in food consistency, memory complaints, and xerostomia were identified as factors increasing the risk of bronchoaspiration. Early identification and a multidisciplinary approach to swallowing disorders in frail elderly individuals are crucial for preventing aspiration pneumonia and maintaining quality of life. These findings underscore the significance of proactive management strategies in clinical practice.

Objective: To analyze the evolution of socioeconomic and regional inequalities in mortality among children under five years of age in Brazil between 2010 and 2022.

Methods: Data from 37,639,196 live births (LB) and 563,711 deaths among children under five years during the period were analyzed. Mortality rates for infants (

Results: The IMR decreased from 13.0 to 12.7 per thousand LB between 2010 and 2022, while mortality among children aged one to four years remained stable at 2.5 per thousand LB in 2010-2022. There was only a slight reduction in inequalities, with the SII oscillating from -5.63 to -4.91 in IMR and from -2.42 to -1.71 in mortality among children aged one to four years between 2010-2022. In 2022, municipalities with lower M-HDI had mortality rates 49.0% and 93.0% higher than those with higher M-HDI in IMR and mortality among children aged one to four years, respectively. Inequalities in IMR were more pronounced in nutritional, metabolic, and endocrine diseases, where mortality was four times higher in municipalities with lower M-HDI. There was an excess of 76,832 child deaths in Brazil between 2010-2022. In 2022, 42.2% of the microregions in the North were among the top 100 with the highest IMR, compared to only 3.2% in the South.

Conclusions: There was a slight reduction in child mortality, but significant socioeconomic and regional inequalities persisted in Brazil.

Objective: To assess the validity of the internal structure and reliability of the Brazilian version of the Hospital Anxiety and Depression Scale (HADS) for screening depressive and anxious symptoms in primary care health professionals.

Methods: A psychometric study carried out with health professionals from primary health care services in a municipality in Rio Grande do Sul, Brazil, in 2023. The quality of the HADS instrument was assessed by internal structural validity, using Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and internal consistency, using Cronbach's Alpha and McDonald's Omega coefficients.

Results: 217 health professionals took part in the study, of both sexes and from different professional categories, such as doctors, nurses, nursing technicians and assistants, dentists and oral health assistants, and community health workers. The EFA showed the two-factor model, anxiety and depression, as originally proposed. The CFA confirmed that the two-dimensional model was a good fit for the sample investigated. The Alpha and Omega values were 0.833 and 0.838 for anxiety and 0.763 and 0.766 for depression, respectively. Both indicated acceptable reliability.

Conclusions: The HADS is a valid and reliable instrument for screening symptoms of anxiety and depression in primary care professionals in Rio Grande do Sul, Brazil.

Objective: The Munduruku indigenous people are among those most severely impacted by mercury (Hg) contamination in the Amazon region. Mercury exposure can have severe consequences for the physical and cognitive development of children. We aimed to describe the health assessment in indigenous Munduruku children in the Tapajós River basin, possibly exposed chronically to Hg.

Methods: A cross-sectional study with children <12 years old living in the Sawré Muybu (SM), Poxo Muybu (PM), and Sawré Aboy (SA) villages. We collected data between October 29th and November 9th, 2019, through interviews and clinical evaluation (child neurodevelopment tests and anthropometric measurements), and measured blood hemoglobin levels and Hg in hair samples. The history of immunization and other health issues were collected from the Brazilian health booklets. We investigated the prevalence of Hg exposure ≥ 6.0 µg/g. The measure of association used was the Prevalence Ratio (PR), with a 95% CI.

Results: We examined 83 children, 40 in SM, 15 in SA, and 28 in PM. 51.8% were girls, 45.7% had completed the vaccination schedule, 16.0% had changes in the neurodevelopment test, and 13.9% had anemia. Their weight and height/length averages were (Z-scores) -0.86 and -1.59, respectively. 45.1% of children had Hg-levels ≥ 6.0 µg/g. The prevalence of mercury contamination in children in SA was almost four times greater (PR:3.66; 95%CI 2.17-6.18) than that in children in SM, and girls were almost twice as likely (PR:1.67; 95%CI 1.07-2.62) to have mercury levels ≥ 6.0 µg/g, when compared with boys in the study villages.

