Health Secretary Research Articles

Protocol for Identifying and Retaining Critical Knowledge in a Public Health Administration

The Secretary of Public Health (SSP) faces a looming skills gap due to retirements and rotations of civil service staff. Critical knowledge retention is crucial across all generational cohorts due to the retirement and turnover of workers. This study develops a protocol that addresses the knowledge retention needs of the four generations (Baby Boomers, X, Y, Z) that coexist in the workforce to ensure the continuity of the Public Health Secretariat. The objective of the study is to develop a protocol for the management, transfer, and retention of critical knowledge. A scoping review is conducted in Scopus and Web of Science to develop the protocol, to identify critical knowledge workers through tool scores. The instrument developed in this research includes two pilots on Baby Boomer and Millennial workers. Both workers had critical and essential knowledge for the continuity of the organisation. The Baby Boomer worker presented a higher amount of tacit, operational, and individually owned knowledge, while the Millennial worker showed a predominance of tacit technological knowledge. This protocol provides a practical and adaptable approach to identifying and prioritising critical knowledge holders, allowing organisations to map and determine the amount of essential knowledge within the workforce. An important limitation of the study is the small sample of workers who participated in the pilot test of the protocol. Further research is therefore recommended in other public administrations and across all generations in employment.

Providing Quality Family Planning Services in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024)

This update, titled Providing Quality Family Planning Servicesa in the United States: Recommendations of the U.S. Office of Population Affairs (Revised 2024), provides recommendations developed by the Office of Population Affairs (OPA) within the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS). These recommendations represent an update to Providing Quality Family Planning (QFP) Services: Recommendations of the Centers for Disease Control and Prevention (CDC) and the U.S. Office of Population Affairs (OPA), originally published in 2014. The updated recommendations outline how to provide quality sexual and reproductive health (SRH) services for people of reproductive age but can also be used to guide the care of people of any age when the content is relevant to their needs, including family-building services, contraception, pregnancy testing and counseling, early pregnancy management, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) prevention and testing services, and other preventive health services. The recommendations aim to enable health care providers with the knowledge, skills, and attitudes to ensure that all people, regardless of individual characteristics such as sex, sexual orientation and gender identity, age, disability, or race, can have their SRH needs met. The primary audience for these recommendations is providers and potential providers of SRH services to people of reproductive age, such as providers working in clinical settings dedicated to SRH service delivery, including those funded by the Title X family planning programb as well as primary care providers and other subspecialty providers who may identify SRH needs and make referrals. During the past decade, several changes have taken place in the United States that have affected SRH care delivery, including technological advances, recognition of long-standing inequities, and other legal and regulatory changes. This broader context has been considered in designing the updated recommendations. This update of the QFP aims to provide guidance on the provision of person-centered SRH care focused on individuals' needs, values, and preferences. The update offers specific recommendations for how to provide high-quality SRH care and connects users to relevant guidelines, primary research, and other resources to inform best practices. In addition to incorporating new evidence, this update incorporates newer approaches to care, including adopting a health equity lens that recognizes the impact of structural and interpersonal racism, classism, ableism, and bias based on sexual orientation and/or gender identity on health and the provision of quality SRH care. OPA will update these QFP recommendations periodically to reflect new findings in the scientific literature and revisions to the clinical guidelines referenced in this update.

Diálogo Inicial

This study investigates the application of the Collective Benefit, Authority to Control, Responsibility, and Ethics (CARE) principles to the indigenous health data collected by the Secretariat of Indigenous Health (SESAI) in Brazil. Initially, the context of indigenous health policies in the country is discussed, highlighting the importance of integrating the Unified Health System (SUS) with indigenous policy to promote access to health for all. The research focuses on the need to align SESAI's data with the CARE principles, aiming to promote transparency and data availability for scientific research. Using a quantitative approach with exploratory aspects, the methodology included a bibliographic and documentary analysis to understand the CARE principles and propose strategies for aligning SESAI's data. The results indicate a growing interest in the topic, although there are gaps in data availability and in recognizing the rights of indigenous peoples over their data. The study initiated data processing, prioritizing the CARE principles, with the data made available in a geolocated tool. It concludes that the CARE Principles should guide future data collection and processing, supporting transparency and access to indigenous health data within the context of open government.

