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To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID-19 pandemic.Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross-sectional analysis, with application of a questionnaire.Six Brazilian Reference Centres on gestational trophoblastic disease.2662 patients with MP/postmolar GTN treated from March-December/2015-2020 were retrospectively evaluated and 528 of these patients answered a questionnaire.Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross-sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID-19 pandemic compared with previous years.The incidence of MP/postmolar GTN.Compared with the last 5 pre-pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID-19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90-3.29, P 0.001), have a pre-evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38-2.28, P 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01-3.43, P = 0.047) when compared with 2015-2019.Although the incidence of MP/postmolar GTN remained stable during the COVID-19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN.

We conducted a cross-sectional study to assess how the top 3 highest circulation newspapers from 25 countries are comparing and presenting COVID-19 epidemiological data to their readers. Of 75 newspapers evaluated, 51(68%) presented at their websites at least one comparison of cases and/or deaths between regions of their country and/or between countries. Quality assessment of the comparisons showed that only a minority of newspapers adjusted the data for population size in case comparisons between regions (37.2%) and between countries (25.6%), and the same was true for death comparisons between regions (27.3%) and between countries (27%). Of those making comparisons, only 13.7% explained the difference in the interpretation of cases and deaths. Of 17 that presented a logarithmic curve, only 29.4% explained its meaning. Although the press plays a key role in conveying correct medical information to the general public, we identified inconsistencies in the reporting of COVID-19 epidemiological data. Supplementary Information The online version contains supplementary material available at 10.1057/s41271-021-00298-7.

Background: To describe success and failure (S&F) after lumbar spine surgery in terms that are preciseand that are equally understandable across the entire health ecosystem. Methods: Back and leg pain (NPRS scale) and disability (Oswestry Disability Index –ODI) of patients operated were prospectively recorded before and 6 to 12 months after the procedure. Satisfaction was recorded in the postoperative period. Initially, patients were classified as Satisfied or Unsatisfied.Optimal cutoff values for disability and pain were estimated with ROC curves. Satisfied and Unsatisfied groups were subdivided into four categories based on a combination of satisfaction, disability and pain: Success, Incomplete success, Incomplete failure and Failure. These categories were translated into operational definitions with simple verbal terms, according to previously described norms of numeric-to-verbal equivalence. Results: 486 consecutive patients were recruited from May 2019 to February 2021, with a drop-out rate of 16.4%; Preoperative PROMs mean values were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 (+ 2.9) points; 19.3% were classified as Unsatisfied and cutoff values for disability (ODI=28; AUC 0.79) and pain (NPRS=6; AUC 0.79) were defined. Satisfied and Unsatisfied groups were further subdivided based on concordance or non-concordance with the discrimination cutoff values: Success (59.6%) - satisfied with pain and disability levels concordant (NPRS ≤5, AND ODI ≤27); Incomplete success (20.4%) - satisfied with pain and disability levels non-concordant (NPRS ≥6 AND/OR ODI ≥28); Incomplete failure (7.1%) – unsatisfied with pain and disability levels non-concordant (NPRS ≤5 AND/OR ODI ≤27); and Failure (12.4%) - unsatisfied with pain and disability levels concordant (NPRS ≥6 AND ODI ≥28). After that, groups were translated to: Success - patients are satisfied and present no or only mild to tolerable pain, and no or borderline disability; Incomplete Success – patients are satisfied despite levels of pain and/or disability worse than the ideal for success; Incomplete Failure – patients are not satisfied despite levels of pain and/or disability better than expected for failure; Failure – patients are unsatisfied and present moderate to severe pain and disability.Conclusion: It is possible to report S&F after surgery for degenerative disc disease of the lumbar spine with precise and meaningful operational definitions focused on the experience of the patient.

Background Syphilis has recently resurfaced as a significant public health problem. Since the 2000s, isolated syphilis outbreaks have increasingly occurred in North America, Europe, and Australia; in Brazil, there have been progressive increases in both congenital and acquired syphilis. There are several possible explanations, such as misdiagnosis of acquired syphilis, which could increase the number of untreated transmitters in the population; failure to initiate or complete treatment; and nontreatment of sexual partners (leading to reinfection). Mobile technologies have been successfully used to promote behavior changes and can positively impact treatment and follow-up adherence in patients with infectious diseases. The purpose of this clinical trial is to evaluate treatment and monitoring methods in patients with syphilis, including follow-up by telephone, via a game in a smartphone app, and at public health centers. Methods The SIM study is a single-center, randomized controlled trial with a 12-month follow-up period. The aim is to identify the most effective method of follow-up regarding patient compliance with treatment. The tests will be performed in a mobile unit in easily accessible locations. The goal is to perform 10,000 rapid tests for syphilis. Patients with a confirmed diagnosis according to VDRL tests will be randomized to one of three arms: telephone, smartphone game, or conventional in-person follow-up. All analyses will follow the intention-to-treat principle. Conclusion If we find differences in effectiveness, a major change in the conventional approach for this patient population may be needed, potentially affecting current Brazilian health policy strategies. Trial registration NTC04753125. Version 1 of protocol 1/09/2020.

