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To correlate the incidence of leptospirosis with sociodemographic data in the Brazilian Unified Health System from 2011 to 2022.

This ecological study used national health and economic secondary data sources. Secondary analyses summarized the scenario of disease-related hospitalizations among federative units. In total, two analyses were conducted: variable description for relationship analysis and a secondary analysis with population health and sanitation indicators and economic indicators from the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). The statistical analysis following this framework summarized raw data by year-month-federative unit. A time series regression was conducted, comparing the time variable with other national-level variables. Then, several simple linear regressions were performed.

Linear regressions show the relationship between the reduction in cases and improved access to treated water and sewage collection, whereas an increase in per capita income seems to be inversely related to leptospirosis incidence. Geospatial distribution shows higher incidence in the Brazilian South and Southeast. Disease lethality varied over time but without significant change during the period. The average treatment cost remained constant over the years, despite its complexity.

Leptospirosis incidence in Brazil from 2011 to 2021 decreased and was associated with improvements in socioeconomic conditions despite no changes in lethality.

To investigate the elements of the social network associated with frailty syndrome in older Brazilian adults.

Baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015-2016) were used. Frailty was defined by the Fried phenotype (unintentional weight loss, exhaustion, weakness, slowness, and low level of physical activity). The social network was assessed using the conceptual model of Berkman and Krishna (social network structure, characteristics of social network ties, social support, and negative social interaction). Potential confounding variables included sociodemographic (age, sex, education, self-reported race, per capita family income, and place of residence) and health characteristics (polypharmacy, multimorbidity, depression, falls, hospitalization, and cognitive function). Analyses were based on multinomial logistic regression.

Among the 8,629 participants, 53.5% were pre-frail individuals and 9.1% were frail individuals. The elements of the social network that were consistently associated with pre-frailty and frailty were the following: characteristics of social network ties, social support, and negative social interaction. A positive association was found for less-than-weekly frequency of virtual contact with sons and daughters (OR = 1.15; 95%CI 1.01-1.33 for pre-frailty and OR = 1.51; 95%CI 1.13-2.02 for frailty) and for loneliness (OR = 1.36; 95%CI 1.19-1.56 for pre-frailty and OR = 1.40; 95%CI 1.12-1.75 for frailty). A negative association was found for social support (help with loans) (OR = 0.75; 95%CI 0.60-0.94 for pre-frailty and OR = 0.54; 95%CI 0.40-0.74 for frailty). However, the perception of criticism was only associated with frailty (OR = 1.35; 95%CI 1.11-1.64).

Social network is an important element for reducing/preventing frailty in older adults. Therefore, public policies and health and social assistance professionals should encompass the older adults' social network regarding the characteristics of social network ties, social support, and negative social interaction.

Objective: To describe two low-burden diet quality scores and evaluate their performance in reflecting the dietary share of the least and most processed foods defined within the Nova food system classification.

Methods: This cross-sectional study included data from the NutriNet-Brasil cohort. Participants answered the Nova24hScreener, a 3-minute self-administered questionnaire measuring the consumption of a set of foods on the day before. Food items included in this tool belong to two main groups of the Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 items) and ultra-processed foods (UPF, 23 items). Two scores were obtained by summing the number of items checked: the Nova-WPF and the Nova-UPF. We compared the scores, respectively, with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods obtained from a full self-administered web-based 24-hour recall performed on the same day.

Results: The approximate quintiles of each score had a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend < 0.001). We found a substantial agreement between the intervals of each score and the corresponding % of energy intake (Nova-WPF score: Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK) 0.72, 95%CI 0.64-0.81; Nova-UPF score: PABAK 0.79, 95%CI 0.69-0.88).

Conclusions: These two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can be used to evaluate and monitor diet quality.

Objective: To analyze the investments made in medicines by the federated entities and the asymmetries in these investments from 2016 to 2020, which may have an impact on the supply of and access to these medicines in the SUS.

