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Brazil is characterized by an unfinished agenda of health inequalities, which impact health problems in the childhood. This study aimed to evaluate the socioeconomic inequalities of health problems in the early childhood. This is a prospective study, using data from the birth cohort carried out in the city of Pelotas (Rio Grande do Sul State, Brazil) in 2015. The outcomes were health problems presented at 12 and 24 months: cough, breathing difficulty, diarrhea, ear pain, pneumonia, urinary infection, hospitalization, and other health problems. Socioeconomic inequalities were measured applying the slope index of inequality (SII) and the concentration index (CIX), with wealth index and maternal schooling being the socioeconomic variables. The inequalities in the number of health problems were evaluated by Poisson regression. The perinatal sample comprised 4,275 children. At 12 months approximately 74% of the children presented 1 or more health problems, while at 24 months, approximately 44% presented 2 or more health problems. For all period, the mean number of health problems was 2.9 (standard deviation = 2.0). Higher frequencies were observed for children belonging to the poorest income quintile and with lower maternal education, except for 1 or more health problems at 24 months. The greatest absolute and relative inequality was observed for 2 or more health problems at 12 months (SII: -0.23, 95%CI: -0.29; -0.18 and CIX: -0.19, 95%CI: -0.25; -0.14). There is an opposite dose-response relation for the risk of accumulation of health problems according to maternal schooling (1.07, 95%CI: 1.04; 1.09) and wealth categories (1.03, 95%CI: 1.01; 1.04), in the full adjusted models. The study confirms inequalities due to health problems in Brazilian children, especially in the first year of life.

Accidents in childhood have a high morbidity and mortality rate and are often preventable, which reinforces the importance of educational measures to prevent unintentional injuries. This study aimed to identify and describe useful educational strategies for preventing childhood accidents in communities. This systematic review was guided by PRISMA (2020) and registered on the PROSPERO platform (ID: CRD42024500956). A search strategy was developed by combining the descriptors "Accident Prevention", "Child", and "Health Education" with the Boolean operator AND, applied to the PubMed/MEDLINE, Web of Science, LILACS, and SciELO databases. A total of 5,037 studies were located, including observational articles published from 2018 to 2023, with children aged 0-12 years and/or their parents/caregivers. The quality of the studies was assessed based on the Qualitative Studies Checklist and the Research Triangle Institute Item Bank instruments. The bibliographic sample consisted of 30 articles, mostly classified as high quality, with a population of 4,510 adults and 54,190 children from various countries. Educational strategies for accident prevention were described, aimed at parents and guardians, children, and both. This review, addressing innovative educational strategies for preventing childhood accidents, highlights playful approaches for children and visual methods for caregivers. Implementation faces challenges related to evaluation and socioeconomic factors, making rigorous criteria and prolonged follow-ups important for continuous effectiveness.

The aim of this study was to compare the food consumption of the population of Coari, Amazonas State, Brazil, according to the NOVA Classification, during the hydrological phases of drought and flooding of the Amazon rivers. An epidemiological, population-based, cross-sectional study was carried out. The sample consisted of 457 adult individuals. Data were collected in two stages using a sociodemographic instrument, a 24-hour food recall and a food frequency questionnaire adapted to local habits. The data were analyzed using the statistical program R version 4.2.4, using Pearson's chi-square, Fischer's exact and Bhapkar's tests. The sample was predominantly female (drought = 70%/flood = 71.2%) and brown (drought = 65.4%/flood = 66.2%). Most of the interviewees ate meals (breakfast, lunch and dinner). Afternoon snacks were the most common intermediate meal, especially during flooding (274/70.2%). In natura or minimally processed foods predominated at the three main meals (95%). Ultra-processed foods were consumed little or not at all and were mentioned especially during the drought (152/33.3%; p = 0.007). On the other hand, consumption of regional foods (tucumã, beiju, tapioca flour and açaí) increased during the flood (p < 0.001). Consumption of in natura or minimally processed foods continues to be the mainstay of the diet in the interior of Amazonas, with a predominance of regional foods during the flood and processed and ultra-processed foods during the drought, demonstrating the influence, albeit subtle, of the hydrological phases on the food consumption of this population.

In society, cancer is commonly associated with an incurable and disabling disease that causes damage beyond the biological scope, impacting the psychological and sociocultural dimensions of cancer patients. From a cultural point of view, men construct narratives about prostate cancer based on their experiences and social contexts, expressing moral, ethical, and sociopolitical elements attributed to the cause of this type of cancer. We sought to understand the causes of prostate cancer as represented by men living with this type of cancer and its repercussions on self-care. A descriptive, qualitative study based on the Theory of Social Representations was conducted with 31 men diagnosed with prostate cancer treated at a High Complexity Oncology Unit. Data were collected from April to June 2022 by in-depth, individual, and semi-structured interviews. The corpus was inserted into the ALCESTE software. Alcohol intake, smoking, sexual promiscuity, and not taking care of oneself were the main behaviors understood as causes of cancer, which generates self-responsibility and guilt for the illness. Social representations of these causes, translated into behaviors not aligned with what social morality dictates as right, have repercussions on the moralizing notion of cancer as punishment, in which the disease expresses the patient's character, anchored in the Judeo-Christian religious discourse, which reduces the sociopolitical burden of male vulnerabilities and reinforces stereotypes from patriarchal society.

