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This study aims to identify and analyze the obstacles to intersectorality in the São Paulo Policy for the Prevention of Violent Deaths of Children and Adolescents in the State of São Paulo, Brazil, established by Law n. 17,652/2023, within the scope of the actions of the São Paulo Committee for the Prevention of Homicide in Adolescence. This is a qualitative study using the case study technique based on: interviews, participant observation, field diary and document analysis. The results showed that obstacles to the implementation of intersectorality in this Law exist, given the sectorization present both in Bill n. 382/2022, which originated it, and the vetoes in its final version, enacted by the government in March 2023. Intersectoral policies must have instruments to guarantee the articulation of sectors, clearly defining the responsibilities of those involved. In addition, it is of fundamental importance to recognize the limits of the powers attributed to the legislature when proposing laws that aim to establish them.

This cross-sectional study evaluated the configural and metric structures of the Intersectional Discrimination Index (InDI), an instrument that measures anticipated (InDI-A), dat-to-day (InDI-D), and major (InDI-M) discrimination. Data from a broader study, focused on the impacts of discrimination on the mental health of women living in Brazil, were used. Approximately 1,000 women, selected according to a convenience sampling scheme, answered the InDI and questions about sociodemographic characteristics in an electronic form that was administered in 2021. Exploratory factor analyses and exploratory structural equation modeling were applied to the first half of the sample; for the second, confirmatory factor analysis was conducted. Taken together, the findings suggest that each of the three measures is one-dimensional. However, unlike the study that originally proposed the InDI for use in Canada and the United States, we observed the presence of residual correlations in the three subscales evaluated, all of which were suggestive of content redundancy between specific pairs of items. The three measures showed moderate to strong factor loadings and acceptable fit to the data. InDI exhibited reasonable internal validity, potentially becoming a valuable instrument for investigating the health effects of intersectional discrimination in Brazil. Future studies should evaluate the consistency of these findings, examine the scalar structure of the instrument, and analyze its invariance among different marginalized groups.

This article aimed to assess the temporal trend of work-related mental and behavioral disorders in Brazil, as well as to measure the effect of changes in the implementation of the Social Security Technical Nexus (NTP, acronym in Portuguese) on the incidence of these disorders among beneficiaries of the General Social Security System (RGPS, acronym in Portuguese). It is an analysis of time series and interrupted time series with data from the Brazilian Ministry of Social Security information system on cases of work-related mental and behavioral disorders from 2003 to 2019. The Prais-Winsten method was employed to calculate the annual percent change (APC) of the incidence rates for the conditions under study. The average incidence of work-related mental and behavioral disorders was 35.48 per 100,000 RGPS links during the period 2003-2019, with an increasing trend (APC = 9.67%; p = 0.033) for Brazil. Before the implementation of changes in the NTP (2003-2007), this value was 15.59, with an increasing trend (APC = 29.28%; p < 0.001), and it more than doubled (43.77) after the RGPS modified the way of establishing the nexus between illness and work (2008-2019). The post-NTP trend for work-related mental and behavioral disorders was a decrease in the country (APC = -23.73%; p < 0.001), a pattern that was repeated for all regions of the country. The findings suggest that the changes in the way of establishing the NTP between illness and work represented an advancement in the system of recording and notifying work-related mental and behavioral disorders in Brazil.

This study aimed to assess the prevalence and factors associated with lipid profile abnormalities of children aged 6 to 42 months in a Central-West Brazilian capital city. This cross-sectional study used data from the baseline of a cluster-randomized clinical trial conducted in parallel. It evaluated the lipid profile, usual nutrients intake (direct food-weighing method and 24-hour dietary recall), anthropometric parameters, and socioeconomic aspects of 169 children from early childhood education centers. Poisson regression with robust variance analysis was conducted. Of the total sample, 85% had dyslipidemia, 72% had high-density lipoproteins (HDL-c) levels below the desired range, 49% had increased triglycerides (TG), 17% exhibited elevated low-density lipoproteins (LDL-c), and 15% showed high total cholesterol (TC). An increase in the body mass index (BMI) for age z-score was associated with a higher prevalence of increased TG (PR = 1.22; 95%CI: 1.05-1.41; p = 0.009). Higher age in children was associated with an increased prevalence of high LDL-c (PR = 1.037; 95%CI: 1.01-1.07; p = 0.022) and TC (PR = 1.036; 95%CI: 1.00-1.07; p = 0.037), however it was a protective factor against low HDL-c (PR = 0.991; 95%CI: 0.98-1.00; p = 0.042). High energy intake was associated with low HDL-c (PR = 1.001; 95%CI: 1.00-1.00; p = 0.023). A higher prevalence of increased LDL-c (PR = 1.005; 95%CI: 1.00-1.01; p = 0.006) and decreased HDL-c (PR = 1.002; 95%CI: 1.00-1.00; p < 0.001) were associated with dietary cholesterol intake. Most of the children presented at least one alteration in serum lipids. Lipid profile abnormalities were associated with higher BMI, older age, and increased caloric and cholesterol intake.

This study aimed to estimate the prevalence of malnutrition using clustered anthropometric indicators and to describe the sociodemographic and dietary factors and health conditions that determine malnutrition in elderly Colombians. This was a secondary analysis of the study Health, Well-being and Ageing (SABE) Colombia, 2015. The survey included 23,694 people aged ≥ 60 years. Malnutrition excess was defined by clustering two indicators: body mass index (BMI) and waist circumference; weight deficit was defined by clustering BMI and arm and calf circumferences. The chi-square test was used to associate malnutrition with sociodemographic variables, dietary and health conditions, and to determine the heterogeneity of malnutrition, a latent class analysis was performed. Overweight was 31.9%, whereas underweight, according to BMI and calf circumference, was 7.9%, and increased to 18.8% when arm circumference was also taken into account. Five latent classes of malnutrition were generated - class 1: no overweight and deteriorated health conditions; class 2: no weight deficit and deteriorated health conditions; class 3: no malnutrition and deteriorated health conditions; class 4: overweight and multimorbidity; and class 5: low protein food intake without being underweight or overweight. It is concluded that a high prevalence of malnutrition in older adults exists, with excess rather than deficit. Sociodemographic and dietary factors and health conditions are associated differently with overweight and underweight.

