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Regulatory measures on the sale of food at schools can influence consumption by students. The aims of the present cross-sectional study were to determine whether attending schools with norms that regulate the sale of food is associated with the consumption of ultra-processed foods by students in Brazilian state capitals and investigate the association between the availability and consumption of ultra-processed foods in school cafeterias. A systematic survey was performed of Brazilian norms in force up to 2019 that regulate the sale of food and beverages in school cafeterias. In terms of regulatory coverage, schools were categorized as covered/not covered. The availability and consumption of ultra-processed foods were assessed using data from the 2019 Brazilian National Survey of School Health. Multilevel linear regression analyses were adjusted by sociodemographic variables and school characteristics to test the association between regulatory coverage and the consumption of ultra-processed foods by students (n = 81,362). A second analysis restricted to students at schools with cafeterias (n = 53,137) investigated the association between the availability and consumption of these foods. Attending schools with regulatory coverage on the sale of food and beverages was associated with a reduction of -0.10 points (95%CI: -0.16; -0.03) in the consumption score of ultra-processed foods by students in Brazilian capital cities, whereas the availability of ultra-processed foods in school cafeterias was associated with an increase of 0.02 points (95%CI: 0.00; 0.03) in the consumption score in the adjusted analyses. These findings can assist in the establishment of a national Law on the offer of ultra-processed foods at schools.

The aim of the present study was to investigate birth weight and associated factors among Indigenous peoples in the state of Mato Grosso do Sul, Brazil. A cross-sectional baseline study was conducted with an Indigenous birth cohort of 407 livebirths to Indigenous women living in villages, retaken territories, and urban communities between 2021 and 2022. Birth weight (in grams) was considered the main outcome, with means and 95% confidence intervals calculated according to maternal and household characteristics. A multiple linear regression model was run to determine associations between mean birth weight and maternal household, demographic, and obstetric characteristics, with a 95% confidence level. Mean birth weight was 3,160.5g. The prevalence of low birth weight and macrosomia was 6.4% and 3.7%, respectively. After the adjustment for confounding variables, lower birth weight was found among livebirths of women living in households with a communal outdoor faucet and those with insufficient gestational weight gain. Children with higher birthweights were found among women with excessive gestational weight gain and multiparous women. The birth weight of Indigenous children was associated with maternal nutritional status, multiparity, and limited access to drinking water, indicating the need to improve nutritional surveillance for Indigenous women of childbearing age and strengthen intersectoral public policies that ensure access to drinking water on Indigenous lands.

This study aimed to analyze the occurrence, evolution, and factors associated with physical disability due to leprosy at diagnosis and discharge from multidrug therapy (MDT) in the state of Bahia, Brazil, 2001-2023. A cross-sectional population-based study was conducted of the degree of physical disability (DPD) at diagnosis and discharge from MDT in new cases of lepropsy. Poisson regression analysis with robust variance was used to calculate proportions and prevalence ratios (PR) with 95% confidence intervals (95%CI). A total of 58,168 new cases of leprosy were detected. The proportion of cases with the assessment of DPD was 85% at diagnosis (n = 49,434) and 48% at discharge (n = 27,860). Among the cases with DPD 0 at admission, 5.9% (n = 1,077) and 1.2% (n = 212) worsened to DPD 1 and DPD 2, respectively, at discharge. Among the new cases with DPD 1, 44.5% (n = 2,231) maintained the grade and 4% (n = 201) worsened to DPD 2. Among those with DPD 2 at diagnosis, 53.8% (n = 830) maintained the grade. The lowest detection rate of new cases with DPD 2 per 1,000,000 residents occurred in 2020 and the highest proportion of cases at admission occurred in 2023 (7.8%, post-COVID-19). Associations were found between DPD 1/2 and the male sex (adjPR = 1.17; 95%CI: 1.06-1.27; p-value = 0.001), the absence of schooling (adjPR = 1.85; 95%CI: 1.29-2.63; p-value = 0.001), multibacillary classification (adjPR = 1.52; 95%CI: 1.20-1.91; p-value = 0.001), and type 1 and 2 reactions (adjPR = 1.27; 95%CI: 1.12-1.43; p-value < 0.001). An association was found between the worsening of DPD and type 1 and 2 reactions (adjPR = 1.34; 95%CI: 1.02-1.76; p-value = 0.039). Leprosy still causes a high burden of physical disability in Bahia, underscoring the need for early diagnosis, the longitudinal monitoring of DPD, and the integration between surveillance and care, with special attention to socially vulnerable individuals.

