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Avoidable hospitalizations due to ambulatory care sensitive conditions (ACSC) are an indirect indicator of primary health care quality and effectiveness of care coordination. This study aims to analyze the proportion and trends of hospital discharges for ACSCs (2000-2023) among children under five years, project rates through 2026, and compare standardized rates across cantons. We conducted an ecologic time-series analysis using Ecuador's national hospital discharge data for 20 ACSCs, as defined by the Pan-American Health Organization. Annual percentage changes were estimated using Joinpoint regression, and forecasts were generated with the Prophet package in R. Standardized morbidity ratios (SMRs) were used to compare rates across 221 cantons, based on Ecuador's population from the 2001, 2010, and 2022 censuses. Between 2000 and 2023, ACSCs accounted for 26.6% of all hospital discharges. The overall average of annual percent change increased by 2%, and by 6.8%, 6.4%, and 4.2% for respiratory diseases, urinary and skin infections, respectively. Gastrointestinal diseases declined by 1.9% annually. Significant changes in ACSC trends were observed during the following periods: 2000-2007; 2018-2021; and 2021-2023. No significant change occurred from 2008 to 2018. Projections indicated that ACSCs may still represent 20.3% of hospital discharges by 2026. Moreover, 5.4% of cantons consistently exceeded expected SMRs across all three census years analyzed. The rising ACSC rates during the early 2000s, marked by economic structural adjustment and limited public healthcare investment, contrasts with the decline observed during the COVID-19 pandemic. These findings underscore the need to strengthen primary care and public health planning.

Climate change has led to an increase in the frequency and intensity of extreme weather events, forcing approximately 72 million people throughout the world to face limitations in terms of access to food in 2023. In Brazil, this scenario intensifies situations of chronic hunger, poverty, and social inequalities, increasing vulnerability particularly among young children. The aim of this paper is to propose a conceptual model that elucidates and explains these relationships. A literature review was conducted using the terms "climate change", "food insecurity", "child malnutrition", and combinations of these terms, with the inclusion of the word "Brazil" in order to discuss the model in the Brazilian context. A conceptual model was proposed that addresses relationships among the main elements and three other mediating factors - the food system, water insecurity, and social inequalities, which are interrelated in five ways: (a) the direct impact of extreme weather events on access to food; (b) the impact of extreme weather events on access to food due to the effects on the food system; (c) water insecurity as an element that adds complexity to the relationship between extreme weather events and food insecurity; (d) social inequalities as determinants of the effect of climate change on households in situations of food insecurity, little access to water, and/or child malnutrition; and (e) child health and nutrition affected by all these factors. The connections addressed in this model can help guide future studies, favoring the development and implementation of collaborative, multisectoral, adaptational actions for the strengthening of resilience to climate change in Brazil.

International borders pose health risks due to the intense movement of people and products, requiring surveillance and specific public health interventions. In Brazil, territorial diversity accentuates these challenges. The aim of the present study was to analyze the pattern of the mandatory immediate reporting of public health events in border regions of Brazil and more specifically in the state of Paraná from 2010 to 2019. Fourteen events from the National List of Compulsory Notification of Diseases that require immediate reporting to the three levels of government were analyzed using data from the Brazilian Health Information and Informatics Department. For each event, incidence rates were compared between border and non-border municipalities on two levels (nationally and in the state of Paraná). Absolute and relative frequencies as well as incidence and mortality rates (per 100,000 inhabitants) were calculated. Rate ratios (RR) were calculated to compare excess risk between groups. A total of 50,628 public health events occurred in the period studied; the most frequent were cases of measles (66.44%) and deaths related to dengue (11.52%). Cases of extra-Amazonian malaria (RR = 32.41), botulism (RR = 6.94), hantavirus (RR = 2.49), and deaths related to dengue (RR = 1.39) were concentrated at the borders. The incidence of measles was lower in border regions. The dynamics of extra-Amazonian malaria, dengue, hantavirus, and botulism at borders differed from those in the rest of the country. The high incidence at borders reveals critical vulnerabilities that require urgent, coordinated action. It is essential to strengthen surveillance and promote shared intersectoral strategies to address the unique challenges of these areas. Strengthening strategic units, such as the Strategic Information Center for Health Surveillance, improves surveillance and integration and ensures rapid responses.