This study evaluated the explanatory factors of humoral immune response in older adults admitted to long-term care institutions in Buenos Aires, Argentina, up to 180 days after vaccination. An open-label, prospective, multicenter cohort study was conducted with volunteers who received two doses of the Sputnik V, Sinopharm, or AZD1222 vaccines. Plasma samples were analyzed at 0 and 21 days after the first dose, 21 days after the second dose, and 120 and 180 days after the first dose. Marginal linear models and generalized additives mixed models were adjusted to determine the behavior of anti-spike IgG antibody concentration over time according to exposure group (naïve/no-naïve) and vaccine. Occurrence of an outbreak of COVID-19 in long-term care institutions and comorbidities were the covariates analyzed. A total of 773 participants were included, with a mean age of 83 years (IQR: 76-89). Results showed that antibody levels in the naïve: Sinopharm group were significantly lower to the other groups (p < 0.05). Antibody levels in the no-naïve: Sinopharm group were similar to those in the naïve group who received AZD1222 (p = 0.945) or Sputnik V (p = 1). Participants exposed to outbreaks in long-term care institutions had significantly higher antibody levels, regardless of exposure group and vaccine (p < 0.001). In conclusion, previous exposure to COVID-19, type of vaccine, and admittance into a long-term care institution with a history of outbreaks are factors to be considered in future epidemic events with transmission dynamics and immunological mechanisms similar to COVID-19, in populations similar to the one analyzed.

Caring for a visually impaired child can affect the caregiver's income and, in turn, the family's. Catastrophic spending resulting from increased expenses and reduced income must be taken into account, whether due to unemployment, a reduction in the number of hours worked or the difficulty of entering or reentering the job market. Given this scenario, the main objective of this study was to estimate the catastrophic spending attributed to the caregiver of blind or low-vision children in reference centers for education for the blind, ophthalmology and child health located in the city of Rio de Janeiro, Brazil, identifying which factors are associated with a higher or lower prevalence of this expenditure. It was found that 53.3% of care for blind children involved 40% or more of their income. Among the caregivers of children with low vision, catastrophic spending is milder, compromising at least 40% of income for 36.8% of the caregivers. The factors associated with a higher prevalence of catastrophic spending were the caregiver's age, the number of residents in the household, higher schooling, lower household income, renovations to the home, health insurance, taking out loans, selling assets, the number of health units where the child receives treatment and the relationship of the main caregiver. The burden placed on caregivers of visually impaired children indicates a situation of vulnerability that shows the need for access to financial and social protection mechanisms, through policies that are capable of serving this group.

This article aims to analyze the performance of the Brazilian Unified National Health System (SUS, acronym in Portuguese) hospital network based on the national databases of the Brazilian Hospital Information System (SIH, acronym in Portuguese) and the Brazilian National Registry of Health Establishments (CNES, acronym in Portuguese). The research used a set of indicators covering the production of admissions, the profile, quality and performance of care, associated with hospital size and legal nature. For data analysis, the Analysis of Variance with Tukey-Kramer test was used to highlight the differences between public and private hospitals, the moderation analysis to verify the effect of hospital size and the Pabon Lasso model to integrate the results. The results show that the increase in the number of beds influences the performance of the indicators differently for public and private hospitals. Public hospitals showed higher gains in scale efficiency with the increase in beds, whereas private non-profit hospitals showed a higher performance in the set of indicators and a more balanced performance in the different sizes. The application of the Pabon Lasso model showed that small hospitals, both public and private, perform poorly. It also showed that from medium-sized onwards, public and private hospitals perform well. However, each category displays particularities in its performance profile, reflecting a diversity of practices and operational results. This study thus confirms previous findings that hospital performance tends to improve as the number of beds increases, but also reveals that it varies significantly depending on the legal nature of these institutions.

Cesarean section is a life-saving intervention, but its use without obstetric indication leads to short- and long-term complications. Brazil is internationally known for its high cesarean rates, especially in the private sector. To reverse this problem, the Brazilian National Regulatory for Private Health Insurance and Plans launched the Adequate Childbirth Program, and this retrospective study aims to analyze its effectiveness. We included the total of births performed in private maternity hospitals between 2014 and 2019 registered on the Brazilian Information System on Live Births (SINASC) database to compare the evolution of cesarean section rates in hospitals participating and not participating in the project. A total of 277,747 births were analyzed, showing a reduction in the cesarean section rate in both groups but more pronounced among the participant institutions. No reduction in cesarean performance was observed before the program launch (2014), but there was a constant downward trend after 2014, until it became significant in 2018. This result occurred independently of demographic, maternal, and Robson group variables. The cesarean section rate of hospitals participating in the program went from 83.8% to 72.3% (95% confidence interval - 95%CI: 71.7-72.9). Despite the reduction, it remains well above the expected rates according to the c-model tool, which would be 45.2% (95%CI: 33.9-56.5) for this population. Results showed that a well-conducted public policy together with private institutions can change the scenario of labor and birth care, reducing high cesarean section rates.