Human T-lymphotropic virus type 1 (HTLV-1) infection may cause serious disease, while pathogenicity of HTLV-2 is less certain. There are no screening or surveillance programs for HTLV-1/-2 infection in Brazil. By performing this systematic review, we aimed to estimate the prevalence of HTLV-1/-2 infections in pregnant women in Brazil. This review included cohort and cross-sectional studies that assessed the presence of either HTLV-1/-2 infection in pregnant women in Brazil. We searched BVS/LILACS, Cochrane Library/CENTRAL, EMBASE, PubMed/MEDLINE, Scopus, Web of Science and gray literature from inception to August 2020. We identified 246 records in total. Twenty-six of those were included in the qualitative synthesis, while 17 of them were included in the meta-analysis. The prevalence of HTLV-1 in Brazilian pregnant women, as diagnosed by a positive screening test and a subsequent positive confirmatory test, was 0.32% (95% CI 0.19–1.54), while of HTLV-2 was 0.04% (95% CI 0.02–0.08). Subgroup analysis by region showed the highest prevalence in the Northeast region (0.60%; 95% CI 0.37–0.97) for HTLV-1 and in the South region (0.16%; 95% CI 0.02–1.10) for HTLV-2. The prevalence of HTLV-1 is much higher than HTLV-2 infection in pregnant Brazilian women with important differences between regions. The prevalence of both HTLV-1/-2 are higher in the Northeast compared to Center-West region.

This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants’ first months of life on ultraprocessed food (UPF) consumption at 4–7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child’s age of 4–7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final analysis included 194 children, with mean age of 6·1 (sd 0·5) years. Mean dietary contribution of UPF was 38 % in the intervention group and 42·7 % in the control group, from total daily intakes. Results adjusted for BF duration, propensity score, income and total energy content demonstrated that the intervention reduced the risk of high consumption of UPF by 35 % (relative risk 0·65, 95 % CI 0·43, 0·98). BF duration was not associated with UPF consumption. The intervention was effective in reducing the risk of high UPF consumption at the age of 4–7 years.

The COVID-19 pandemic exerted major impacts on the entire population, but some groups such as sexual and gender minorities have been disproportionately affected. Therefore, we aim at assessing the impacts on the social life and mental health of Brazilian sexual and gender minorities during the COVID-19 pandemic. This is a cross-sectional nationwide study conducted between September and October 2020. Participants were recruited through convenience sampling (snowball), being invited to answer an online questionnaire. The participants were invited to participate by social networks and websites directed to the LGBT+ population over 18 years old. This study included 659 sexual and gender minorities from all five Brazilian regions. The main impacts caused by the COVID-19 pandemic reported by the participants were anxiety (73.5%), stress (71%), loneliness (59.6%), sleep pattern changes (69%) and income reduction (36.9%). Participants with low educational level presented higher income reduction than participants with high educational level (0.61, 95% CI 0.48-0.77) and high income (0.46, 95% CI 0.34-0.62). Low income (1.14, 95% CI 1.03-1.26) and being lesbian (1.13, 95% CI 1.01-1.26) are related to changes in sleep patterns. Totally isolated participants presented high stress rates. The LGBT+ population presented high economic and emotional impacts during COVID-19 pandemic. The results of this study highlight the need for heath public policies directed for sexual and gender minorities.

Introduction: Syphilis is a major public health problem. Its incidence has increased in Brazil, particularly in the Southern Region. New tools are available, and immediate action is necessary. Objective: To describe the pilot study of an investigation aimed to assess the prevalence of syphilis, hepatitis B and C, and HIV and evaluate three strategies for adherence to syphilis treatment. Methods: A spontaneous sample of participants was evaluated with a structured questionnaire and underwent rapid tests for syphilis, HIV, and hepatitis B and C after signing an informed consent form (ICF). Rapid tests reagent for syphilis were confirmed by quantitative venereal disease research laboratory (VDRL) and Treponema pallidum hemagglutination assay (TPHA). Participants with confirmation of syphilis were randomized into three groups for follow-up: telephone calls, SIM app, and usual care at the health unit. Results: During a two-day pilot, 68 participants were included. Fourteen (20.6%) had tests reagent for syphilis, 1 (1.5%) for hepatitis B, 3 (4.4%) for hepatitis C, and 1 (1.5%) for HIV. Eight (57.1%) of the initial 14 individuals with rapid tests reagent for syphilis agreed to participate in the study. Out of the 8 rapid tests for syphilis, 2 (25%) were confirmed as active syphilis (>1/8). Conclusion: The prevalence of active syphilis estimated in this population was 3.5%. The demand for tests was high. The COVID-19 epidemic had a negative impact on the development of the study, which is ready for implementation. Discussions on the role of such a testing unit and the coverage of the research project in a context that requires increasing COVID-19-focused testing are fundamental for the future development of the project.