Introduction: the initial spread of the pandemic in Brazil was mainly affected by patterns of socioeconomic vulnerability. It should be noted that the Central-West region of Brazil is one of the regions with the lowest number of cases, but the states of this region together have the highest mortality rate of COVID-19 in the country. Goiás was the most affected state of this region, with the highest number of deaths in the area. Objective: to assess the incidence of mortality and lethality caused by COVID-19 from March 2020 to June 2021 in the State of Goiás, Brazil. Methods: an ecological study, using a series of time series of public and official data of the Department of Health of the State of Goiás, Brazil. Information was collected on cases and deaths from COVID-19 from March 2020 to June 2021. Mortality, case fatality, and incidence rates were calculated. The Prais-Wisten regression model was used to build time series. The daily percent change (DPC) and the effective reproductive number (Rt) were estimated. Results: Goiás had a predominance of a greater viral spread during the first and the beginning of the second wave, with Rt higher than 1. The second wave from December 2020 to June 2021 was more lethal and had higher mortality rates than the first wave. It was observed, higher scores of case fatality and mortality belonged to males and the elderly. Conclusion: an analysis of mortality and case fatality rates helps understand the COVID-19 pandemic behavior in Goiás. It is essential to monitor epidemiological indicators and strengthen intervention strategies to contain the pandemic in this state.

Este relato de experiência apresenta o processo de construção e manutenção de uma rede multicêntrica e transdisciplinar de pesquisadores no campo das migrações transnacionais e da saúde no contexto da Covid-19. Descrevemos os desafios no processo, a organização das estratégias metodológicas, os processos de trabalho, as contribuições dos atores, bem como os limites e as potencialidades. Na pesquisa multissituada em seis estados no Brasil, identificamos problemáticas em saúde e no adoecimento no acesso aos serviços de saúde e proteção social por migrantes internacionais e refugiados durante a pandemia. Nesse relato sobre o processo de planejamento e execução, evidencia-se a complexidade do design na perspectiva teórico-metodológica provocando reflexões e decisões singulares. Com a experiência coletiva busca-se contribuir para a pesquisa qualitativa, multicêntrica e interdisciplinar com foco nas migrações internacionais por meio das Ciências Sociais em Saúde na Saúde Coletiva.

Introduction: coronavirus 2019 Disease (COVID-19) was quickly declared a pandemic, and Brazil is facing the most significant health and hospital crisis in its history. From March to June 2021 represented 50.8% of all deaths in the State of Espirito Santo. Objective: to analyze the lethality and mortality by COVID-19 in the State of Espirito Santo from March 2020 to June 2021. Methods: an ecological study was carried out, using a time series of public and official data available on the Health Department of the State of Espirito Santo, Brazil. Were considered information about cases and deaths (from March 2020 to June 2021) of COVID-19. Percentage case-fatality and mortality and incidence rates per 100,000 population were calculated. Time-series analyses were performed using the Prais-Winsten regression model, estimating the Daily Percent Change (DPC), and the trends were classified as flat, increasing, or decreasing. Significant differences were considered when p<0.05. Results: 524,496 confirmed cases of COVID-19 as of June 30, 2021, and 11,516 progressed to death. The presence of cardiovascular diseases represents more than half of confirmed comorbidities (54.37%) in patients with COVID-19, followed by diabetes (19.95%) and obesity (9.34%). Men had higher mortality and lethality, especially in older age groups, but the incidence was higher among women. A characteristic profile of two waves was observed; the first wave was extended from March to October 2020 and the second complete wave from November 2020 to June 2021. During the second wave, high peaks of incidence, lethality, and mortality were recorded. At the end of the second wave, the incidence rate remained with increasing trends (p < 0.05), with a DPC of 2.06%. Conclusion: the peak concentration of cases, deaths, and indicators of lethality, mortality evidenced even after one year of pandemic, characterizes the severity of the COVID-19 pandemic, still in entire evolution in the State Espirito Santo and Brazil.

