Nevin Manimala

Rev Assoc Med Bras (1992). 2026 May 1;72(2):e20251085. doi: 10.1590/1806-9282.20251085. eCollection 2026.

ABSTRACT

OBJECTIVE: The aim of this study was to determine the relationship between satisfaction with prenatal care and labor satisfaction and perception of labor.

METHODS: The cross-sectional and correlational study was conducted in the obstetrics ward of a public hospital. The population of the study consisted of women who gave birth in this hospital, while the sample consisted of 200 women. The data were collected face-to- face using the “Personal Information Form, Prenatal Care Satisfaction Scale, Birth Satisfaction Scale, and Mother’s Perception of Childbirth Scale.”

RESULTS: It was found that 56% of the mothers who participated in the study received prenatal care from a midwife/nurse, 60.3% received prenatal care at a Family Health Center, and the mean total scores of the mothers were 71.69±9.67, 73.66±5.48, and 102.56±5.26 on the Prenatal Care Satisfaction Scale, Mother’s Perception of Childbirth Scale, and Birth Satisfaction Scale, respectively. In addition, a positive and significant correlation was found between the mean scores of the women on the Prenatal Care Satisfaction Scale and the mean scores on the Mother’s Perception of Childbirth Scale and Birth Satisfaction Scale.

CONCLUSION: In the study, it was concluded that as women’s prenatal care satisfaction levels increased, their birth satisfaction and positive birth perception also increased.

PMID:42090683 | DOI:10.1590/1806-9282.20251085

Braz Dent J. 2026 May 1;37:e256778. doi: 10.1590/0103-644020266778. eCollection 2026.

ABSTRACT

This study was a parallel, double-blind, randomized clinical trial that aimed to evaluate the effect of silver diamine fluoride (SDF) on the prevention of dental caries in the first permanent molars of children. A total of 68 students aged 6 to 9 years from a public school in Diamantina, Brazil, participated. All children were classified as high caries risk and had at least one fully erupted molar without restorations or sealants. The participants were randomly divided in a 1:1 ratio to receive either SDF or resin sealant. The main outcome was the incidence of new carious lesions after 24 months. Secondary outcomes included plaque accumulation, gingival bleeding, oral health-related quality of life (OHRQoL, CPQ-8-10), caregiver satisfaction, and discomfort reported by the children using the Wong-Baker scale. Sociodemographic and health information were collected using questionnaires, dietary diaries, and clinical examinations in accordance with ICDAS-II criteria. Statistical analysis was performed using SPSS 22.0, employing Chi-square, Mann-Whitney, and Wilcoxon tests. Most families had low incomes, and mothers were usually responsible for the children’s daily care. After 2 years, the SDF group showed a significant reduction in plaque compared with baseline, whereas the sealant group showed a small, non-significant increase. No significant difference in gingival bleeding was observed between groups. Both interventions were well tolerated, although the dark staining of the SDF-treated teeth was clearly visible. In conclusion, SDF demonstrated good preventive performance and acceptance among children at.

PMID:42090679 | DOI:10.1590/0103-644020266778

Sao Paulo Med J. 2026 May 1;144(2):e20253337. doi: 10.1590/1516-3180.2025.3337.13022026. eCollection 2026.

ABSTRACT

BACKGROUND: Frailty in older adults is a multifactorial geriatric syndrome associated with inflammation, malnutrition, and hematological decline. Objective and easily applicable laboratory-based indices may complement clinical frailty assessment by providing rapid and low-cost screening tools, particularly in primary care and resource-limited settings.

OBJECTIVES: To develop a simple laboratory-based frailty screening index (FINE, Frailty Index for the Elderly) using C-reactive protein (CRP), albumin, hemoglobin, and sex, and to evaluate its association with the Clinical Frailty Scale (CFS) in older adults.

DESIGN AND SETTING: A retrospective descriptive study conducted using electronic health records of individuals aged 80 years and older.

METHODS: Data from 322 older adults were analyzed. Their FINE scores were calculated by assigning 0 or 1 point to CRP, albumin, hemoglobin, and sex based on clinically accepted reference thresholds, yielding a total score ranging from 0 to 4. Frailty was assessed using pre-recorded CFS scores. Associations between FINE scores, CFS, and individual biomarkers were examined. The screening performance was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS: The mean age of participants was 84.9 ± 4.0 years, and 55.6% were female. The prevalence rate of frailty was 46.6%. FINE scores exhibited a positive correlation with CFS and CRP levels, and a negative correlation with albumin and hemoglobin levels (p < 0.005). ROC analysis demonstrated a statistically significant but moderate discriminatory ability for frailty (area under the curve = 0.642; 95% confidence interval: 0.5820.703). At a cut-off value of ≥ 0.5, FINE scores demonstrated high sensitivity (89.3%) but low specificity (22.1%).

