Tag: nevin manimala

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

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