Introduction: Inserted in the vulnerable context of the Brazilian Amazon, the state of Tocantins has suffered damages with the dissemination of COVID-19 in its territory; however, little evidence is published from this state. Objective: This study aims to analyze the case-fatality, mortality, and incidence of COVID-19 in Tocantins. Methods: This is an ecological study, population-based, time-series analysis of COVID-19 cases and deaths in the state of Tocantins from March 2020 to August 2021. Results: During the examined period, 219,031 COVID-19 cases, and 3,594 deaths were registered due to disease. Two possible occurrence peaks were characterized in this time-series analysis. Remarkably, the Second Wave had the highest lethality rates (3.02% - April 2021), mortality (39.81 deaths per 100,000 inhabitants – March 2021), and incidence (1,938.88 cases per 100,000 inhabitants – March 2021). At the end of the period, mortality, incidence, and lethality showed flat trends, suggesting a positive outcome of the vaccination program. Conclusion: The prevention, surveillance, and control actions of COVID-19 cases in Tocantins State have been directed to mitigate the deleterious effects of the pandemic. Nevertheless, efforts are still needed to decrease lethality, mortality, and incidence trends, and ultimately to achieve control of the COVID-19 pandemic in the region.

Introduction: by late 2019, China notified a new disease rising, and with the agent’s identification, it was called COVID-19. Despite the efforts of the World Health Organization (WHO) and worldwide countries, the disease spread out of control; on March 11, WHO declared the pandemic state. Brazil is the biggest country in South America, demarcated into 26 states with different economic, cultural, and social aspects. Paraná is one of the Brazilian federative units, it is the sixth more economically important and ranks second in Education. Its first COVID-19 case was confirmed on March 12, 2020, and the first death was on March 27, two weeks after the first death in Brazil. Objective: This study objective is to determine the mortality and case-fatality rates of COVID-19 in the State of Paraná, Brazil, from March 1, 2020, to March 31, 2021. Methods: It is an ecological time-series study, using all cases (854,326) and deaths (17,229 deaths) of COVID-19 reported in public and official database of the State of Paraná Health Department. Case fatality and mortality rates were stratified by sex and age. For trend analysis, the period was divided into a first “wave” (March to November 2020) and a second “wave” (December 2020 to March 2021). The Prais-Winsten regression model for population mortality and case-fatality rates allowed classifying whether it increased, decreased, or was flat. Results: Women were more affected by the number of cases, with 454,056 cases (53.15%) confirmed and 7,257 fatalities (42.12%). A total of 400,270 men (46.85%) were infected and 9,972(57.87%) died. For the first year of COVID-19, in the State of Paraná, the incidence was calculated as 7404.12/100,000 inhabitants, the mortality was 149.32/100,000 inhabitants, and the case-fatality rate was 2.02%. We saw a tendency for decreasing the case-fatality rate (DPC = -0,18; p<0,001). The mortality and incidence showed an increasing trend (DPC=1,13, p<0,001; DPC=1,58, p<0,001, respectively). Conclusion: The level and variability of transmission during this first year of pandemic suggest that the disease in the State of Paraná was never under control.

Introduction: Since the first case of COVID-19 was confirmed in February 2020, Brazil has reported more than 20 million cases and more than 600,000 deaths on October 31, 2021. The behavior of the pandemic was also different in the various regions of the country, from those with less economic development to those with greater economic development, such as the state of São Paulo. Objective: to describe step-by-step time series for analyzing trends in mortality, lethality and incidence of COVID-19 in Brazil. Methods: a protocol for an ecological study of time series, covering the 26 states and the federal district (Brasilia). Results: The descriptions have the potential to provide information for the government and society in decision-making, about knowledge and conduct, clinical, epidemiological and research investments in health care for the Brazilian people. It is focused on fully understanding the spread of SARS-COV-2 infection in the Brazilian territory, and developing a database for public and universal access for comparative studies between countries and continents. Conclusion: database built from ecological studies are essential for a full understanding of the virus behavior, its transmissibility, lethality and mortality, and a repository for data that’s been collected and integrated from multiple sources. It is a relevant tool for the search of information and decision-making in global health.

