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Aim: The Health Gym Program is the main health promotion strategy in the Brazilian public health system. This paper aims to measure the impact of the Health Gym Program on hospital admission expenses for stroke in the state of Pernambuco, Brazil. Subject and methods: This public health impact evaluation used a panel of socioeconomic, demographic, and epidemiological data from 2007 to 2019 for all 185 municipalities in the state of Pernambuco. The empirical strategy used pre-tests, ordinary least-squares econometric modeling, and quantile regression as a robustness test. Results: The municipalities that implemented the Health Gym Program spent an average of 21.04% less on hospitalizations for stroke than the municipalities that did not, and this result was statistically significant at the 1% level. Further, the density of program coverage within the municipality also impacts the reduction of expenses. This saving is directly proportional to the number of hubs of the program in the municipalities. An increase of one program hub for every 10,000 inhabitants results in a 4.57% reduction in expenditure on stroke hospitalizations in the municipalities. Conclusion: The presence of the Health Gym Program led to a reduction in expenses related to hospital admissions for stroke, which may indicate that this program effectively expands the scope of health promotion actions in primary healthcare. The evidence generated from this study can be used to implement evidence-based policies aimed at preventing and controlling chronic diseases in Brazil. [ABSTRACT FROM AUTHOR]

Disease surveillance is used to monitor ongoing control activities, detect early outbreaks, and inform intervention priorities and policies. However, data from disease surveillance that could be used to support real-time decisionmaking remain largely underutilised. Using the Brazilian Amazon malaria surveillance dataset as a case study, in this paper we explore the potential for unsupervised anomaly detection machine learning techniques to discover signals of epidemiological interest. We found that our models were able to provide an early indication of outbreak onset, outbreak peaks, and change points in the proportion of positive malaria cases. Specifically, the sustained rise in malaria in the Brazilian Amazon in 2016 was flagged by several models. We found that no single model detected all anomalies across all health regions. Because of this, we provide the minimum number of machine learning models top-k models) to maximise the number of anomalies detected across different health regions. We discovered that the top three models that maximise the coverage of the number and types of anomalies detected across the thirteen health regions are principal component analysis, stochastic outlier selection, and the minimum covariance determinant. Anomaly detection is a potentially valuable approach to discovering patterns of epidemiological importance when confronted with a large volume of data across space and time. Our exploratory approach can be replicated for other diseases and locations to inform monitoring, timely interventions, and actions towards the goal of controlling endemic disease. [ABSTRACT FROM AUTHOR]

Background: Social Frailty is a significant public health concern affecting the elderly, particularly with the global population aging rapidly. Older adults with social frailty are at significantly higher risk of adverse outcomes such as disability, cognitive impairment, depression, and even death. In recent years, there have been more and more studies on social frailty, but no bibliometrics has been used to analyze and understand the general situation in this field. Therefore, by using CiteSpace, VOSviewer, and Bilioshiny software programs, this study aims to analyze the general situation of the research on social frailties of the older adults and determine the research trends and hot spots. Methods: A bibliometric analysis was conducted by searching relevant literature on the social frailty of the older adults from 2003 to 2022 in the Web of Science core database, using visualization software to map publication volume, country and author cooperation networks, keyword co-occurrences, and word emergence. Results: We analyzed 415 articles from 2003 to 2022. Brazil has the highest number of articles in the field of social frailty of the older adults, and the United States has the highest number of cooperative publications. Andrew MK, from Canada, is the most published and co-cited author, with primary research interests in geriatric assessment, epidemiology, and public health. "Social Vulnerability," "Health," "Frailty," "Mortality," and "Older Adult" are among the research hotspots in this field. "Dementia," "Alzheimer's disease," "Population," and "Covid-19" are emerging research trends in social frailty among the older adults. Conclusion: This scientometric study maps the research hotspots and trends for the past 20 years in social frailty among the older adults. Our findings will enable researchers to better understand trends in this field and find suitable directions and partners for future research. [ABSTRACT FROM AUTHOR]