Public and health care provider attitudes, understanding, and behaviors regarding emergency use authorizations: a scoping literature review

BackgroundUnder Sect. 564 of the Federal Food, Drug, and Cosmetic Act, when the US Department of Health and Human Services Secretary issues a declaration based on one of four types of determinations, FDA may authorize an unapproved product or unapproved uses of an approved product for emergency use. It is unclear how much the public and health care providers understand about emergency use authorizations and how that understanding influences perceptions or behavioral intentions. The current study aimed to explore consumer and health care provider perceptions of emergency use authorizations and how promotion of emergency use authorizations has been investigated in the literature.MethodsWe conducted a scoping review via PubMed, Embase, Web of Science, and CINAHL for original research published in English from January 1, 2012, through November 10, 2022. We conducted surveillance of the literature through March 2023.ResultsWe identified 13 studies reported in 14 publications that addressed public and health care provider attitudes, understanding, and behaviors with regard to products authorized under an emergency use authorization. We did not identify any articles describing research regarding the promotion of emergency use authorization products. Findings suggest gaps in understanding of emergency use authorizations, both for the public and health care providers. Findings also suggest the public and health care providers have concerns about safety or the lack of full FDA approval that may contribute to decreased willingness to receive treatments and vaccines under an emergency use authorization.ConclusionsFuture research should explore how emergency use authorizations have been promoted and how that promotion impacts public and health care provider perceptions.

Perception et Conservation des Archives à la Direction « Etudes et Planification » du Ministère de la Santé, Hygiène et Prévention, République Démocratique du Congo

The administrative services of the Ministry of Health are not immune to the multifaceted crises affecting the Congolese public administration. As administration is both the foundation and backbone of public management in a country, the Democratic Republic of the Congo is a nation where archival science, in all its nobility, plays a vital role in good governance. If administrations continue to thrive at the beginning of the 20th century, it is due to the importance of archival documents, which every modern and organized nation strives to preserve well, as an essential tool of national memory. Archives are data with an indefinite lifespan and cannot be materials that disappear. The observation within the General Secretariat of Health is that archives are thrown haphazardly into dark rooms where they are exposed to the elements and various kinds of rodents. Under these conditions, the disappearance of historical data is inevitable, which could constitute a significant loss, especially as some documents exist in a single copy and, once destroyed, they cannot be reconstructed.

Legal abortion performed by pre-teens: primary health care workers’ perception and knowledge

This study aims to put into evidence Distrito Federal’s (DF) primary health care workers’ perception and knowledge regarding legal abortion, performed by 10 to 14 year old pre-teens. This is a descriptive study of qualitative approach. Semi-structured interviews were done to 17 primary health care workers currently working in Basic Health Units (BHU) of DF, under contract with DF’s Secretariat of Health. This article showed the worker’s lack of knowledge regarding legal abortion and specific care towards the age group, copying their knowledge regarding adults without adaptation for pre-teens. Workers’ personal beliefs influenced their practice and their choice to correctly inform Health Care users.

Outcomes from a Zoonotic Disease Prioritization workshop using One Health approach in Mozambique, 2018 to 2023

IntroductionAround 75% of (re)emerging infections are of zoonotic origins. The risk of zoonotic transmission in Mozambique is high because approximately 81% of the country’s labor force is involved with agriculture, which represents a vulnerability for more frequent human-animal interaction and risk of spillover events. A One Health Zoonotic Disease Prioritization (OHZDP) workshop was conducted in Mozambique to facilitate coordination and collaboration within and across sectors to prevent, detect, and respond to zoonotic disease threats. Based on the success of this integrated workshop, the stakeholders developed actions whose results have a great impact on animal welfare, environment and improving public health.MethodsIn 2018, representatives from Mozambique’s human, animal, and environmental sectors from government, universities, research institutions and partners used US CDC’s OHZDP Process to prioritize endemic and emerging zoonotic diseases of greatest national concern and develop recommendations and key interventions needed to advance One Health in Mozambique. After the OHZDP workshop, the Mozambique One Health Secretariat used a theory of change methodology to identify activities for implementation from the recommendations of the OHZDP workshop. Since the OHZDP workshop, the Secretariat has monitored progress of activities annually.ResultsMozambique’s priority zoonotic diseases are rabies, zoonotic tuberculosis, salmonellosis, zoonotic avian influenza, trypanosomiasis, brucellosis, and Crimean-Congo hemorrhagic fever. One Health recommendations and interventions to address the priority zoonotic diseases focused on One Health collaboration, communication, and coordination; laboratory; surveillance; preparedness and response; prevention; workforce development; and research. After the OHZDP workshop, Mozambique established One Health coordination mechanisms, developed training courses for surveillance, laboratory diagnosis, outbreak investigation, and preparedness and response for the priority zoonotic diseases, conducted joint research, and developed plans.ConclusionPrioritization of zoonotic diseases is critical as it facilitated the key One Health players in Mozambique to optimize resources, gain a greater understanding of zoonotic diseases, and implement policies and activities that promote multisectoral, interdisciplinary, and transdisciplinary collaboration across human, animal, and environmental sectors to prevent, detect, and respond to public health threats. The success of these activities implemented by the local Government and One Health partners were built from the implementation and momentum from the Mozambique’s OHZDP workshop.