Methods: This is an exploratory, retrospective study to identify who are the main entities responsible for investment in Primary Care medicines in municipalities, the evolution, counterparts, and regional differences of this investment between 2016 and 2020.

Results: The amounts spent on medicines by Brazilian municipalities were higher than the contribution to the CBAF from the MS or the MS + State in all the years analyzed. The average percentages of federal funds transferred and municipal spending varied according to the region of Brazil. The average per capita amount invested in medicines by municipalities increased between 2016 and 2020 (deflation applied), with a greater impact for municipalities with lower MHDI. The Farmácia Popular program mainly reaches municipalities with the largest populations and the highest MHDI and is therefore not enough to address the inequalities in access pointed out.

Conclusions: There has been a widening of inequalities in the capacity of municipalities to ensure access to medicines, especially among the most vulnerable municipalities, accumulating even more risks of illnesses and deaths from primary care-sensitive diseases.

Lutzomyia longipalpis (Lutz & Neiva, 1912) constitutes the most epidemiologically relevant vector of visceral leishmaniasis (VL) in the New World. On October 25, 2023, the Macapá Center for Strategic Information in Health Surveillance registered a case of VL in the Km9 neighborhood, in Macapá. This study aimed to describe the Phlebotominae species in this area to assist the confirmation of the autochthony of the case. In total, 12 specimens were collected, of which five belonged to the Lutzomyia longipalpis species, confirming the presence of the VL agent vector and the possible autochthony of the transmission.

The objective of this commentary is to describe the characteristics, development and functionalities of the food intake data collection platform QuestNova. The platform was developed by two information technology specialists, with the support of a team from Nupens/USP. The development process took place in stages, with all the functionalities of each step being thoroughly tested by multiple team members before moving on to the next. QuestNova is a free online platform that offers three self-administered instruments for assessing food intake, based on the Nova classification: Screener-Nova, QFA-Nova and R24h-Nova. On the platform, the researcher can select the instrument of interest and send it via a link to the participants in their study, who will answer it autonomously, without the presence of an interviewer. Databases containing relevant indicators for evaluating food according to the level of processing are automatically generated from the responses. A crucial aspect of QuestNova is its commitment to the confidentiality and safety of participant data. No information is stored internally on the platform; on the contrary, data is transmitted directly to a Google Drive account provided by the researcher themselves. QuestNova democratizes access to innovative research tools, boosting studies on the impact of food processing on Brazilian health. Future updates may extend its usefulness.

Objective: To propose a method for detecting and analyzing under-registration and highlight its potential financial effect in view of the implementation of the Previne Brasil Program.

Methods: An ecological study was carried out to analyze cytopathological exams in programmatic area 3.1 in the municipality of Rio de Janeiro. The data was collected from the Departamento de Informática do Sistema Único de Saúde (DATASUS - Department of Informatics of the Unified Health System) database, including information on reports from outsourced cytopathology laboratories and those available in the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Care) and the Sistema de Informação do Câncer do Colo do Útero (SISCOLO - Cervical Cancer Information System) of DATASUS/Ministry of Health.

Results: The estimated under-registrations per health unit totaled 108,511 exams in the last two years in the programmatic area 3.1 area, which corresponds to an estimated total of R$ 435,129.00 that would have been foregone if the Previne Brasil Program had been in place during the period studied.

Conclusion: The article's main contribution lies in the presentation of empirical evidence of the potential effects of under-registration on Primary Health Care financing. In addition, there are two other significant findings - firstly, it highlights weaknesses in the process of recording health information inherent to vulnerable regions; secondly, it indicates a vicious circle potentially fueled by sudden changes in Primary Health Care funding conditions, in addition to potential consequences for other levels of care.

Objective: To investigate perspectives of people with disabilities in Brazil regarding the access to primary healthcare.