This paper uses the internet-based biosurveillance to describe the Brazilian e-commerce of non-inspected dairy products and maps its traditional sale in a medium-sized city (Londrina). We searched the sales of illegal dairy products on Facebook Marketplace and conducted a census of street markets and a random sample of formal markets. Although prohibited in Brazil, consumers can easily find informal dairy products on internet and retail sale. In addition, 7% of the food products hold a false label to mimic food inspection. The e-commerce was linked with regions with higher access to technology and Human Development Index (HDI). We believe that our approach shows a step forward in the public health interventions and could be replicated stimulating debates about policies required to improve the public health surveillance. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To discuss studies conducted in Brazil relating to PrEP, from 2012 to 2022, based on a narrative review. METHODOLOGY: The databases of the Virtual Health Library/PAHO, portals from Scielo, Scopus, and PubMed, and the descriptors in English and Portuguese 'Pre-exposure to HIV' and 'Brazil' were used, as well as a list of planned/in-progress demonstrative studies. Inclusion criteria consists of articles with fieldwork in Brazil coupled with PrEP in the Brazilian scenario; and articles in English or Portuguese. Articles in which PrEP was not the central theme and the participating Brazilian population did not reside in Brazil were excluded. RESULTS: 107 papers have been reviewed, 80 articles met the inclusion criteria. The majority participating population was men who have sex with men. 61 studies preceded the implementation of PrEP in Brazil. Studies carried out after implementation (n = 19) deal primarily with the impact of the COVID-19 pandemic. CONCLUSIONS: There was an incipient number of studies on the injectable form of PrEP. Fewer studies included segments with greater difficulties in access, use, and adherence. Despite the issues that circumscribe this prevention technology, literature is consensual on the importance of Brazilian leadership for implementing PrEP. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas. [ABSTRACT FROM AUTHOR]

Civil society engagement around health care and population health improvement is an important driver towards Health for All. Research can improve the effectiveness of health activism by examining the resources, structures and strategies of civil society engagement. However, research to support such engagement faces epistemological and methodological challenges which call for specific research strategies. A four year multi-country study was undertaken by the People's Health Movement, a global network working for health for all. The research took place in six countries (Brazil, Colombia, DR Congo, India, Italy, South Africa) and globally, and was directed to understanding five domains of civil society engagement: movement building; campaigning and advocacy; capacity building; knowledge generation, access and use; and engaging with governance. The research plan and methods of data collection and analysis were tailored to address the objective of improving activist practice, while negotiating research challenges identified during the design phase. Results include insights into the practice of civil society engagement in relation to the five domains of activist practice, as well as experience gained in managing six methodological challenges which we describe as: making meaning, aligning research and action, managing power relations, valuing experiential knowledges, chaos and contingency, challenging preconceptions. Researching activism can produce useful insights into practice as well as support continuous improvement in the effectiveness of such activism. However, there are significant methodological challenges that can be addressed through appropriate strategies. More research, building on the approach described in this paper, can contribute to more effective civil society activism for health. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to discover whether experiences of sexual violence suffered by a sample of adolescents and young-adults at a Brazilian public health had been disclosed or detected, why or why not, and what happened after disclosure or detection. Seventy-one (8.3%) students were victims of sexual violence, and 52 (73.2%) were females. The researchers interviewed 22 participants to obtain an oral history of these abuse experiences. The 22 interviewees had experienced 29 episodes of violence. Acquaintances had perpetrated 26 of these attacks, and of these 26 only four (15.4%) occurrences were never disclosed. Twenty-two experiences were disclosed or detected, of which four (18.2%) were promptly revealed (days after the event), resulting in a discontinuation of the violence. Unfortunately, molestation continued without intervention in nine (41.0%) of the revealed situations, despite disclosure or detection. The authors find that children or adolescents disclosing their experiences of sexual violence cannot end the attacks. This study identifies an urgent need to educate society about how to respond appropriately to revelations of sexual violence. Children or adolescents must be oriented to disclose their abuse and seek help from as many people as necessary until they are heard, believed and the violence is ended. [ABSTRACT FROM AUTHOR]

