Nevin Manimala

Rev Assoc Med Bras (1992). 2026 May 1;72(1):e20250309. doi: 10.1590/1806-9282.20250309. eCollection 2026.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the change of Doppler measurements among late-onset intrauterine growth restriction and appropriate for gestational age fetuses and to estimate the neonatal adverse outcome in late-onset intrauterine growth restriction during longitudinal Doppler assessments.

METHODS: This study was conducted at a tertiary referral hospital with 50 appropriate for gestational age and 50 late-onset intrauterine growth restriction fetuses. Late-onset intrauterine growth restriction was defined as the detection and diagnosis of growth restriction from the 32nd week of gestation. Doppler assessments were performed longitudinally for the uterine arteries, umbilical artery, and middle cerebral artery from 32 weeks of gestation until delivery. The cerebroplacental ratio was calculated for each analysis. Neonatal outcomes were recorded after delivery. Statistical analysis was performed, and a p<0.05 was considered statistically significant.

RESULTS: Compared with appropriate for gestational age, umbilical artery pulsatility index and adverse neonatal outcomes were higher in late-onset intrauterine growth restriction (p<0.001, p<0.001), while term middle cerebral artery pulsatility index and term cerebroplacental ratio were lower (p=0.013, p<0.001). According to adverse neonatal outcomes in late-onset intrauterine growth restriction, term uterine arteries pulsatility index and pre-term umbilical artery pulsatility index were higher (p=0.002, p=0.013); middle cerebral artery pulsatility index and term cerebroplacental ratio were lower but without statistical significance.

CONCLUSION: Umbilical artery pulsatility index, term middle cerebral artery pulsatility index, and cerebroplacental ratio are significantly different between appropriate for gestational age and late-onset intrauterine growth restriction fetuses; however, only increased uterine arteries pulsatility index on term Doppler scans may be useful in detecting adverse neonatal outcomes in late-onset intrauterine growth restriction.

PMID:42090668 | DOI:10.1590/1806-9282.20250309

Rev Saude Publica. 2026 May 1;60(suppl 1):e9s. doi: 10.11606/s1518-8787.2026060006945. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the monitoring of an intervention for expanding testing, isolation, quarantine, and telemonitoring of Covid-19 (TQT-Covid-Strategy) in an administrative health region of a municipality in Northeastern Brazil.

METHODS: This is an evaluative study, whose object of analysis were data produced in the monitoring of a health intervention (TQT-Covid-Strategy), for six months, in 17 health units, namely 12 Family Health Units and five Health Centers. Monitoring matrices created through field reports, workshops with professionals and managers, and permanent education activities were analyzed. Monitoring took place in the three components of the TQT-Covid-Strategy intervention: expansion of accessibility to testing, monitoring of cases and surveillance strategies, and digital platform. The actions in each component were considered adequate (A), partially adequate (P), and inadequate (I) in relation to the activities determined in the action plan and in the protocol of the TQT-Covid-Strategy.

RESULTS: The component of the expansion of accessibility to testing was considered adequate, while the monitoring of cases and surveillance strategies presented partially adequate or inadequate results in many units. As for the digital platform component, there was predominantly adequate performance in relation to registration and access to test results and case reporting. However, the use of other surveillance-related resources, such as contact tracing, was inadequate.

CONCLUSIONS: Boosting the institutionalization of monitoring can be an important instrument for the implementation and improvement of health interventions. The regular presence of enablers and a widely disseminated protocol, in addition to community health agents, enhanced the intervention. However, partially adequate or inadequate results reinforced the importance of qualification of the work process in primary health care regarding surveillance actions and the use of information and communication technologies.

PMID:42090665 | DOI:10.11606/s1518-8787.2026060006945

Rev Saude Publica. 2026 May 1;60(suppl 1):e8s. doi: 10.11606/s1518-8787.2026060006626. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the demand creation strategies for Covid-19 testing and to describe surveillance indicators for testing, quarantine, contact tracing, and telemonitoring in primary health care services.

METHODS: This cross-sectional study used data from the Covid-19 Testing, Isolation, Quarantine, and Telemonitoring (TQT Covid-19) study, conducted from July 2022 to July 2023. Primary healthcare service units in Rio de Janeiro and Salvador were selected to apply an intervention to develop demand creation strategies for testing uptake. Demand creation strategies were grouped into online strategies, traditional means, primary health care service units, community, and active search. Logistic regression was performed to determine the characteristics of the population reached by each strategy. The following Covid-19 surveillance indicators were estimated for testing and prevention (testing rate, positivity rate, monthly incidence, and full vaccination rate); for telemonitoring (monitoring rate, severity, referrals, and mortality); for quarantine (quarantine conditions); and for contact tracing (proportion of contacts traced and refusals of testing).