Methods: In-depth interviews were conducted with 44 individuals with disabilities in Pernambuco, Distrito Federal, and São Paulo between March 2020 and November 2021. These interviews were transcribed, coded, and analysed thematically, using the Levesque framework to identify healthcare access barriers.

Results: Participants expressed a solid understanding of their healthcare needs and existing obstacles. However, individuals with hearing and visual impairments experience challenges because of communication barriers. In Pernambuco, the Community Health Agent was often the initial point of contact for primary care services. Public transportation lacked accessibility, from buses to driver attitudes, posing difficulties for people with disabilities. More accessible transportation and improved urban infrastructure could enhance service access. High medication costs were reported due to limited healthcare unit availability. Communication accessibility issues, inadequate audio-visual resources and equipment were also identified as barriers. Attitudinal barriers among healthcare professionals and subpar home visit services further hinder access.

Conclusion: To address these challenges and improve the well-being of individuals with disabilities in Brazil, comprehensive action is essential. This includes leadership, governance, and resource allocation reforms to meet healthcare needs. Initiatives like disability-focused training for service providers, enhanced transportation options, improved information accessibility, and increased support from community healthcare workers can collectively enhance the lives of people with disabilities.

Objective: To investigate the relationship between childhood consumption of ultra-processed foods and symptoms of hyperactivity/inattention in adolescents from São Leopoldo, a city in southern Brazil.

Methods: Data were collected at four distinct stages: when participants were 12-16 months old in 2001 and 2002 and later when they were 3-4, 7-8, and 12-13 years old. During the interview at 12-16 months, mothers were asked about the introduction of sugar in their child's diet. Two 24-hour recall surveys were conducted with children aged 3-4, 7-8, and 12-13 years to assess their consumption of ultra-processed foods. At the age of 12-13 years, the participants completed the Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), which screens for mental health problems.

Results: Among the 173 adolescents, 22.5% exhibited hyperactivity symptoms. The consumption of ultra-processed foods in grams, kilocalories, and as a percentage of energy intake at 3-4 years old were found to be predictors of hyperactivity/inattention symptoms (RR: 0.81, 95%CI: 0.69-0.95; RR: 1.01, 95%CI: 1.00-1.02; RR: 1.02, 95%CI:1.01-1.02; RR: 1.25, 95%CI:1.04-1.51, respectively).

Conclusion: The consumption of ultra-processed foods at an early age was associated with hyperactivity and inattention symptoms in adolescence.

Objective: To understand the social representations of HIV and their repercussions for the healthcare among recently diagnosed youth.

Methods: This qualitative research was conducted within PrEP15-19, a study that analyzed the effectiveness of HIV pre-exposure prophylaxis in adolescents aged 15 to 19 years. Semi-structured interviews were conducted with nine participants, of whom eight identified themselves as gay men and one as travesti. All were diagnosed with HIV as this study was conducted in São Paulo and Salvador from 2019 to 2020. The interview guide covered aspects of HIV prevention and repercussions on care. Data were thematically analyzed and interpreted based on social representations theory.

Results: Participants reported experiences of stigma and discrimination related to their sexual orientation and gender identity and expression. Their diagnosis renewed these painful experiences as it referred to the common-sense social representations of HIV and AIDS based on precarious knowledge of HIV prevention, treatment, and transmission. Analysis of facilitators and barriers to care strongly related treatment adherence to health services welcoming people with information, support, and careful listening. Barriers were related to health services' constraints, such as lack of privacy, professionals' hostility, and insecurity regarding diagnosis confidentiality.

Conclusions: The social representations of HIV are an important dimension of youths' experience receiving their diagnosis, especially since it renews stories of violence, homophobia, transphobia, stigma, and discrimination. Understanding this based on youths' narratives is an important tool to formulate public policies aimed at the needs of this age group. Therefore, building new social representations to mitigate stigma constitutes one of the most important elements to face the HIV epidemic among adolescents and youth.