Professional Doctorate in Primary Care (DPAPS): a legacy for the Rio de Janeiro SUS.

Since 2009, the Municipal Health Secretariat of Rio de Janeiro (SMS-RJ) has encouraged the creation of a Master's degree in primary health care at the National Health School/Fiocruz (ENSP/Fiocruz). In the following decade, this proposal became one of the main lines of the institution's professional stricto sensu postgraduate program, which culminated in CAPES approving the first professional doctorate class in the history of Fiocruz-RJ offered in 2024. The class comprises primary health care (PHC) students from Rio's SUS and Fiocruz employees in science, technology and innovation. Regarding the profile of the PHC students, the highlights were women (61.5%), a degree in medicine (53.8%), a mean of 15 years since graduating, 10 years working in PHC, graduates of a medical or multiprofessional residency course (69.2%) and a Master's degree in primary care from ENSP/Fiocruz or UFRJ (84.6%). The SMS-RJ thus leaves a legacy for Brazilian Public Health as a leader in the promotion of Fiocruz-RJ stricto sensu professional training programs, innovating in the end-of-course work, reviving the presence of doctors in the classes and bringing the contributions of the Portuguese SNS, a source of inspiration for the PHC reform undertaken in Rio de Janeiro, to the Rio de Janeiro SUS debate.

A Prototype for Monitoring the Continuing Education of Indigenous Health Professionals: A Study with the Indigenous Health Secretariat of the Brazilian Ministry of Health

A Prototype for Monitoring the Continuing Education of Indigenous Health Professionals: A Study with the Indigenous Health Secretariat of the Brazilian Ministry of Health

WP6.12 - What the bleep? Have we finally found a solution to the bleep system?: Exploring the efficacy of a WhatsApp-style messaging system as an alternative to traditional bleeps in the healthcare setting

Abstract Aims Traditionally, bleeps have been integral to the role of a doctor. A pre-pandemic study estimated that more than 10% of the world’s bleeps are currently being used by the NHS. However, in response to the 2021 directive by the health secretary to phase out bleeps within NHS England, new approaches to communication in healthcare are being implemented. One of these is Alertive, a WhatsApp-style messaging system. This study utilises a quality improvement approach to determine the efficacy of Alertive in conveying messages as a replacement for bleeps, and to investigate the reasons behind its perceived poor uptake. Methods A ten-day evaluation of the uptake of 15 distinct Alertive roles within the surgical department, accompanied by a satisfaction survey circulated among departmental juniors. Results The survey findings revealed a prevailing consensus among users endorsing the efficacy and superiority of Alertive as a concept over the previous bleep system. However, user-reported constraints related to functionality and application logistics. These have been identified as sources of frustration and thereby impeding the broader utilisation and efficacy of Alertive. Conclusion Effective multi-disciplinary communication is imperative in a hospital setting. While Alertive presents a potential alternative to traditional bleeps, challenges such as poor role uptake and communication appropriateness persist and represent significant barriers to full integration and staff satisfaction. Role uptake is variable with some surgical teams having better compliance than others. While users report that the concept of Alertive is beneficial, no single communication system has been identified as being superior, emphasising the ongoing need for solutions in healthcare communication.