Chronic stress is associated with various morbidities, but the physiological effects require greater understanding, especially with regards to inflammatory biomarkers. This study investigated the association between stressful events and mean levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in both cross-sectional (at ages 18 and 22) and longitudinal (exposure at age 18 and outcome at age 22) analyses. Participants from the 1993 Pelotas (Brazil) birth cohort with complete data at both ages were included (n = 2,871 at age 18; n = 2,444 at age 22). Exposure was assessed as the number of stressful events (none, 1, ≥ 2) and by stressful events group (6 groups at age 18; 8 groups at age 22). Linear regression models were used for the determination of associations, including the analysis of interactions with sex. Unstratified associations were either null or conflicting. Cross-sectional associations were observed after stratification by sex: at 22 years of age, men exposed to physical abuse had higher levels of CRP (β logCRP: 0.41, 95%CI: 0.04; 0.78) and IL-6 (β logIL-6: 0.26, 95%CI: 0.06; 0.46) than those not exposed; at 18 years of age, women exposed to unwanted changes had higher IL-6 levels (β: 0.15, 95%CI: 0.02; 0.28), while at 22 years of age, those with relationship problems had lower CRP levels (β: -0.15, 95%CI: -0.29; -0.01) compared to those not exposed. The results suggest that the impact of stressful events on inflammation varies according to the type of event, age, and sex, possibly reflecting differences in biopsychological mechanisms.

While not a phenomenon exclusive to the COVID-19 pandemic, vaccinal hesitation became more evident during this period, directly impacting vaccination coverage and exposing tensions among science, misinformation, and public health practices. The aim of this essay is to offer a critical description of the dimensions that influence the motivation to adhere to vaccination, analyzing (1) fears related to adverse events and the safety of vaccines, (2) the role of social media in the dissemination of misinformation, and (3) gaps in health communication as a barrier to the education of the population. A paradox emerges from observational data and reports from the primary health care: although the rate of initial refusal was low, the poor adherence to booster shots reveals residual hesitation. Therefore, the right to health communication, which is understood as a practical-methodological axis, is fundamental to the realization of the right to health in the Brazilian Unified National Health System. Strategies based on critical dialogue, transparency, and social participation can enhance vaccination coverage, strengthening not only the response to critical periods of health emergencies, but also collective pacts in public health.

This study sought to classify and characterize the exposure of artisanal fishers from Pernambuco, Brazil, to oil during disaster-crime that took place on the Northeast coast of the country in 2019. A cross-sectional epidemiological study was conducted involving interviews with 1,259 artisanal fishers registered with 27 fishing colonies and/or associations along the coast of Pernambuco. Cluster analysis was employed with non-hierarchical k-modes for the classification of the degree of exposure: low (72.3%) - most had no direct contact; medium (12.3%) - 66.4% handled contaminated materials, 60% smelled the odor, and 63% had occasional contact; and high (15.4%) - 77.8% handled waste, 81% smelled a strong odor, and 72.2% reported skin irritation. Two exposure groups were identified for the oil cleanup activities: low (73.1%) - 92.9% did not participate; and medium (26.9%) - all participated, 45.1% used contaminated instruments, 79.9% reported a strong odor, and 20% had frequent contact with the oil. The northern coast of Pernambuco had the highest percentage of individuals in the high-exposure group (17.1%). This group was formed predominantly of women. Fishers were exposed to oil both at work and while cleaning beaches, reefs, and mangroves, many with high exposure rates. These results underscore the need for strategies to monitor the physical and mental health of this population, as well as the assessment of bioindicators and the implementation of occupational and environmental health surveillance actions.