This paper describes the results of the study I Want More! The Lives of Sex Workers During the COVID-19 Pandemic, which is part of the EPIC community research program. The study analyzed the effects of the pandemic on the lives of cis, trans and travesti sex workers in nine Brazilian states and 11 cities throughout 2020 and 2021. This article focuses on the qualitative component of the study, which was based on semi-structured, remote and face-to-face interviews carried out with 43 sex workers, and its comparison with the quantitative component. The effects are analyzed in relation to the Brazilian pandemic framework, considering the social, economic and political dimensions of the COVID-19 virus. Some of the key themes of the analysis are cases of illness, specific social isolation practices, prevention and care management practices, individual vaccination and collective vaccination strategies. We also share the daily and activist responses drawn up by sex workers in a political agenda that opposes the individualistic, familialist, domestic, and neoliberal logic of isolation by adopting community care perspectives, which was the only line of health action for this work category during the pandemic. Collective actions reposition sex work at the interface between public health and human rights and take as their principle the "street knowledge", from activism, and the workers' power of decision over their own bodies.

During the pandemic, Latin American countries suffered the collapse of their health systems. This was caused by the high demand for care of patients infected with SARS-CoV-2, which was added to the care of patients with other diseases. The significant increase in demand for health services caused medical and laboratory supplies to decline rapidly. The COVID-19 pandemic exacerbated a health crisis in several developing countries, mainly caused by insufficient systematic policies for integrating scientific knowledge. The current Colombian government must formulate a Biotechnological or Biosecurity Sovereignty Law that guarantees scientific autonomy, ensuring that Colombia is self-sufficient in Science, Technology, and Innovation. Colombian government should also focus on establishing and developing pharmaceutical chemical production by acquiring active chemical ingredients from other countries. This strategy could reduce the production costs and final prices of medicines, as well as generate high-level employment and wealth for the country. In this way, the Colombian government could prevent shortage of essential medicines and excessive price increases by commercial intermediation. In conclusion, the manuscript focuses on the lack of biotechnological sovereignty in Colombia. We propose a model of a Latin American Science and Technology ecosystem to achieve biotechnological sovereignty via state funding of research, strengthening universities, and fostering participation among private companies and Ministries of Science, Education, Trade, and Health. Scientific autonomy based on innovative processes that strengthen biotechnological independence can contribute to the economy by generating gross added value, creating high-quality employment, and facilitating the appropriation and social dissemination of knowledge, and cost reduction.

This study aimed to estimate the population-based Parkinson disease prevalence, and to explore potentially associated factors and conditions. A population-based survey was conducted in Northern Peru. Symptoms compatible with Parkinson's were defined using a validated Spanish questionnaire (≥ 42 points suggest Parkinson's). Potential factors (e.g., age, sex, etc.) and clinical conditions (e.g., depressive symptoms, perceived stress, etc.) associated with Parkinson's were assessed. In total, 1,609 subjects were included, mean age of participants was 48.2 (SD: 10.6), and 810 (50.3%) were women. Parkinson's prevalence was 1.6% (95%CI: 1.0; 2.4). Those aged ≥ 55 years, and those who reported using wood as fuel for household cooking had a Parkinson's prevalence from 3.5 to 4 times greater than those who did not. The presence of depressive symptoms, anxiety symptoms, perceived stress, poor sleep quality, and cognitive impairment was more common among those with Parkinson's, and quality of life in these participants was lower than those without Parkinson's. In conclusion, 1.6% of the population shows symptoms compatible with Parkinson's. Age and use of wood for household cooking were factors associated with Parkinson's. Several mental health conditions and lower quality of life were more frequent among those with Parkinson's. Appropriate strategies are required to detect, prevent, and manage Parkinson's cases.

Ischemic stroke is a major cause of mortality worldwide; however, few studies have been conducted to measure the impact of the distribution of healthcare services on ischemic stroke fatality. This study aimed to explore the relationship between three ischemic stroke outcomes (incidence, mortality, and fatality) and accessibility to hospitals in Spain, considering its economic development. A cross-sectional ecological study was performed using data on hospital admissions and mortality due to ischemic stroke during 2016-2018. Gross geographic product (GGP) per capita was estimated and a healthcare accessibility index was created. A Besag-York-Mollié autoregressive spatial model was used to estimate the magnitude of association between ischemic stroke outcomes and economic development and healthcare accessibility. GGP per capita showed a geographical gradient from southwest to northeast in Spain. Mortality and case-fatality rates due to ischemic stroke were higher in the south of the country in both women and men aged 60+ years. In women and men aged 20-59 years a EUR 1,000 increase in GGP per capita was associated with decreases in mortality of 5% and 4%, respectively. Fatality decreased 3-4% with each EUR 1,000 increase of GGP per capita in both sexes and in the 20-59 and 60+ age groups. Decreased healthcare accessibility was associated with higher fatality in the population aged 60+. Economic development in southwest Spain would not only improve employment opportunities but also reduce ischemic stroke mortality. New health related strategies to improve hospital accessibility should be considered in more sparsely populated regions or those with worse transport and/or healthcare infrastructure.