RESULTS: The intervention reached 12,401 individuals, and 11,843 tests were performed. Demand creation strategies that reached more individuals for testing were primary health care service units (37.0%) and active search (25.9%). The positivity rate during the study period was 27.2% in Salvador and 11.5% in Rio de Janeiro. A total of 14.1% of cases were monitored, and most were asymptomatic (42.5%) or mild (52.3%). No deaths were reported among monitored cases. The proportion of fully vaccinated individuals was 91.8%. Contact tracing identified 25.1% of reported contacts, and 41.5% declined testing.

CONCLUSIONS: The intervention facilitated expanded testing. Primary health care service units and active search were the strategies that reached more individuals for testing. Telemonitoring and contact tracing were the most challenging components to implement in primary health care services units and, given their importance, should be strengthened for future pandemics. These findings underscore the relevance of surveillance for assessing public health measures, identifying gaps, and supporting data-driven decision-making to improve epidemic management.

PMID:42090664 | DOI:10.11606/s1518-8787.2026060006626

Rev Saude Publica. 2026 May 1;60(suppl 1):e6s. doi: 10.11606/s1518-8787.2026060006674. eCollection 2026.

ABSTRACT

OBJECTIVE: To investigate factors associated with self-reported capacity to comply with home isolation after Covid-19 diagnosis in vulnerable communities in two Brazilian cities.

METHODS: Cross-sectional study, with data from a study on the implementation of an intervention based on strategies of testing, isolation, quarantine, and telemonitoring (TQT) of Covid-19 in Primary Health Care in vulnerable neighborhoods (TQT Covid-19 Study). Demographic, socioeconomic, and behavioral data were used to perform descriptive and logistic regression analyses, aiming to evaluate the factors associated with home isolation capacity.

RESULTS: The sample consisted of 324 participants, most of them women (72.5%) and who self-reported to be Black or mixed-race (85.2%). Regarding level of education, 20.1% had up to elementary school degree; 42% had high school degree; and 37.9% had higher education or graduate degree. The density of people per room was high in 57.1% of households. In the multivariate analysis, high household density (≥ 0.5 residents/room) was significantly associated with reduced isolation capacity (ORa = 0.41; 95%CI 0.20-0.82). Other sociodemographic and behavioral variables, including age, sex, race/skin color, level of education, history of Covid-19 infection, access to health services, and preventive behaviors, did not present a statistically significant association.

CONCLUSION: According to the study, housing conditions, especially high household density, can be a determinant for adherence to home isolation. Thus, innovative prevention strategies should combine educational and structural actions that consider the household context of vulnerable families.

PMID:42090662 | DOI:10.11606/s1518-8787.2026060006674

Rev Saude Publica. 2026 May 1;60(suppl 1):e4s. doi: 10.11606/s1518-8787.2026060006988. eCollection 2026.

ABSTRACT

OBJECTIVE: To explore factors associated with the use of chloroquine, hydroxychloroquine, and ivermectin for Covid-19 prevention in socioeconomically vulnerable populations in Brazil.

METHODS: A cross-sectional study was conducted using data from the project “Expansion of testing, quarantine, digital health, and telemonitoring strategies to tackle the Covid-19 pandemic in Brazil.” Participants were users of 19 primary healthcare units in Salvador (Bahia, BA) and Rio de Janeiro (Rio de Janeiro, RJ) from July 2022 to July 2023. Data were collected via a socioeconomic questionnaire and analyzed using logistic regression to assess factors associated with the use of chloroquine, hydroxychloroquine, or ivermectin for Covid-19 prevention. Multicollinearity was assessed using the generalized variance inflation factor (GVIF), with GVIF^(1/(2*df)) > 5 indicating potential collinearity. Sensitivity analyses were performed using the same backward selection procedure as the main model: excluding “sometimes” responses and stratifying analyses by city (Rio de Janeiro and Salvador).

RESULTS: Among 7,505 participants, 11.7% reported using chloroquine, hydroxychloroquine, or ivermectin for Covid-19 prevention. Use was more frequent among people who identified themselves as Brown (ORa = 1.38; 95%CI 1.10-1.75), aged 35-44 (ORa = 1.34; 95%CI 1.03-1.75) or 44-59 (ORa = 1.36; 95%CI 1.06-1.77), evangelical (ORa = 1.32; 95%CI 1.14-1.53), and with comorbidities (ORa = 1.25; 95%CI 1.07-1.47). Having up to two doses of Covid-19 vaccine (ORa = 1.30; 95%CI 1.06-1.59) and being unvaccinated while living with someone with comorbidities (ORa = 10.34; 95%CI 2.27-53.48) also increased the odds of use. GVIF values were low except for city (8.79), due to its interaction with income; the variable was retained for conceptual reasons. Sensitivity analyses yielded results consistent with the main model.