Stressful events are avoidable and potentially traumatic situations that cause damage to physical and mental health. Research on this topic is generally carried out in contexts without significant social inequalities. We described the prevalence and inequality measures for exposure to different stressful events according to sex, skin color, family income, and schooling using data from five follow-ups of the 1993 Pelotas (Brazil) birth cohort. We evaluated stressful events until adolescence (< 18 years, n = 2,755), in adulthood (18-30 years, n = 1,752), and in both periods (n = 1,400). The characteristics of the analytical samples were approximated to baseline using inverse probability weighting. Simple and complex measures were used to measure inequalities (difference, ratio, SII, and CIX). Until adolescence, the most prevalent stressful events were parental separation (67.5% of men) and the death of a relative (66.1% of women). The death of a relative was the most prevalent stressful event for both sexes in adulthood (men: 65.8%; women: 63.2%) and in both periods (men: 44.1%; women: 44.2%). Regardless of the period of life, black, less educated, and poorer individuals were the most exposed to the majority of stressful events. Emotional neglect, incarceration, parental separation, and discrimination were among the most unequal exposures, with blacks, those with less schooling, and the poorest being most affected, women being more exposed to emotional neglect and discrimination, and men to the other exposures. Physical and mental health care programs should be developed to prevent such exposures and minimize their damage to health, especially in the most vulnerable groups.

The study aims to assess the hypothetical construct underlying the WHOQOL-BREF scale of quality of life in the working environment, wherein individuals are reasonably healthy. We analyzed cross-sectional data from civil servants at university campuses in Rio de Janeiro, Brazil, which focused on social determinants of health possibly related to quality of life. We simultaneously assessed the association of quality of life domains with physical and mental health, physical activity, eating habits, stress and social support at work, situations of discrimination, and socioeconomic status using structural equation modeling. Most of the 3,574 participants were non-manual workers (57%), woman (56%), with median age of 42 years, and 42% had a university degree. The association of psychological distress stood out from other covariates in all four domains of quality of life, particularly the psychological domain. The direct association between socioeconomic status and the environmental domain, the inverse association of recent morbidity to the physical domain, and the inverse association of discrimination with all domains were also noteworthy. The results strengthened the construct validity from factor analysis of WHOQOL-BREF, with additional evidence from the association with constructs related to quality of life obtained in a study of social determinants of health. There seems to be space to expand the use of WHOQOL-BREF to provide valid inferences on the quality of life of workers, targeting individuals whose very low scores might signal the need for support, and to assess changes in quality of life following interventions in groups of workers.

This study aimed to evaluate whether individuals who self-identify as black and/or mixed-race have a higher prevalence of tooth loss compared to white individuals in Brazil, using a systematic review and meta-analysis. Searches were conducted in the PubMed, Scopus, Web of Science, Virtual Health Library, Embase, and gray literature databases. Two independent reviewers performed the searches and article selection processes. The Newcastle-Ottawa Scale was used for observational cohort studies, and its modified version was used for cross-sectional studies. The I2 statistic assessed the heterogeneity of studies included in the meta-analyses. Of the 25 articles eligible for qualitative evaluation, 17 were included in the quantitative assessment. Sample sizes ranged from 101 to 18,718 individuals aged 11 to 74 years. Most studies compared white individuals to non-white individuals (black, mixed-race, Asian, and Indigenous people). In the comparison between white and non-white individuals, no differences were found concerning edentulism (OR = 0.86; 95%CI: 0.71; 1.06), absence of functional dentition (OR = 0.82; 95%CI: 0.33; 2.03), or mean number of missing teeth (MD = -0.21; 95%CI: -2.92; 2.49), but it was associated with tooth loss (OR = 1.40; 95%CI: 1.26; 1.55). When comparing black/mixed-race people to white individuals, tooth loss was higher among those who self-identified as black/mixed-race (OR = 1.41; 95%CI: 1.27; 1.57). This difference was also observed when comparing black/mixed-race individuals to other races/skin color (OR = 1.24; 95%CI: 1.15; 1.33). Overall, studies conducted in Brazil found that tooth loss was more prevalent among self-declared black and/or mixed-race individuals.