COVID-19 fatality rate conditioned by risk factors in Mexico in 2020

The COVID-19 fatality rate exhibited significant variations during the first year of the pandemic, and such divergences seem to show different levels of risk of death among populations. Very few studies stratified fatality based on the presence or absence of risk factors. To identify COVID-19 fatality rates conditioned by risk factors. Secondary analysis using an open health database from the Secretariat of Health of Mexico (Secretaría de Salud), covering patients studied from January 1, 2020, to January 6, 2021. Patients with confirmed COVID-19 result were included; those with 5 risk factors or more, or with rare combinations of factors were excluded. The final sample consisted of 394,537 patients. The database was segmented into groups based on 0, 1, 2, 3, and 4 risk factors. The fatality rate conditioned by risk factors was estimated (83 combinations). Among patients with 0 risk factors, the fatality rate was 2.1%. In those aged ≥ 50 years alone or more, the fatality rate was 20.2%. The combination of factors with the highest fatality rate was age ≥ 50 years + diabetes + obesity (57.1%). COVID-19 fatality rates conditioned by risk factors ranged from 1.7% to 57.1%, according to the presence or absence of specific comorbidities. Studies like this are necessary to address more precisely the risk of death among subpopulations exposed to different risk factors.

Toward the Institutionalization of a One Health Agenda: What the World can Learn from Bangladesh

Abstract In 2005 and 2007, prompted by Nipah and avian influenza outbreaks, respectively, faculties at Chattogram Veterinary and Animal Sciences University (CVASU) in Bangladesh initiated a civil society network of researchers in animal and human health. This network led to the launch a year later of One Health Bangladesh (OHB), a platform with membership open to multi-disciplinary scientists, practitioners, and activists. Along with continued advocacy to advance One Health agenda, OHB partnered with government, UN agencies, and other stakeholders to develop, in 2012, a National One Health Strategic Framework and Action Plan. The National Plan was later endorsed by the Ministry of Health and Family Welfare (MoHFW), Ministry of Fisheries and Livestock (MoFL), and Ministry of Environment, Forest, and Climate Change (MoEFC) followed by its implementation which introduced a three-tier multi-sectoral coordination mechanism including the establishment of a One Heath Secretariat in 2016. In 2017, an operational budget for the One Health Secretariat (OHS) was allocated by the MoHFW and three mid-level government officers from three government agencies, and the Directorate General of Health Services (DGHS), Department of Livestock Services (DLS), and Bangladesh Forest Department (BFD) were seconded to the OHS to make the Secretariat functional. OHB and the OHS now work together to advance the institutionalization process and implement One Health activities including One Health capacity building, joint surveillance, outbreak investigation and intervention, advocacy in the form of arranging dialogs, seminars, workshops, and conferences, and promoting cross sectoral and transdisciplinary collaboration, networking, and partnership nationally and internationally. Information © The Authors 2024

Performance of a municipal health secretariat in the face of the oil disastercrime in Pernambuco

RESUMO O desastre-crime do petróleo em 2019 é tido como o maior desastre ocorrido no litoral do Brasil. Considerada a primeira linha de enfrentamento de desastres no território, a gestão municipal de saúde é fundamental no processo de gestão de risco de desastre. Objetivou-se analisar a atuação de uma secretaria municipal de saúde da região metropolitana do Recife, Pernambuco, em relação ao derramamento do petróleo ocorrido em 2019. Foi realizado um estudo de caso do tipo descritivo com abordagem qualitativa. Foi realizada Análise de Conteúdo, com utilização do software IRaMuTeQ, das entrevistas com gestores da saúde, cujos resultados revelaram quatro categorias: gestão municipal na atenção com o mar; governança de risco de desastre e suas ausências; sindemia da covid-19 e impactos na reabilitação e recuperação das comunidades afetadas pelo desastre do petróleo; o que fazer se um desastre voltar a acontecer. No município em análise, houve a organização antecipada das ações de enfrentamento, a ausência da governança no desastre-crime e o enfoque da gestão em saúde na sindemia da covid-19, que foram apontados como dificuldades e vulnerabilidades na atuação, enquanto a educação permanente e a articulação com pescadores(as) e marisqueiras foram algumas das lições aprendidas.