This article explores stakeholders' perceptions of the challenges for developing a One Health agenda to tackle antimicrobial resistance (AMR) in Brazil, including the development and implementation of the Brazilian National Action Plan (BR-NAP). The data originate from 27 interviews conducted with human, environmental, and animal health stakeholders, including academics, managers, and policymakers involved in developing the BR-NAP. Through thematic analysis, we identified three interconnected themes: governance, the health system, and technical and scientific challenges. The findings draw particular attention to failures in the agenda-setting process, revealed by interviewees strongly emphasising that AMR is not considered a policy priority in Brazil. The lack of political will and awareness of the clinical, social, and economic impacts of AMR are considered the main impediments to the agenda's progress. The joint work across disciplines and ministries must be reinforced through policymaker engagement and better environmental sector integration. The agenda must include sustainable governance structures less affected by political winds. Policies should be designed jointly with state and local governments to create strategies to engage communities and improve their translation into effective implementation. [ABSTRACT FROM AUTHOR]

In 2021, the COVID‐19 pandemic remained uncontrolled in Brazil, with more than 17.6 million cases diagnosed and more than a half a million deaths in total. It is known that an accurate risk perception by populations and a consequent adherence to preventive measures can increase the effectiveness of policies to contain the transmission of infectious diseases. The objective of this study was to draw a panorama of COVID‐19 in São Paulo State and investigate the population's risk perception about the new coronavirus, attitudes regarding preventive measures and vaccine confidence through an open web survey. A total of 1111 individuals participated (71.6% females). Of those, 15% declared themselves unemployed, almost 6% lost their jobs during the pandemic, and more than 30% suffered a decrease in their monthly income. As for the COVID‐19, almost 32% of the participants were tested sometime in 2020, and 11.3% reported a confirmed diagnosis for a level of hospitalisation of 5%. As for the risk perception, it was observed that situations with crowds of people were more frequently considered as of high risk and cause of greater concern with contamination of family members than with themselves. Almost 23% of the participants questioned whether they would take the vaccine when available and do not know if the COVID‐19 vaccine will be safe for the population. Almost 70% disagreed with the statement that the actions of the country's health authorities are effective in combating COVID‐19. Considering the Cramer's V coefficient, these variables were not associated with gender or educational level. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the development and analyze the content validity of an educational material with intervention strategies to promote a healthy consumer food environment according to the Dietary Guidelines for the Brazilian Population. Subject and methods: The recommendations of the Brazilian Dietary Guideline were used to develop the educational material. The content validity was performed by a panel of experts who assessed the aspects of clarity, pertinence, relevance, and representativeness for each of the 31 educational strategies included in the material. The content validity index (CVI > = 0.90) was used for the content validity analysis through item level-CVI and scale-CVI. The reliability was accessed by the percentage of the interrater agreement (IRA > 0.80 was considered great) to clarity and representativeness aspects. Results: The educational material was named Healthy Food Trade: A guide to action for public managers and retailers to promote a healthy food environment in the community (HFT). Ten experts participated in the content validation process; 20% worked in the public supply sector, 70% had academic experience in food retail environments, and 10% worked on communication strategies. The percentage of IRA was 0.93 to clarity and 0.94 to representativeness to the overall material. The S-CVI was 0.93. After the modifications, the final version presents intervention strategies that can be carried out in food retailers to make them healthier. Conclusion: The HFT Guide had intervention strategies validated by a panel of experts that could support public managers and food retailers in promoting a healthier consumer food environment. [ABSTRACT FROM AUTHOR]

This study aimed to understand how the internal strategies of British American Tobacco (BAT) selling 'light' cigarettes to young people in Brazil may inform current global efforts to promote new tobacco and nicotine products. We reviewed industry documents in the Truth Tobacco Industry Documents (TTID) Library. In 1976, Philip Morris and BAT introduced 'low tar' or 'light' cigarettes in Brazil to maintain and attract new young smokers. At the time it was a novel tobacco product that implied lower health risks. While an initial push for 'light' cigarettes in Brazil did not materialise in the 1970s, BAT launched a new 'light' cigarette, Free, in 1984, with a marketing campaign consisting of symbols of personal freedom and choice to attract young people. In the mid-1990s, BAT used the success in Brazil to expand the lights segment throughout Latin America. BAT drove the lights segment through brand marketing and claims of a healthier alternative. As tobacco companies introduce and market new tobacco and nicotine products, mixing health and imagery messages, governments should recognise aggressive brand marketing messaging to attract new tobacco users and ensure that marketing regulations are enforced. [ABSTRACT FROM AUTHOR]