The mental health of women is significantly shaped by gender-related issues stemming from social and cultural disparities, which intensify female susceptibility and culminate in mental disorders. Despite a plethora of studies delineating the effects of gender on mental health, there exists a conspicuous deficiency in research investigating women’s viewpoints regarding their own experiences of rehospitalization. Therefore, the principal aim of our investigation was to assess the relationship between rehospitalization and the Quality of Life (QoL) among women undergoing treatment at a psychiatric care institution. We employed a mixed-methods research framework to examine the QoL and the variables pertinent to the readmission of twenty women from a public psychiatric hospital situated in the interior region of Espírito Santo, Brazil. The quantitative aspect evaluated QoL using the scores and analytical guidelines established by the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire. The results from this phase were subjected to descriptive statistical analysis. The qualitative data were derived from semi-structured interviews aimed at exploring the factors associated with readmission; the insights obtained underwent narrative analysis. This study was approved by the ethics committee. The interviews were only carried out after the patients were medically discharged. Women who are readmitted do not have their problems viewed objectively and, consequently, are not having them resolved, as the factors contributing to the mental health of these patients are complex and span across the domains of physical, psychological, social relationships, and environment. There is a notably low overall QoL (M = 47.78) in the study population, with particularly poor scores in the environment (44.49), psychological (47.71) and social relationships (48.54) domains. These findings align with participants’ testimonies, which emphasize the role of unstable living conditions, financial insecurity, social isolation, and family dysfunction in their ongoing struggles with mental health. The mental health outcomes of women are shaped by a multitude of factors, encompassing social support, access to resources, and individual coping strategies. Approaches to mental health care that are humanized and that address these factors are imperative for enhancing QoL and mitigating readmission rates.

Neck circumference (NC) is a predictive measure for the diagnosis of Metabolic Syndrome (MS). The aim of the present study was to establish cutoff points for NC as a predictor of the presence of MS in Brazilian rural workers, based on the MS components according to the IDF and NCEP-ATP III criteria. This is a cross-sectional study carried out with rural workers in the municipality of Santa Maria de Jetibá, in the state of Espírito Santo, Brazil. The ROC curve was calculated and the cutoff points for predicting the risk of developing MS were stipulated from the NC, identified by the area under the curve, using different methods of criteria for determining MS. Sensitivity, specificity, positive and negative predictive values and Youden index were applied. The significance level adopted was 5%. The cutoff points were different for males, resulting in 39.550 cm (AUC 0.832) according to the NCEP-ATP III criterion and 39.125 cm (AUC 0.888) according to the IDF criterion. For women, the cutoffs were similar, resulting in a single cutoff of 34.725 cm (AUC 0.862 for NCEP-ATP III and 0.849 for IDF). The cutoff points defined for men and women for NC showed good sensitivity and specificity for predicting MS in the studied population. The NC measurement proved to be a simple, low-cost and accurate measure for assessing this morbidity in Brazilian rural workers.

The anti-poverty agenda has been at the heart of the World Bank's discourse in recent decades. Social policies started to be identified as strategic for combating poverty and promoting development in poor countries. We analyzed the health policy recommendations made by the World Bank to Brazil in the Lula da Silva and Rousseff administrations from 2003 to 2014. Document analysis was used to explore the partnership contracts between the World Bank and Brazil, projects financed by the World Bank in Brazil, and the document “20 Years of Construction of the Health System in Brazil: An Analysis of the Unified Health System.” Content analysis of documents show that there was a predominance of projects focusing on reducing poverty, while social policies occupied a secondary place in the agenda. The World Bank approached states and municipalities expanding the spread of its state reform agenda, in addition to reinterpreting the structural framework of the Sistema Único de Saúde (SUS). We conclude that the Bank acted to limit the original principles of the SUS in favor of hegemonic interests of the current phase of capitalist accumulation.

O artigo é resultado de um estudo piloto qualitativo realizado com trabalhadores de hospitais públicos administrados por instituições privadas, cujo objetivo foi identificar e analisar os principais impactos do trabalho nessas instituições, conhecidas como Organizações Sociais de Saúde. A pesquisa foi realizada no Espírito Santo, Brasil, em 2019. Foram realizadas entrevistas individuais com trabalhadores que atuam em pelo menos uma das instituições participantes. A análise baseou-se nas técnicas da Grounded Theory, Teoria Fundamentada nos Dados, com codificação criteriosa e metodologia comparativa, resultando em quatro categorias empíricas: Admissão, Gestão de Pessoas, Gestão e Qualidade, Saúde e Qualidade de Vida. Os resultados mostraram que os profissionais de saúde são afetados de maneiras diferentes e contraditórias de acordo com a categoria e a formação profissional; há precariedade e problemas de qualidade que impactam negativamente tanto o trabalho, como os trabalhadores; há insatisfação, sobrecarga, adoecimento e perda de qualidade de vida.As principais conclusões apontaram para a necessidade de se instituir práticas e condições apropriadas na gestão do trabalho nas instituições, visando a melhoria na saúde do trabalhador e a qualidade na assistência à saúde da população.

O presente trabalho tem por objetivo contribuir com a proteção e valorização do patrimônio cultural de cada região brasileira.Para tanto, utilizou o método hipotético-dedutivo e realizou uma pesquisa bibliográfica para fundamentar o desenvolvimento de um jogo de cartas, capaz de expressar características que representam as cinco regiões do Brasil sob a ótica do design territorial em função dos seguintes temas: flora, artefatos, culinária, lugares e cultura.A proposta é que o jogo compartilhe informações como forma de promover um aprendizado dinâmico em um ambiente escolar, a partir do qual os jogadores sejam capazes de se inteirar sobre a diversidade e pluralidade nacional. Territorial design, craft production, game, brazilian culture, information designEach place carries in its territory diverse characteristics that make it unique.This work aims to contribute to the protection and enhancement of the cultural heritage of each Brazilian region.To do so, we used the hypothetical-deductive method and carried out a bibliographical research to support the development of a card game, capable of expressing characteristics that represent the five regions of Brazil from the perspective of territorial design based on the following themes: flora, artifacts , cuisine, places and culture.The proposal is for the game to share information as a way to promote dynamic learning in a school environment, from which players are able to learn about national diversity and plurality.

BACKGROUND:Elements of charrette planning were employed to develop and examine the relationship between transnationalism, culture and health.OBJECTIVE:This paper describes the partnership, the first two stages of the planning charrette and lessons learned.METHODS:During charrette planning phase 1 we collected data through social network interviews (n = 58), cultural conversations (n = 88), and photovoice (n = 9). In the second phase we performed five charrette planning meetings. Data were synthesized by the planning team.LESSONS LEARNED:The issue centered focus facilitated trust among partners. The holistic, iterative process to planning and interpreting preliminary data provided a deeper understanding of the issues under investigation. Community partners at the table held us accountable to the communities we were studying and infused an undercurrent of social justice in our work.CONCLUSIONS:There are advantages in employing a community engaged transdisciplinary team-based approach to the study of transnationalism, culture and health.

Introduction: Obesity is considered a growing public health problem by the Brazilian Ministry of Health and a global epidemic by the World Health Organization (WHO). In 2020, the Centers for Disease Control and Prevention (CDC) estimated the prevalence of adult obesity at 31.9% in the USA. The USA is one of the main destinations for Brazilian immigrants in search of better living conditions, and Massachusetts is one of the states with the highest presence of Brazilians. Changes in lifestyle and eating habits are often associated with increases in overweight and obesity in immigrants in the USA, especially Hispanics, an official classification that does not, however, include Brazilians. The aim of this study was to describe the temporal trend of overweight and obesity in Brazilian immigrants assisted by the Cambridge Health Alliance (CHA) healthcare network in Massachusetts. Methods: This was an ecological time series study of 128,206 records of Brazilians aged between 18 and 60 years based on hospital data from 2009 to 2020. Results: Mean age was 38.9 (SD = 10.6), and 61% of the sample were women. The prevalence of overweight and obesity was 38.4% and 25.4%, respectively. Obesity exhibited an increasing trend, while eutrophy and overweight decreased during the study period. Conclusion: As little is known about the health of Brazilian immigrants in the USA, this study contributes to the literature on the subject. The observed increasing trends agree with the worldwide increase in obesity and indicate the need for future research exploring individual factors associated with immigrant acculturation.

Introduction: validated educational technologies favor access to reliable and adequate information, representing a critical risk communication tool for cancer patients during public health emergencies. Objective: to assess the validity and reliability of an electronic booklet on COVID-19 for adults with cancer. Methods: methodological validation by a panel of 22 experts linked to Brazil’s national curriculum vitae database. Sampling was performed by convenience, snowball, and selection techniques according to Jasper’s criteria. The validity of the booklet was evaluated by an electronic questionnaire using the content validity index (CVI), intraclass correlation coefficient (ICC), the suitability assessment of materials (SAM) instrument, and the metalinguistic thematic analysis for educational technologies (MeTA-Edu) of dissertation proposals. Results: the expert panel consisted of 22 doctors with homogeneous sociodemographic characteristics, high specialization in education (86.4%), and teaching experience (average = 17.8 years). In general, the educational technology was validated by experts for content (overall CVI = 0.953) with a high degree of agreement (ICC = 0.958) and suitability of the content, literacy demand, graphics, layout, and typography, learning stimulation and motivation, and cultural appropriateness (SAM = 90.6%). After thematic analysis, 94 dissertation proposals were identified, mainly of the visual language type (47.9%) and referential/informative function (68.1%). Most expert suggestions were accepted (83.0%), and only 17.0% were rejected. Conclusion: the validity and reliability of the booklet “Uncomplicating COVID-19 for people with cancer” were ratified by experts. These findings can contribute to the methodological optimization of the validation of educational technologies and innovation of health education strategies, subsidizing cancer care in times of crisis.

The Metabolic Syndrome (MetS) is an increasingly prevalent condition globally. Latino populations in the USA have shown an alarming increase in factors associated with MetS in recent years. The objective of the present systematic review was to determine the prevalence of MetS and its risk factors in immigrant Latinos in the USA and perform a meta-analysis of those prevalence. The review included cross-sectional, cohort, or case–control studies involving adult immigrant Latinos in the USA, published during the period 1980–2020 in any language. Studies involving individuals who were pregnant, aged <18 years, immigrant non-Latinos, published outside the 1980–2020 period, or with other design types were excluded. The Pubmed, Web of Science, Embase, Lilacs, Scielo, and Google Scholar databases were searched. The risk of bias was assessed using the checklists of the Joanna Briggs Institute. The review included 60 studies, and the meta-analysis encompassed 52 studies. The pooled prevalence found for hypertension, diabetes, general obesity, and abdominal obesity were 28% (95% Confidence Interval (CI): 23–33%), 17% (95% CI: 14–20%), 37% (95% CI: 33–40%), and 54% (95% CI: 48–59%), respectively. The quality of the evidence of the primary studies was classified as low or very low. Few studies including immigrants from South America were identified. Further studies of those immigrants are needed due to the cultural, dietary, and language disparities among Latin American countries. The research protocol was registered with the Open Science Framework (OSF).

Abstract: Introduction: The quantitative deficit and inequalities in the distribution of doctors exacerbate the global health workforce crisis. Many policies have been adopted to face the problem, with the ‘Mais Médicos’ Program standing out due to its scope. Objective: This study aimed to characterize, among undergraduate medical students in the state of Bahia, the intentions of future medical specialty and professional retention in priority areas defined by the More Doctors Program (PMM), according to the predictors indicated in the literature. Methods: This is a cross-sectional exploratory study conducted with medical students from four federal universities in the state of Bahia. Results: The study predominantly included students aged 20 to 24 years, with a lower socioeconomic profile in relation to previous studies, born in small and medium-sized municipalities in the state of Bahia, who mostly stated their option for medical residency in specialties other than the basic areas after graduation. An inequality was observed between the percentage of students who intended to work in Primary Care and those who wanted basic specialties, with the option for Family and Community Medicine being even lower. Female students clearly predominated among those who desired basic specialties and who envisioned a future employment in Primary Care in this state. Conversely, male students mostly chose specialties in other areas, especially those who had financial aspects as the main motivation for career choice. Final considerations: The study added knowledge to the body of literature on changes in medical training in the country and the effects of policies leading to a generalist professional profile that meets the social needs of the population.

Background: High blood pressure is an important public health problem due to its high prevalence, the difficulty to control it, and its high contribution to morbidity. A series of changes may be linked to the aging process, compromising cardiac conduction, and reducing cardiovascular baroreceptor function. Advancing age promotes a decline in heart rate variability and this decrease can increase the probability of cardiovascular disease. The aim of this study was to analyze the autonomic modulation of heart rate in hypertensive elderly individuals during and after a session of aerobic exercise, and to compare it with elderly individuals without cardiovascular or metabolic disease. Our study was a non-randomized controlled study with hypertensive elderly (HBP group) and elderly without cardiovascular and/or metabolic diseases (control group). Data on blood pressure and heart rate variability (HRV) were collected before, during, and after 30 min of aerobic physical exercise on a treadmill. There was a reduction in HF (ms2) and SD1 (ms) in the 5 min of recovery for the elderly in the control group. The elderly in the control group also had greater RMSSD and SD1 30 min post-exercise when compared to the initial mins of recovery. We concluded that there was no difference in autonomic modulation and global heart rate variability between elderly individuals without cardiovascular and metabolic diseases and hypertensive individuals after a bout of aerobic exercise. Elderly individuals without metabolic diseases showed a decrease in parasympathetic modulation and global variability between the time of rest and 5 min of recovery. However, up to 30 min of post-exercise recovery, they restored parasympathetic activity.

Resumo: Introdução: O déficit quantitativo e as desigualdades na distribuição de médicos agravam a crise global da força de trabalho em saúde. Muitas políticas têm sido adotadas para enfrentamento do problema, destacando-se pela sua abrangência o Programa Mais Médicos. Objetivo: Este estudo objetivou caracterizar, entre graduandos de Medicina do estado da Bahia, as intenções de especialidade médica futura e de fixação em áreas prioritárias definidas pelo Programa Mais Médicos, conforme os preditores apontados na literatura. Método: Trata-se de um estudo de corte transversal com caráter exploratório, realizado com estudantes dos cursos de Medicina de quatro universidades federais da Bahia. Resultado: Predominaram estudantes de 20 a 24 anos, com perfil socioeconômico mais baixo em relação aos estudos anteriores, naturais dos pequenos e médios municípios baianos, que afirmaram, em sua maioria, a opção pela residência médica em especialidades de outras áreas, que não as áreas básicas, após a graduação. Verificou-se uma disparidade entre o percentual de estudantes com intenção de trabalhar na atenção primária à saúde e aqueles que desejaram especialidades básicas, sendo ainda consideravelmente menor a opção pela medicina de família e comunidade. As estudantes do sexo feminino predominaram de modo evidente entre aqueles que desejaram as especialidades de áreas básicas e que vislumbraram um futuro trabalho na atenção primária à saúde, nesse estado. De modo contrário, os estudantes do sexo masculino escolheram, na sua maioria, especialidades de outras áreas, especialmente aqueles que tiveram os aspectos financeiros como motivação principal para escolha de carreira. Conclusão: O estudo acrescentou conhecimento ao corpo de literatura sobre as mudanças na formação médica no país e os efeitos de políticas indutoras de um perfil profissional generalista que atenda às necessidades sociais da população.

Amazonas suffered greatly during the COVID-19 pandemic. The mortality and fatality rates soared and scarcity of oxygen and healthcare supplies led the health system and funerary services to collapse. Thus, we analyzed the trends of incidence, mortality, and lethality indicators of COVID-19 and the dynamics of their main determinants in the state of Amazonas from March 2020 to June 2021. This is a time-series ecological study. We calculated the lethality, mortality, and incidence rates with official and public data from the Health Department. We used the Prais–Winsten regression and trends were classified as stationary, increasing, or decreasing. The effective reproduction number (Rt) was also estimated. Differences were considered significant when p < 0.05. We extracted 396,772 cases of and 13,420 deaths from COVID-19; 66% of deaths were in people aged over 60; 57% were men. Cardiovascular diseases were the most common comorbidity (28.84%), followed by diabetes (25.35%). Rural areas reported 53% of the total cases and 31% of the total deaths. The impact of COVID-19 in the Amazon is not limited to the direct effects of the pandemic itself; it may present characteristics of a syndemic due to the interaction of COVID-19 with pre-existing illnesses, endemic diseases, and social vulnerabilities.