CONCLUSION: The use of ineffective medications for Covid-19 prevention was higher among specific demographic groups, reflecting inequalities in access to information and the influence of religious factors. Scientific communication and community engagement strategies remain essential to combat misinformation.

PMID:42090660 | DOI:10.11606/s1518-8787.2026060006988

Rev Saude Publica. 2026 May 1;60(suppl 1):e3s. doi: 10.11606/s1518-8787.2026060006406. eCollection 2026.

ABSTRACT

OBJECTIVE: To describe the prevalence of adoption of Covid-19 preventive behaviors and to evaluate associated factors among users of health units in Salvador and Rio de Janeiro.

METHODS: Cross-sectional study conducted between July 2022 and July 2023. Adoption of preventive behaviors was assessed based on eight behaviors, grouped into the following outcomes: social distancing; respiratory etiquette; mask use; hand hygiene; sociodemographic, housing, structural characteristics, and individual perceptions. All analyses were stratified by study site. Bivariate and multivariate analyses were performed using Poisson regression with robust variance.

RESULTS: A total of 5,476 participants from Salvador and 1,940 from Rio de Janeiro were evaluated. The most prevalent preventive behaviors were respiratory etiquette (82.7 and 84.3%) and hand hygiene (84.9 and 79.1%), respectively. In Salvador, age remained associated with all behaviors assessed. In Rio de Janeiro, adoption of preventive behaviors increased among those who received a Covid-19 vaccine booster. In both cities, individuals aged 40-59 years, ≥ 60 years, and those not employed showed higher adherence to social distancing. Respiratory etiquette was more prevalent among women, individuals with complete high school education, and those who received a Covid-19 booster. Mask use and hand hygiene were associated with female sex, older age, and vaccine booster in both locations. Mask use was also more frequent among those vaccinated against influenza, while hand hygiene was associated with higher education.

CONCLUSIONS: These findings reinforce the importance of public policies that promote maintenance of preventive behaviors and awareness of epidemic prevention, particularly among men, younger individuals, those with lower education, and those who do not receive recommended vaccines or booster doses.

PMID:42090659 | DOI:10.11606/s1518-8787.2026060006406

Rev Saude Publica. 2026 May 1;60(suppl 1):e10s. doi: 10.11606/s1518-8787.2026060006399. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify factors associated with the acceptability of Covid-19 self-testing among socioeconomically vulnerable populations.

METHODS: Cross-sectional study using data from the “TQT Covid-19” project, which involved users from 19 primary health care (PHC) units located in socioeconomically vulnerable areas in Salvador (BA) and Rio de Janeiro (RJ), Brazil. Data were collected between July 2022 and July 2023. Descriptive analysis of Covid-19 self-test acceptability was performed, and logistic regression models were used to estimate factors associated with acceptability, with respective 95% confidence intervals (95%CI).

RESULTS: Among 7,939 study participants, 45.8% (95%CI 44.75-46.95) reported willingness to use a Covid-19 self-test. In the analysis of associated factors, regarding sociodemographic profile, non-Black individuals (ORa = 1.17; 95%CI 1.02-1.34), cisgender men (ORa = 1.23; 95%CI 1.12-1.37), and participants with higher educational levels (ORa = 1.60; 95%CI 1.43-1.79) were more likely to accept the self-test. Those with prior knowledge of the self-test (ORa = 2.33; 95%CI 2.11-2.58) and those previously diagnosed with Covid-19 (ORa = 1.17; 95%CI 1.05-1.28) also reported higher acceptance.

CONCLUSIONS: Provision of Covid-19 self-testing should be considered as a complement to testing within the public health system, especially due to its acceptance among vulnerable populations and the difficulties in accessing testing in many Brazilian regions. During periods of increased Covid-19 incidence, self-testing may serve as an important strategy for mass case detection, provided that access and knowledge are expanded so communities can play an active role in SARS-CoV-2 epidemiological surveillance.

PMID:42090656 | DOI:10.11606/s1518-8787.2026060006399

Cien Saude Colet. 2026 Mar;31(3):e13322024. doi: 10.1590/1413-81232026313.13322024.