Conclusions: The higher concentration of hair Hg-levels occurred in SA, where Hg exposure is higher. Although we cannot prove causality, we believe that understanding the possible health impacts of mercury exposure among the Munduruku children is vital for developing strategies to mitigate these effects and for supporting the fight for their rights and the protection of their territories.

Objective: To identify spatial clusters of risk and map the care network for people with drug-resistant tuberculosis in the state of São Paulo.

Methods: This is an ecological study, carried out by collecting data from the Special Tuberculosis Treatment Information System (Site-TB) of people treated for drug-resistant tuberculosis from 2013 to 2020, in the state of São Paulo. Mapping was carried out using Kernel and scan statistic techniques.

Results: 1,084 cases were reported in the period analyzed. São Paulo, Ribeirão Preto, Santos, Guarulhos, and Campinas were the municipalities with the highest number of cases. The spatial pattern of agglomeration of cases and referral centers for treatment were similar, with gaps in coverage in the southwest and northwest of the state. Six spatial clusters were identified: four low-risk and two high-risk, located in São Paulo, Diadema, Santos, and Guarujá.

Conclusions: The concentration of cases and tertiary referral centers in metropolitan areas highlights inequalities in access to treatment for drug-resistant tuberculosis. These findings indicate the need for health policies to expand diagnosis and treatment, improving the control of drug-resistant tuberculosis in the state of São Paulo.

Objective: To evaluate the differential impact of arboviral infections, specifically dengue virus, chikungunya virus, and Zika virus, on women in Brazil, with a focus on sex- and age-disaggregated analyses.

Methods: A comprehensive epidemiological and geospatial data analysis was conducted utilizing data from Brazil's national health data system, including the disease notification system (Sistema de Informação de Agravos de Notificação) and mortality information system (Sistema de Informação sobre Mortalidade), covering national and municipal level data. Arboviral case notification rates were analyzed using generalized linear mixed models with negative binomial regression, stratified by sex, age group, and year. Geospatial visualizations mapped the case rate distribution highlighting the top municipalities with the most female case rate and hospitalizations rate. All analyses were implemented in the statistical software R.

Results: Significant sex- and age-stratified differences were observed in the arbovirus notification rates for dengue virus, chikungunya virus, and Zika virus over the past seven years, with consistently higher rates among women compared to men. Stratified analyses revealed that females aged 20-59 years, particularly those of reproductive age, bore a disproportionately higher burden across all three viruses. The low serotyping resolution for the dengue virus constrained further granular analysis, particularly for severe outcomes such as hospitalizations and mortality based on dengue serotype.

Conclusion: Sex- and age-disaggregated epidemiological surveillance is critical to inform public health policies and interventions targeting arboviral diseases. This study underscores the necessity of incorporating sex-specific data analyses to optimize responses for vulnerable female populations. Geospatial visualizations reveal infection hotspots, providing actionable insights for region-specific interventions to improve health outcomes in Brazil.

Objective: To analyze the time trend of indicators from the Vigitel data collection operation between 2006 and 2023.

Methods: A methodological study that analyzed the temporal trend of three Vigitel operation indicators: eligibility rate, response rate and refusal rate, as well as the number of contacts answered according to days of the week and times of day. A series of linear regressions was used to identify temporal variations for the entire period (2006 to 2023) and for the final five years of this period (2018 to 2023).

Results: During the 17 editions analyzed, there was a decrease in the eligibility rate (-3.26 pp/year; p < 0.001) with the greatest magnitude in the most recent period (-12.23 pp/year; p = 0.010). Although the inclusion of mobile phones in the register in 2023 has mitigated the drop in eligibility, especially in recent years, the reduction has remained high (-10.43 pp/year; p = 0.020). The response rate also fell over the entire period (-0.78; p < 0.001) and, together with the fall in eligibility, represents an obstacle to the sustainability of the survey. On the other hand, the refusal rate also fell (-0.23 pp/year; p = 0.030), indicating the consistent quality of the system's operation. The number of contacts answered was concentrated on weekdays and between 9am and 8pm.

Conclusions: An analysis of the data from the Vigitel survey suggests that the methodology used has become fatigued, with reductions in eligibility and response rates over the years. Only the refusal rate, despite being far from its lowest levels, remains at satisfactory levels. The search for alternatives that make participation more convenient for the respondent is an important path for surveys of this nature, with a view to maintaining the quality of health surveillance in the country.