Atuação de uma secretaria municipal de saúde diante do desastre-crime do petróleo em Pernambuco

ABSTRACT The 2019 oil disaster-crime is considered the largest disaster on the Brazilian coast. Given the frontline in disaster response, the municipal health secretariat is crucial in the disaster risk management process. This study aimed to analyze the performance of a municipal health secretariat in the metropolitan region of Recife, Pernambuco, regarding the 2019 oil spill, adopting a descriptive, qualitative case study. We performed content Analysis with the IRaMuTeQ software on interviews with health managers, and the results revealed four categories: municipal management in marine care; disaster risk governance and its absence; the COVID-19 syndemic and its impacts on the rehabilitation and recovery of oil disaster-affected communities; what to do if a disaster strikes again. In the municipality under study, we noted early organization of response actions, the lack of governance in the disaster-crime, and health management focus on COVID-19 syndemic, which were identified as difficulties and vulnerabilities in their actions, while continuing education and coordination with fishermen and shellfish gatherers were among the lessons learned.

Quality improvement work in general practice; a Norwegian focus group study

Background Quality improvement work is an essential feature of healthcare services, including general practice. In this study, we aimed to gain more knowledge regarding general practitioners’ (GPs) motivation for such work in their practices, as well as what kind of measures were considered motivating and feasible. Materials and methods We conducted five focus group interviews among Norwegian GPs between November 2021 and November 2022. We included 21 GPs of varying age, gender, experience, and geographic situation. The data were transcribed verbatim and analysed by Systematic Text Condensation, a thematic cross-case analysis. Results Many GPs had a diverse and imprecise understanding of the term quality improvement, and sound routines in everyday practice were often given as examples of quality improvement measures. There was a universal attitude that quality improvement initiatives should be close to practice, professionally relevant, and sufficiently small to be manageable. The availability of professional communities, either in the GP practices or in continuous medical education groups, was important for motivation. The role of nurses and health secretaries was highlighted as essential to achieve change. Participants commonly described negative reactions to programs that were imposed by external actors without regard for the GPs’ perceived needs. Conclusion GPs were motivated for quality improvement measures provided feasibility within the framework of general practice. Well-functioning professional communities, including involvement of nurses and health-secretaries, were emphasised as requisite for quality improvement. Small scale quality improvement programs suited for the needs of general practice were well received and should be further developed.

Exclusive breastfeeding in Colombia: analysis of data on respiratory infections and acute diarrhoeal diseases

Introduction: Despite the fact that Colombia is the fourth country in the world with the highest concession of maternity leave days, it still does not cover what is defined as essential to reduce Respiratory Tract Infection (RTI) and Acute Diarrhoeal Disease (ADD) in infants. Objective: The objective of this research was to analyze indicators of respiratory infections and acute diarrheal diseases during exclusive breastfeeding (EBF) in Colombia. Methodology: The management of solid research data at the institutional level used as instrument the LERU roadmap for health indicators in institutions attached to the Secretariat of Health of Bogota, based on the case study and matched controls 1: 2, from publications of the SaluData observatory, the Ten-Year Breastfeeding and Complementary Feeding Plan- PDLMAC 2021-2030, as well as the registry book of infants between 0 to 5 months of age, taking as a focused sample the Hospital San Juan de Dios in Colombia, the detection of the occurrence of events that allow formulating a hypothesis in accordance with the variables: breastfeeding and maternity leave; respiratory infections and acute diarrheal diseases. Results: The findings show that there is an association between exclusive breastfeeding during maternity leave to reduce respiratory infections and acute diarrheal diseases in the hospitals attached to the Health Secretariat of Bogota. One in six children does not receive exclusive breastfeeding during maternity leave in Colombia. Conclusion: As implications, the public health strategies must be reconsidered to favor EBF and extend maternity leave times, complying with the 6-month goal defined by the World Health Organization.

The influence of political disagreements and corruption on state health leader turnover during the COVID-19 pandemic in Brazil