This study assessed the implementation of PROTEJA, which is a national intersectoral strategy for the prevention and treatment of childhood obesity targeting small municipalities. Through a qualitative multiple-case study grounded in implementation science, 35 interviews were conducted with municipal technical leaders from the five macroregions of Brazil from different human development scenarios and different degrees of adherence to innovation. The identification and categorization of facilitators and barriers with regards to implementation was based on the Consolidated Framework for Implementation Research (CFIR) using content analysis. The facilitators identified were intersectoral governance, participatory territorial planning and diagnosis, technical support for management, adaptability to local situations, compatibility with the list of health services, and the perception of relative advantage over similar programs. The main barriers were difficulty in the use of financial resources, the high turnover of technical leaders, difficulty in coordinating agendas for the full functioning of spaces of governance, resistance from healthcare professionals, and low relative priority given to childhood obesity as a public health problem by municipal authorities. The implementation of PROTEJA was made possible by coordinating guidelines, technical support, and financial incentives. The analysis guided by CFIR revealed how the interaction among technical (planning instruments and goals), organizational (intra- and intersectoral structures and networks), and human (capabilities and learning curves) elements facilitated or hindered the implementation of the policy.

Sedentary behavior is a growing public health concern due to its association with chronic diseases and functional decline, especially among older adults. This study aimed to assess the prevalence of sedentary behavior among older adults living in São Paulo, Brazil, and to analyze its associations with sociodemographic characteristics and physical activity domains. Data were collected from the Health Survey in São Paulo City (ISA-Capital), with 1,010 individuals aged ≥ 60 years. Sedentary behavior was assessed using the International Physical Activity Questionnaire, considering total sitting time (both leisure and non-leisure) and categorized as ≤ 4h/day or > 4h/day. Sociodemographic variables and physical activity domains were examined using Poisson regression models. Overall, 43.7% of participants reported sedentary behavior of > 4h/day. Multivariate analyses revealed a higher likelihood of sedentary behavior among individuals aged 80 years or older, with an increase ranging from 41% to 58% compared to those aged 60-69 years. Men were 23% more likely to report sedentary behavior than women. Participants with four or more years of education had a 29% to 64% higher likelihood compared to those with up to three years. Individuals who self-identified as Indigenous or others had a 38% to 41% greater likelihood compared to white participants. Engaging in less than 150 min/week of commuting, domestic, and total physical activity was associated with a 41% to 67% increase in sedentary behavior. These results highlight sociodemographic disparities and the influence of specific physical activity domains on sedentary behavior among older adults, reinforcing the need for targeted public health interventions.

This study examined the health-disease process among women agriculturalists in traditional communities of the Central Amazon, focusing on the intersections between labor, environmental conditions, and social factors. Fieldwork was conducted in the Rio Negro Sustainable Development Reserve, using semistructured interviews and participant observation across five communities. Content analysis was validated by rarefaction and word co-occurrence techniques, confirming the adequacy of the sample and the obtained thematic categories. Results indicate that agricultural work contributes to women's health, autonomy, and dignity, while also exposing them to physical risks such as accidents and bodily strain. Care practices centered around traditional remedies and limited access to primary healthcare, which is hampered by long distances and resource shortages. Land conflicts, illegal land grabbing, and the impacts of major infrastructure projects, such as the Rio Negro Bridge and the proposed roads, further undermine healthcare provision. This study concludes that the multifactorial health-disease process is deeply tied to living and working conditions within a broader socioenvironmental context. Strengthening primary care and safeguarding traditional territories are essential to ensuring comprehensive health for these populations.

Aporophobia compromises access to and the quality of care at health services. Health professionals of the Family Health Strategy (FHS) play a central role in ensuring universal, comprehensive, equitable health care. The aim of the present study was to understand perceptions about aporophobia among higher-level FHS professionals. A sequential, explanatory, mixed-methods study was conducted with 96 FHS professionals in Fortaleza, Ceará State, Brazil. In the first stage, quantitative data were collected using the Attitudes Towards the Homeless Questionnaire. In the qualitative phase, 10 professionals were interviewed based on the scores they received on the questionnaire (lowest and highest quintiles). The data were analyzed using the IraMuTeq software and included similarity analysis interpreted in light of the theories of philosopher Adela Cortina. Significant associations were found between aporophobia and both skin color (p = 0.022) and employment status (p = 0.008). The qualitative content was categorized into four classes: poverty-related causes; manifestations of aporophobia and its stereotypes; comprehensive care for vulnerable groups; and humanization and adaptation in care. The perceptions of the professionals ranged from humanized practices to subtle or even explicit prejudices, revealing challenges in the assurance of equity in care. These results underscore the need for ongoing training of healthcare providers of the FHS, the inclusion of discussions on the social determinants of health at higher education institutions, and the strengthening of intersectoral collaboration to ensure more humanized and inclusive care.