CONCLUSION: The FINE score is a simple, rapid, and low-cost laboratory-based frailty screening tool that is significantly associated with clinical frailty and key biological processes underlying frailty. Although low specificity limits its use as a diagnostic instrument, it may serve as a practical first-step screening approach in primary care and resource-limited settings. Further multicenter prospective studies are required to validate these findings.

PMID:42090677 | DOI:10.1590/1516-3180.2025.3337.13022026

Arq Bras Cardiol. 2026 Mar;123(3):e20250625. doi: 10.36660/abc.20250625.

ABSTRACT

BACKGROUND: Atrial cardiomyopathy (AC) is a condition detectable by electrocardiogram (ECG) that may play a significant role in the pathophysiology of the etiology of strokes, independently of atrial fibrillation (AF).

OBJECTIVES: To evaluate the association between ECG markers of AC (prolonged P-wave duration >120 ms and P-terminal force in V1 (PTFV1) >4,000 µV·ms) as well as the occurrence of mortality and hospitalization due to stroke.

METHODS: This retrospective cohort study included patients from Belo Horizonte who underwent ECGs between 2006 and 2018. Patients aged ≥40 years, in sinus rhythm, and without a previous history of stroke at baseline ECG were included. Clinical and ECG data were linked to mortality (SIM) and hospitalization (SIH) public databases. Cox regression was used to calculate hazard ratios (HRs), and incremental adjustment models for age, sex, cardiovascular risk factors, and left ventricular hypertrophy were employed. Statistical significance was set at p<0.05.

RESULTS: 245,588 patients were included. 26.3% had prolonged P-wave duration >120 ms, and 10.1% had elevated PTFV1 >4,000 µV·ms. Mean follow-up duration was 3.5 years. AC was associated with mortality and hospitalization due to stroke (HR 1.24; 95% CI, 1.12-1.36 for P-wave duration >120 ms; p<0.001; HR 1.20; 95% CI, 1.05-1.38 for PTFV1 >4,000 µV·ms; p<0.001).

CONCLUSION: ECG markers of AC are associated with death or hospitalization due to stroke, as well as cardiovascular mortality and incident AF in a large, representative Brazilian cohort, highlighting their prognostic value.

PMID:42090675 | DOI:10.36660/abc.20250625

Arq Bras Cardiol. 2026 Mar;123(3):e20250614. doi: 10.36660/abc.20250614.

ABSTRACT

BACKGROUND: The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain.

OBJECTIVES: To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort.

METHODS: This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant.

RESULTS: The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236).

CONCLUSION: The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients.

PMID:42090674 | DOI:10.36660/abc.20250614

Arq Bras Cardiol. 2026 Mar;123(3):e20250440. doi: 10.36660/abc.20250440.

ABSTRACT

BACKGROUND: A potassium-enriched salt substitute, in which part of sodium chloride is replaced with potassium chloride, has shown considerable potential as a population-level strategy to reduce sodium intake and prevent cardiovascular disease. In recent years, research has focused primarily on individuals with hypertension, demonstrating that salt substitutes can influence blood pressure (BP).

OBJECTIVE: To perform a meta-analysis quantifying the magnitude of BP reduction in patients with hypertension using regular salt compared with those using a salt substitute.

METHODS: PubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) comparing regular salt with a salt substitute. Mean differences (MD) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. A p-value < 0.05 was considered statistically significant.

RESULTS: Four RCTs involving 1,430 participants were included, of whom 725 (49.57%) received the salt substitute. The use of a salt substitute was associated with a significant reduction in systolic BP (SBP) (MD, -5.75 mmHg; 95% CI, -6.98 to -2.39 mmHg; I2 = 37%; p < 0.01) and a significant reduction in diastolic BP (DBP) (MD, -1.62 mmHg; 95% CI, -2.34 to -0.91 mmHg; I2 = 0%; p < 0.001).

CONCLUSION: In patients with hypertension, the use of a salt substitute is associated with a significant reduction in both SBP and DBP compared with regular salt.

PMID:42090672 | DOI:10.36660/abc.20250440

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