PurposeGovernments faced formidable challenges in coordinating public health responses to the COVID-19 pandemic. This study aims to enhance the understanding of effective organizational leadership during crises by investigating the factors influencing the turnover of health leaders during the COVID-19 pandemic in Brazil.Design/methodology/approachUsing primary data encompassing all appointments and dismissals of federal and state health secretaries, this paper conducted a quantitative analysis of the relational and reputational factors that contributed to leader turnover during the COVID-19 pandemic. This paper also examined whether leaders’ management and public health experience increase the duration of tenure.FindingsStates encountered significant challenges in retaining experienced and effective leadership during the health emergency, primarily due to political conflicts in policymaking and, to a lesser extent, allegations of corruption. Furthermore, leaders with expertise in public health were found to be less likely to be removed from office. However, managerial experience did not prolong the tenure of state health secretaries during the emergency.Research limitations/implicationsSince most health leaders have public health and management experience, the contributions of each factor to the duration of a secretary’s tenure are difficult to separate and analyze separately.Practical implicationsThis study provides empirical insights into what factors drive health leader turnover during major health emergencies.Social implicationsDuring major health emergencies, health leaders often strongly disagree with elected officials on the response. This paper test how crisis leadership theories help explain state health leaders’ duration in one of the world’s largest public health systems during the COVID-19 pandemic. This paper find that policy disagreements contributed to significant turnover.Originality/valueTo the best of the authors’ knowledge, this paper is the first that are aware of that uses novel primary data on public health executive leader characteristics and turnover causes in the context of the COVID-19 pandemic. It provides empirical evidence contributing to the crisis leadership literature by examining health leader turnover in one of the world’s largest public health systems.

Health care prioritization process for the elderly in rural Tanzania under decentralized system: Prospects and challenges.

Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak. We aimed to analyse the prospects and challenges of the priority setting process for the elderly health care services following the 1990s health sector reforms in Tanzania. We conducted an exploratory case study on priority setting process for the elderly healthcare services in Igunga and Nzega Tanzania. We carried out 24 Key Informant Interviews (KIIs) with the positions of District medical officers, social welfare, Medical Officers in-charge (MOI), planning officers and health system information focal person. Additionally, we carried out two focus group discussions (FGDs), one from each district with six participants from each group. Participants for the FGDs were MOI, health secretary, representative members of Health Facility Governing Committee (HFGC) and Council Health Management Team (CHMT). Data were analyzed using the qualitative content analysis. Two categories emerged from the analysis of the transcripts. These were the prospects and challenges in priority setting for the elderly population under the decentralized health sector in rural Tanzania. The prospects included; the capacity of the LGAs on priority setting; existence of strategies used by LGAs; availability of teamwork spirit and the existence of guidelines for priority setting at LGAs. The challenges included difficulties of elderly identification, insufficient resources to implement the planned activities at the LGAs, unintegrated digitalized government health information tools or programs at the LGAs, interference of LGAs by the Central Government and low interest of stakeholders on elderly health care. This study highlights the prospects and challenges facing priority setting for elderly care at the centralized health system in rural Tanzania. From the results the process is well organized but faces some challenges which if not addressed jeopardized and has potential to continue affecting the priority setting. Addressing the challenges highlighted requires joint efforts from both the elderly population in the community, healthcare providers and decision makers across all levels of the health system. This study serves as an eye-opener and calls for a bigger study to get a comprehensive picture of priority setting of the elderly health care in Tanzania.

First year of COVID-19 in Brazil: Factors associated with the spread of COVID-19 in small and large cities.

To test the association between sociodemographic and social characteristics with COVID-19 cases and deaths in small and large Brazilian cities. This ecological study included COVID-19 data available in State Health Secretaries (managed by brasil.io API) and three national databases (IBGE, DATASUS and Embrapa). Temporal spread of COVID-19 in Brazil during the first year considered as outcome: a) days until 1st case in each city since 1st in the country; b) days until 1,000 cases/100,000 inhabitants since 1st case in each city; c) days until 1st death until 50 deaths/100,000 inhabitants. Covariates included geographic region, city social and environmental characteristics, housing conditions, job characteristics, socioeconomic and inequalities characteristics, and health services and coverage. The analysis were stratified by city size into small (<100,000 inhabitants) and large cities (≥100,00 inhabitants). Multiple linear regressions were performed to test associations of all covariates to adjust to potential confounders. In small cities, the first cases were reported after 82.2 days and 1,000 cases/100,000 were reported after 117.8 days, whereas in large cities these milestones were reported after 32.1 and 127.7 days, respectively. For first death, small and large cities took 121.6 and 36.0 days, respectively. However, small cities were associated with more vulnerability factors to first case arrival in 1,000 cases/100,000 inhabitants, first death and 50 deaths/100,000 inhabitants. North and Northeast regions positively associated with faster COVID-19 incidence, whereas South and Southeast were least. Social and built environment characteristics and inequalities were associated with COVID-19 cases spread and mortality incidence in Brazilian cities.

Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case–control study – FetRisks

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate...