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The aim of the study is to evaluate the treatment patterns, time to start treatment, and healthcare resources utilization (HCRU) of cervical cancer (CC) patients within the Brazilian public health system (SUS). This is an observational retrospective study using SUS administrative database (DATASUS). Data from January-2014 to December-2020 was gathered from patients with the ICD-10 C53 codes. From 2014 to 2020, 206,861 women were included, among whom 90,073 (43.5%) had stage information. Of staged patients, 60.7% (54,719) had advanced disease (stages III and IV) and the most performed treatments were chemoradiotherapy (CRT) (41.6%), surgery + CRT (19.1%), radiotherapy (RT) only (16.8%) and chemotherapy (CT) only (13.3%). The proportion of patients submitted to CT in advanced stages was higher than in non-advanced stages (I and II), in contrast to RT, which was more frequent in stage I than stage IV. Median time to initiate treatment surpassed two months in approximately 30% of the cases, regardless of stage. Conization was the most performed surgical procedure. The hospitalization rate per patient per month for stage IV was twice as high as stage I (0.05 [95%CI 0.05-0.05] and 0.11 [0.11-0.11], respectively). The same trend was observed for outpatient visits (0.54 [95%CI 0.53-0.55] and 0.96 [0.93-0.98], respectively). This study demonstrated a high proportion of advanced CC at diagnosis in Brazil. The treatment pattern showed that chemoradiotherapy was the most frequent regimen overall and the use of chemotherapy and HCRU increased with staging. These results could provide information to improve public policies towards access to prevention, diagnosis, and treatment of CC in Brazil.

ABSTRACT OBJECTIVE To build an integrated database of individual and service data from the cohort of people who started antiretroviral therapy (ART), from 2015 to 2018, in Brazil. METHODS Open cohort study that includes people aged 15 years or older who started ART from 2015 to 2018, with follow-up in services of the Brazilian Unified Health System (SUS), and who responded to the 2016/2017 Qualiaids national survey. The source of individual data was the related HIV database, derived from the probabilistic linkage between data from the SUS systems of diagnostic information, medication, tests, and deaths. The data source for the services was the services’ response database to the Qualiaids survey. After analysis of consistency and exclusions, the database of individuals was deterministically related to the database of services. RESULTS The cohort comprised 132,540 people monitored in 941 SUS services. Of these services, 59% are located in the Southeast region and 49% followed 51 to 500 cohort participants. The average performance of organization and management of patient care ranged from 29% to 75%. Most of the cohort participants are male, black and mixed, aged between 20 and 39 years old, and have between 4 and 11 years of schooling. Median baseline T-CD4 was 419 cells/mm3, 6% had an episode of tuberculosis, and 2% died of HIV disease. CONCLUSION For the first time in Brazil, this cohort provides the opportunity for a joint analysis of individual factors and services in the production of positive and negative clinical outcomes of HIV treatment.

ABSTRACT OBJECTIVE To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015–2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system – no record; follow-up at SUS – two or more records; undefined follow-up – one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents’ self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

Abstract Background Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied. Methods Using geocoded birth records from the ongoing Western Region Birth Cohort (Região Oeste Coorte – ROC-Cohort) of infants born between 2012 and 2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of the mother’s residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy. Results Among the 5268 children included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile had higher odds of being born small-for-gestational-age (1.41[1.06–1.89]), preterm (1.35[1.01–1.80]), and low birth weight (1.42[1.03–1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and birth outcomes. Conclusions Higher exposure to violent crimes in the close vicinity of pregnant women’s residence is associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can potentially contribute not only to the short-term wellbeing of populations but may also have large social, economic, and health benefits in the long term.

RESUMO Objetivo: Verificar a relação entre autocompaixão e adição à comida em mulheres com comportamento alimentar disfuncional. Métodos: Mulheres de um grupo de apoio completaram as escalas de compulsão alimentar, restrição cognitiva, autocompaixão, Escala de Adição à Comida de Yale versão modificada 2.0 (YFAS 2.0) e questionário de Hay para práticas compensatórias. Foram identificados a prevalência de adição à comida e sintomas segundo a YFAS. Para serem incluídas, as participantes deveriam atingir pontuação para compulsão alimentar e, para análises, foram divididas em função da presença de práticas compensatórias. O grupo foi analisado por meio de testes de correlação de Pearson entre variáveis de interesse, e os grupos bulímico e compulsivo foram comparados com teste t de Student (p < 0,05; software JASP). Resultados: Participaram do estudo 190 mulheres. De acordo com a YFAS, 95,3% (n = 181) tinham adição à comida, e os escores da escala apresentaram correlação negativa com a autocompaixão e com a compulsão alimentar (p = 0,014 em ambas). Os níveis de autocompaixão apresentaram correlação negativa com as questões #3, #5, #6, #8 e #9 da YFAS (p < 0,05). Conclusões: Este estudo traz dados para a discussão da necessidade de analisar como a autocrítica atrelada ao sofrimento de quem apresenta comportamento alimentar disfuncional afeta o preenchimento da escala, trazendo identificação com a noção de vício, já que esta é culturalmente aceita.

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged

Objectives: There is a limited number of updated epidemiological Brazilian data on head and neck squamous cell carcinoma (HNSCC). This study aimed to describe demographic and clinical characteristics of HNSCC patients from Brazilian public and private systems. Methods: This is a retrospective observational study that included patients diagnosed with HNSCC from Brazilian public and private settings from 2016 to 2018. As for the public scenario, data were drawn from the public hospital national cancer registry database. As for the private sector, the data were extracted from medical records of patients from Oncoclinicas, a large Brazilian oncology group. Results: A total of 37,121 patients were included in the study, with 36,914 from the public and 207 from the private system. Patients in the public sector were younger than those in the private sector, with medians ages of 61.2 and 66.9 years, respectively. In both cohorts, a predominance of men with a history of tobacco and alcohol consumption and an advanced locoregional stage at diagnosis was observed. The main site of the primary tumor was the oropharynx in the private sector and oral cavity in the public sector. Among patients with oropharyngeal cancer, only those in the private sector were tested for HPV, with the majority being positive. Conclusions: This real-world data study provides epidemiologic characteristics of patients with HNSCC in two different Brazilian healthcare settings, presenting relevant insights into possible opportunities for improvements in the patient's journey with HNSCC.

Abstract Background The prevalence of chronic and complex pediatric health conditions has quickly risen over the last decades. Chronic and complex health conditions make pediatric patients and their families more susceptible to many distressing events during their lifespan. Mindfulness-based interventions have become a popular intervention for individuals living with chronic illnesses and have been adapted for pediatric populations with good results, including online versions. This study intends to report an implementation protocol of an online mindfulness-based program for adolescents to address an important gap in stress relief and health promotion for pediatric patients. Methods In this article, we describe the rationale and design of an implementation study of an online mindfulness-based program for pediatric patients at a tertiary pediatric hospital in South America. Participants will be recruited during one year to participate in an eight-session online mindfulness-based program. To assess our primary aim of feasibility, we will exam recruitment, retention and participation rates. Participants will also complete a symptomatology evaluation (i.e., depression, anxiety, and stress symptoms) at baseline and immediately at post-treatment and fidelity will be evaluated by a structured questionnaire. Discussion This study will be the first known to assess the implementation of an online mindfulness-based program for a pediatric population at a tertiary pediatric center in South America under real-life conditions. This study will establish the feasibility of a novel intervention aimed at promoting mental health and positive coping strategies among pediatric patients with chronic and complex health conditions. Evidence from this study would be useful to patients, families, clinicians, and policymakers and will help to devise strategies of health promotion for the pediatric population, as well as serve as a model for a future trial to examine efficacy of the proposed intervention. Trial registration This research has been registered at Ensaiosclinicos.gov.br , identifier RBR-23trp87 . Registered 25 February 2022—retrospectively registered.