ABSTRACT

More than one billion people are affected by a mental disorder according to the World Health Organization (WHO). In this context, information coverage of mental health is one of the great challenges for the media in a scenario marked by misinformation and digital noise. This work, from a transversal descriptive methodological approach, has analysed the news related to mental health in the main digital media of 20 Latin American countries. The study identifies that depression, anxiety, stress, suicide, substances and addictions, and neurocognitive disorders are the disorders with the greatest presence in news coverage. Furthermore, the work detects a moderate relationship between the variable’s ‘disorder’ and ‘relationship with violence’. On the other hand, only 25% of the information analysed raised recovery processes as a significant topic in the writing. The work also highlights that messages with interviews with experts or citations to medical studies contribute to more positive approaches in mental health coverage.

PMID:42090653 | DOI:10.1590/1413-81232026313.13322024

J Sex Res. 2026 May 6:1-11. doi: 10.1080/00224499.2026.2664807. Online ahead of print.

ABSTRACT

This study assessed the effects of condom types and brands on use in a free condom distribution intervention in hostales (love hotels). New policies are needed to overcome the low levels of contraceptive use in Perú. Hostales could serve as a distribution point in a condom availability program. The last-minute decision of condom use might be affected by the type and brand provided. Previous studies used self-reported measures of use; this methodology is unreliable. New methods are needed. A hostal was used for a field experiment. Its rooms were divided into seven treatments by combining different condom brands (Durex, Piel, Generic/State-provided) and types (Extra-thin, Extra-safe, Textured) and a Control group. Clients were randomly assigned to a room with one free condom or to the control group (no condom provided). Instead of relying on self-reports, I searched the recently vacated room for used condoms. 423 couples were studied. Using Barnard’s Exact Test, statistically significant differences in condom use were found between the control group (23%) and Piel Extra-thin (40%), Piel Extra-safe (41%), Durex Extra-safe (37%), and Durex Textured (34%). No effect from Generic/State-provided condoms (29%) or Durex Extra-thin (25%) was identified. Providing condoms from commercial, well-known brands significantly increased condom use; providing generic condoms did not. No effect from condom type was found; the lack of effect from Durex Extra-thin appears to stem from couples not perceiving the free condom. Additional research is needed.

PMID:42090194 | DOI:10.1080/00224499.2026.2664807

JAMA Surg. 2026 May 6. doi: 10.1001/jamasurg.2026.1259. Online ahead of print.

ABSTRACT

IMPORTANCE: Hospital accreditation programs aim to improve quality of care and patient outcomes but often require substantial institutional investment in staffing, infrastructure, and regulatory compliance. Despite these costs, the broader institutional impact of accreditation, particularly on patient volumes and care patterns, are poorly understood.

OBJECTIVE: To evaluate whether National Accreditation Program for Rectal Cancer (NAPRC) accreditation is associated with changes in rectal cancer patient volume, stage-specific procedural volumes, and care fragmentation.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a quasi-experimental difference-in-differences design. A total of 316 US Commission on Cancer-accredited (COC) hospitals, including 80 that received NAPRC-accreditation and 236 matched nonaccredited centers. Participants included adult patients diagnosed with primary rectal adenocarcinoma between 2010 and 2022 from the National Cancer Database. These data were analyzed from April 2025 to August 2025.

EXPOSURE: Hospital-level NAPRC accreditation, which requires adherence to multidisciplinary rectal cancer care standards, external audits, and specialized training.

MAIN OUTCOMES AND MEASURES: Annual hospital-level rectal cancer patient volume, stage-specific procedural volumes (stage I and stage II/III), and care fragmentation. Care fragmentation was defined as any case in which the diagnosis and first-course treatment (or decision not to treat) were not completed at the reporting COC-accredited facility. Outcomes were assessed using linear fixed-effects multivariable regression models.

RESULTS: Prior to matching, 1336 COC-accredited facilities were identified, including 80 that achieved NAPRC accreditation and 1256 that never attained accreditation. After propensity score matching, the final analytic sample included 316 hospitals: 80 NAPRC-accredited and 236 nonaccredited facilities. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per institution (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first postaccreditation year, with larger point estimates in subsequent years, though later estimates were not statistically significant. Accreditation was associated with an increase in stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), but not stage II/III surgical volume. No significant changes in care fragmentation were observed.

CONCLUSIONS AND RELEVANCE: In this study, NAPRC accreditation was associated with increased institutional rectal cancer patient volumes and higher procedural volume for early-stage disease without evidence of increased care fragmentation. These findings suggest that accreditation may promote institutional growth while preserving care continuity, offering a potential strategic incentive for hospitals to pursue NAPRC accreditation beyond quality improvement alone. Understanding these dynamics may inform hospital investment decisions, payer strategies, and policy efforts to support high-quality oncologic care delivery.

PMID:42090174 | DOI:10.1001/jamasurg.2026.1259