Few studies have investigated corporate political activity by unhealthy commodity industries in low- and middle-income countries, and the significance of social and political context has been largely neglected. This study aimed to explore the stalled development of marketing restriction policies in Brazil with an analysis of strategies used to undermine the Legal Framework for Early Childhood. Using a constructivist approach based on a typology of corporate political strategies, decision-making processes were assessed to understand interference by food companies in the Legal Framework, and how this was perceived by policy actors. Semi-structured interviews were conducted with public health advocates, academics and legislature officials. Three broad strategies that contributed to the stalling of marketing restrictions in the Legal Framework were identified: relational approaches to policy influence; collective participation in formal decision-making; and specific strategy choices (information and financial incentives). Key opportunities for policy influence through informal social networks in the 'backstage' of policy making are found to privilege commercial sector actors. Informal policy making may have a critical function in obstructing the development of health-focused regulation in Brazil. This highlights the need for a better understanding of non-codified and hidden corporate efforts to shape the policy environment. [ABSTRACT FROM AUTHOR]

In Brazil, any advertising strategies that take advantage of the child's judgment or induce consumers to make harmful health choices are considered abusive. However, the efficacy of restrictions on their use on television (TV) food advertising remains poorly understood. This study analysed the extent and nature of abusive techniques according to national regulations and patterns in their use in food-related ads. Cross-sectional studyrecorded the programming of the three most popular TV channels (6 am–12 am), during eight non-consecutive days, in April 2018. Data collection was based on the INFORMAS protocol and two national regulations. Descriptive analyses were used to describe the types of food ads and abusive techniques used in ultra-processed products (UPP) ads. Principal component analysis was applied to identify patterns of abusive marketing techniques and to relate them to specific food groups. More than 90% of food ads included at least one UPP. Overall, 10.1% of UPP ads targeted children and 57.7% used some kind of abusive technique directed to children and adolescents. Most ads contained messages inducing harmful health choices did not present adequate and clear information about the product and contained more than one type of abusive technique. Four out of five patterns in the use of abusive techniques in UPP ads were specifically directed to children, and fast-food meals were associated with three out of five patterns. The high abusiveness of food advertising in UPP ads should be considered a public health concern given their impact on children's food choices and health. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The growth of clinical pharmacy services (CPS) has positively impacted clinical, economic, and humanistic health outcomes. However, detailed studies on the process of implementing CPS in healthcare systems are incipient. Thus, the present study aimed to evaluate the CPS implementation in certain public health units in a metropolis in northeast Brazil. Methods: A quasi‐experimental before‐and‐after study was carried out in Recife City, from July 2015 to March 2016. The study was carried out using the Methodology of Problematization with Maguerez Arc and was divided into: initial evaluation (before), planning, interventions, and preliminary evaluation (after). The participants were pharmacists, patients, health professionals, and local health managers. Descriptive statistics were used to report data. The statistical significance of the comparison between variables was evaluated using the Wilcoxon test (95% CI; P ≤.05). Results: Initial evaluation: Identified incipient CPS, a lack of structure and work process of pharmacists. Planning: Sixteen brainstorming meetings were held with the different actors resulting in a strategic plan. Intervention: Twenty‐two political‐administrative meetings were held with managers and health teams and 768 hours of theoretical and practical training with mentoring for pharmacists. Preliminary evaluation: Structure indicators presented a statistically significant difference, differently from the process indicators. Pharmacists attended 842 patients and performed 1465 pharmaceutical consultations in 6 months. Regarding the outcome indicators, it was possible to identify changes in the clinical status of the most prevalent diseases among those patients who attended three pharmaceutical consultations. Conclusions: It was possible to evaluate the CPS implementation in certain public health units in a metropolis in Brazil, through the Methodology of Problematization with Maguerez Arc. This methodology may be part of models for future implementations of CPS in health systems. [ABSTRACT FROM AUTHOR]

Background To evaluate the early age of onset (AOO) of alcohol consumption and its association with sociodemographic, nutritional and lifestyle characteristics. Methods A national cross-sectional multi-centered study assessed 12–17-year old adolescents from 1247 public and private schools in 124 Brazilian municipalities with more than 100 000 habitants. Our variable of interest was the AOO of alcohol consumption. Covariates comprised sociodemographic status, lifestyle habits and nutritional parameters. We used adapted survival models to investigate the association between covariates and the AOO of alcohol consumption. Results From a sample of 67 672 adolescents, 50% were females. The mean AOO of alcohol consumption was 12.9 years. Male adolescents had a lower mean age of alcohol experimentation when compared to females in Northeast and South regions. The difference between private and public school for AOO was observed only for the Northeast Region (12.6 versus 13.1, respectively). Adolescents who reported smoking or mental health problems or from the Southern Region presented earlier alcohol use. Physical activity and overweight were positively associated with earlier use of alcohol. Conclusions There is no homogeneity in the AOO of alcohol consumption among adolescents, which should be considered when formulating public policies and government campaigns directed toward reducing alcohol consumption. [ABSTRACT FROM AUTHOR]

Background: Although global efforts have resulted in improvements in health and well-being across the world, economic downturns can rapidly undermine achievements in this area. Methods: Using Gallup World Poll data (n = 7,084) this study assessed the changes in health status and well-being before (2009–2013) and during (2015–2017) the current financial and political crisis in Brazil and their association with the Social Determinants of Health Inequalities. Health and well-being were measured by the Personal Life Index and the Life Evaluation Index. Descriptive analysis and logistic regression models were conducted. Results: A significant deterioration of well-being was found during the crisis, with a 29% decline (63–44%) in the prevalence of respondents classified as 'thriving' in life. Food security, age and social support were the best predictors of health status and well-being, mitigating the association of health and well-being with income and unemployment. Education and community environment also showed strong association with well-being, and satisfaction with healthcare system played an important role in health status. Conclusions: In order to protect health and well-being during such crisis, policies should pay particular attention on enhancing the access to food, healthcare system, educational system, community environment (quality of air, water and infrastructure) and fostering social support. [ABSTRACT FROM AUTHOR]

Background: Although there are public policies for eradicating congenital syphilis, they do not seem to be a routine in most health services. The objective of this study was to evaluate the management of sexual partners of pregnant women with syphilis in primary health care in northeastern Brazil.Methods: This is a qualitative assessment carried out from February to October 2014 in the city of Fortaleza, Ceará, northeastern region of Brazil, through the observation of six primary health care centers and interviews with 21 professionals, six coordinators, nine women diagnosed with syphilis during antenatal care and four sexual partners. The data were submitted to thematic content analysis.Results: Important flaws were identified at the primary health centers studied regarding the management of syphilis during pregnancy. Accessing testing and treatment is difficult, and there are no standardized strategies to notify the partner. The responsibility for notifying them is transferred to the women, and counseling does not offer proper guidance nor sufficient emotional support to help them.Conclusion: The management of pregnant women and their sexual partners in our region does not comply with global recommendations. Professional qualification, sensitization, and standardization of health professionals' conduct are necessary. Offering support to health professionals on their clinical practices by means of a supervision process may contribute to the adoption of the recommended guidelines and to the promotion of care based on privacy, respect, confidentiality of information, and awareness of the problems faced by women as a result of syphilis diagnosis. [ABSTRACT FROM AUTHOR]