This cross-sectional study assessed the association of demographic and socioeconomic variables with comorbidities at 40 years of age in participants of the 1982 Pelotas (Brazil) birth cohort. At age 40, study participants were invited to visit the research clinic to be examined and answered an online questionnaire. Subjects reported medical diagnosis of several morbidities that were grouped according to the 11th revision of the International Classification of Diseases into four groups (endocrine, cardiovascular, musculoskeletal, and allergic/respiratory). Ordinal logistic regression was used to estimate the proportional odds ratio, and Brant test to check the proportional odds assumption. Latent class analysis was used to identify multimorbidity patterns, and their association with demographic and socioeconomic factors was evaluated via multinomial logistic regression. A total of 2,986 participants were included in this study. At least one endocrine disorder was reported by 48.1% participant, cardiovascular morbidities by 26.6%, allergic/respiratory morbidities by 59%, and musculoskeletal morbidities by 32.5% of participants. In the latent class analysis, three morbidity patterns were identified: relatively healthy, metabolic and allergic/respiratory. The odds of being in a higher category of number of cardiovascular morbidities was higher among blacks (OR = 1.79; 95%CI: 1.43; 2.24). Notably, lower socioeconomic status was associated with a lower odds of being in a higher category of number of allergic/respiratory morbidities (OR = 0.59; 95%CI: 0.47; 0.74) and a higher odds of being in a higher category of number of cardiovascular and musculoskeletal morbidities. Our findings suggest that multiple morbidities occur in different directions depending on the socioeconomic and educational levels.

The COVID-19 pandemic in Brazil was marked by a set of measures to contain the virus, which had specific repercussions in different social groups, especially the most vulnerable, such as transvestites and transgender individuals. The aim of the present article was to investigate the particularities of transphobia in Brazil in the context of the COVID-19 pandemic as well as the actions of organizations and political groups in this scenario. The novelty and relevance of this study is evident by the scarcity of investigations focused on understanding the transphobic phenomenon in the context of a serious social crisis. Adopting a qualitative approach, five interviews were conducted with representatives of trans support groups on the local, regional, and national levels. The treatment of the material collected involved the content analysis technique proposed by Bardin and prioritized queer theoretical contributions. The results were organized into two major topics: (1) transphobia in everyday relationships; and (2) challenges in accessing public policies, the latter of which was subdivided: (a) education policy and the job market; (b) social assistance policy and food security; and (c) health policy and mental health. In the assessment of the groups interviewed, the pandemic intensified a series of inequalities and violence already experienced by transvestites and transgender individuals, highlighting the (in)action of the government, which itself is an agent of transphobia.

This study aimed to characterize the quality of child health care and explore its relationship with municipal characteristics. Using data from the external assessment of the first cycle of the Brazilian National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, acronym in Portuguese), this cross-sectional study evaluated 16,566 Family Health Strategy teams. In total, nine binary indicators were created based on recommendations from the Brazilian Ministry of Health. We employed latent class analysis and multinomial logistic regression to assess the quality of care and its association with region and the Brazilian Deprivation Index. Three patterns of quality of care were identified: high, intermediate, and low adequacy. The "high adequacy" pattern included 22.5% of teams, "intermediate adequacy" 60.2%, and "low adequacy" only 17.3%. Teams in the Northeast Region were over twice as likely to belong to the "high adequacy" pattern (OR = 2.34; 95%CI: 1.15-4.76) compared with those in the Central-West Region. For teams located in municipalities with moderate and low deprivation, the chance of belonging to the "high adequacy" pattern was 2.04 (95%CI: 1.44-2.89) and 9.08 (95%CI: 4.54-18.14) times higher, respectively, compared with the high deprivation municipalities. This study identified three patterns of quality of child care, with most teams characterized by an "intermediate adequacy" pattern. The quality of care was associated with the municipality's characteristics. The methodology used in this study proved effective in characterizing the quality of care in a more consistent way.

This study aims to analyze the distribution of gestational weight gain in a group of Latin American adolescents according to their pre-pregnancy body mass index (BMI, based on the World Health Organization criteria for adolescents and adults) and its association with their newborns' birth weight. This longitudinal retrospective study used secondary data from national or institutional perinatal information systems about pregnant adolescents from Argentina, Colombia, Mexico, Panama, Paraguay, and Uruguay. The degree of agreement between the two classification criteria for the pre-pregnancy BMI was determined with the B statistic and the Bangdiwala graph. The association of newborns' weight with the pre-pregnancy BMI and the gestational weight gain was assessed using regression models. This study included 6,141 pregnant adolescents. When compared to the adolescents' criterion, the pre-pregnancy BMI classification for adults tends to underestimate the assigned category, leading to a higher recommended weight gain. Regardless of the criterion, overweight and high gestational weight gain were significantly associated with a higher probability of newborns with macrosomia and birth weight > P90, obesity was associated with birth weight > P90, and low weight gain was associated with low, insufficient, and < P10 birth weight. In conclusion, pre-pregnancy BMI and gestational weight gain are associated with the birth weight of newborns from Latin American adolescents.