Brazil’s response to the HIV/AIDS epidemic was characterised by an innovative alliance of governmental and non-governmental actors inspired by a strong progressive tradition in public health. Brazil eventually moved to decentralise HIV/AIDS programmes to its states and cities, a policy endorsed and supported financially by the World Bank as consistent with the mix of public and private elements central to the country’s HIV/AIDS strategy. However, decentralisation has not provided the results anticipated. Through interviews with key informants, government officials and patient advocates as well as observation of treatment sites, we outline how the shift of administration and resources to state and municipal bodies operated in practice. The Bank promoted decentralisation as an uncontroversial technical matter, and its programmatic guidelines implied that the nonprofit sector would be strengthened by it. However, instead of bringing HIV/AIDS policy closer to the grassroots, decentralisation has undermined the country’s early work and opened the door to a rejuvenated epidemic by empowering unsympathetic local elites, marginalising the human rights focus, and removing federal oversight. Its experience holds crucial lessons for developing countries facing similar conditions. [ABSTRACT FROM AUTHOR]

Aim: To compare the impact of three different approaches to primary care mental health on the prevalence of mental disorders. Background: Millions of people suffer from mental disorders. As entry point into the health service, primary healthcare plays an important role in providing mental health prevention and treatment. Methods: Random sample of households in three different areas of the city of Ribeirão Preto (state of São Paulo, Brazil) were selected, and 20 trained medical students conducted interviews using a mental health screening instrument, the Mini-Screening of Mental Disorders, and a socio-demographic datasheet. Primary care mental health was provided in each area through a specific approach. The influence of the area of residence and the socio-demographic variables on the prevalence of mental disorder was explored and analyzed by univariate binary logistic regression and then by a multiple logistic regression model. Findings: A total of 1545 subjects were interviewed. Comparison between the three areas showed a significantly higher number of people with mental disorders in the area covered by the primary care team that did not have physicians with specific primary care mental health training, even when this association was adjusted for the influence of age, education, and socio-economic status. Our results suggest that residing in areas with family physicians with mental health training is associated with a lower prevalence of mental disorders. [ABSTRACT FROM AUTHOR]

Aim: To describe the sociodemographic, clinical, and behavioral characteristics of women who seek treatment for smoking cessation and to investigate the relationship between these characteristics and the nicotine dependence level and treatment duration. Methods: Data were collected using questionnaires that were administered to 655 women. Regression of generalized linear model and regression logistic ordinal were used to assess the correlation between the variables being studied. Findings: The average age of women in the study was 49 years. Among them were those who were employed (54.9%), who had high levels of nicotine dependence (78.5%), and whose primary reason for seeking treatment was related to health concerns (62%). The treatment duration was positively correlated with depression (p = 0.04), hypertension (p < 0.01), and with seeking treatment due to health concerns (p = 0.02). Conclusions: Our study indicates that adherence in women can be increased by providing treatment that is accessible to the lower class. It also indicates the need to reconceptualize the way therapeutic group sessions are conducted. We hypothesize that the reason for the high dropout rate after 6 months of treatment could be related to the way that group sessions operate. [ABSTRACT FROM AUTHOR]

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Background: Visceral leishmaniasis (VL) is a neglected tropical disease of public health relevance in Brazil. To prioritize disease control measures, the Secretaria de Vigilância em Saúde of Brazil's Ministry of Health (SVS/MH) uses retrospective human case counts from VL surveillance data to inform a municipality-based risk classification. In this study, we compared the underlying VL risk, using a spatiotemporal explicit Bayesian hierarchical model (BHM), with the risk classification currently in use by the Brazil's Ministry of Health. We aim to assess how well the current risk classes capture the underlying VL risk as modelled by the BHM.Methods: Annual counts of human VL cases and the population at risk for all Brazil's 5564 municipalities between 2004 and 2014 were used to fit a relative risk BHM. We then computed the predicted counts and exceedence risk for each municipality and classified them into four categories to allow comparison with the four risk categories by the SVS/MH.Results: Municipalities identified as high-risk by the model partially agreed with the current risk classification by the SVS/MH. Our results suggest that counts of VL cases may suffice as general indicators of the underlying risk, but can underestimate risks, especially in areas with intense transmission.Conclusion: According to our BHM the SVS/MH risk classification underestimated the risk in several municipalities with moderate to intense VL transmission. Newly identified high-risk areas should be further evaluated to identify potential risk factors and assess the needs for additional surveillance and mitigation efforts. [ABSTRACT FROM AUTHOR]