Cervical cancer remains a significant public health challenge in Brazil, characterized by pronounced regional disparities in both incidence and mortality rates. For several decades, the country has predominantly relied on opportunistic cervical cytology (Pap smears) for cervical cancer screening. While cytology-based screening served as a cornerstone of preventive measures, its effectiveness has been hindered by limited coverage, opportunistic administration, and deficiencies in follow-up protocols. Brazil is now undergoing a transition towards primary HPV DNA testing, commencing at age 25, in accordance with international guidelines. This perspective article critically examines the potential implications of this transition for cervical cancer prevention over the next 25 years. Evidence suggests that HPV testing provides enhanced sensitivity, facilitates earlier detection of precancerous lesions, and enables the implementation of organized, population-based screening programs. However, challenges persist, including the risk of over-referral among younger women, existing health system inequalities, and the necessity for rigorous quality assurance and follow-up mechanisms. If successfully implemented, the new strategy could enable the detection of high-grade lesions up to a decade earlier, increase screening coverage, and reduce mortality rates, particularly in underserved regions. Nevertheless, the success of this initiative will depend on sustained financial investment, integration with vaccination efforts, and the assurance of equitable access to screening services.

Palavras-chave: Cervical cancer, HPV DNA test, Cytology, Screening, Brazil

OBJECTIVES: to develop an instrument designed to assess pregnant women's expectations regarding labor and birth.
METHODS: a cross-sectional study was conducted, utilizing two focus groups for the questionnaire's construction: one comprising eight obstetrics professionals and another with six pregnant women.
RESULTS: based on the focus group discussions, a preliminary 22-item questionnaire was developed. Its psychometric properties were tested in a pilot sample of 67 pregnant women. The results were descriptively analyzed and submitted to the validation process, where reliability measures and the validity of content, criterion and construction values were evaluated. The final instrument was composed of 10 items. Factorial analysis indicated three dimensions of the instrument: safety (four questions), feelings (four questions) and concerns (three questions). Its reliability was assessed using Cronbach's Alpha and Spearman Brown statistical tests, yielding values of 0.6727 and 0.7658, respectively.
CONCLUSIONS: the Questionnaire (QEDB) demonstrated adequate psychometric properties to measure pregnant women's expectations, particularly when examining the responses of women in the third trimester. Due to its ease of administration, the instrument can serve as a valuable tool in clinical obstetrics practice and for future research.

Palavras-chave: Birth expectations, Childbirth, Measurement instruments, Psychometric properties, Questionnaire

OBJECTIVES: to evaluate changes in breast cancer care among women assisted at a public hospital in Paraíba, Brazil, during the COVID-19 pandemic.
METHODS: retrospective cohort of women using the Sistema Único de Saúde (SUS) (Brazilian Public Health Service) at Hospital Napoleão Laureano (PB), and were diagnosed with in situ or invasive ductal carcinoma in the pre-pandemic (2017-2018) and pandemic (2020) periods. Sociodemographic, clinical and care-related data were collected. Differences between periods were assessed using chi-square or Fisher's exact test for categorical variables and Student's t or Mann-Whitney tests, for continuous variables (p<0.05).
RESULTS: among 218 women included, 114 were treated before the pandemic and 104 during. Most cases were palpable tumors and invasive carcinoma. Mastectomy was the predominant procedure, with immediate reconstruction in 24.8%. The interval between histopathological diagnosis and the first consultation with a specialist increased during the pandemic (p=0.04), and few women outside the capital could access the service (RR=0.63; 95%CI= 0.4-0.9; p=0.01). Delays on the appointment and abandonment of treatment were also higher during the pandemic, whereas immediate breast reconstruction decreased.
CONCLUSION: the pandemic hindered breast cancer care, increasing delays, interruptions of treatment, and reducing immediate reconstructions. These findings highlight the vulnerability of patients dependent of the public health services during health crises.

Palavras-chave: Neoplasias da mama, SARS-CoV-2, Pandemia, Diagnóstico tardio, Tempo para o tratamento

OBJECTIVES: to summarize evidence on the quantitative parameters of skin-to-skin contact during hospitalization in newborns ≤32 weeks of gestational age that are associated with infant interactive skills.
METHODS: a systematic review was conducted, consulting databases in August 2024: BVS, Pubmed, CINAHL, Scopus, APA PsycNET, and Web of Science. Eligible studies were those focusing on mother-preterm infant interaction, evaluated by behavioral observation, that performed skin-to-skin contact during hospitalization, and analyzed infant interactive skills. Studies with indirect evaluation or those including children born above 32 weeks of gestational age were excluded. Data extraction and evaluation of methodological quality were performed independently by three reviewers using the QUIPS Tool and Quality Assessment Tool scales.
RESULTS: eight studies were included. The minimum time for the initiation of skin-to-skin contact was found to be 15 minutes of life for stable preterm infants. The duration varied from 1 to 2 hours/day, for approximately 15 days. Skin-to-skin contact was associated with improving contact initiative, responsiveness, reciprocity, gaze, vocalization, positive affect, and the infant's negative mood.
CONCLUSION: skin-to-skin contact needs to be included in the routines of neonatal units, as a tool to promote initial interaction between mother and infant.

Palavras-chave: Mother-infant relations, Mother-child interaction, Skin-to-skin contact, Kangaroo care, Preterm infant, Systematic review

OBJECTIVES: to assess the COVID-19 pandemic impact on breastfeeding rates during birth hospitalization in a Baby-Friendly certified perinatal hospital in Portugal.
METHODS: observational retrospective study comparing pre-pandemic (2019) and pandemic (April-December 2020) periods. A total of 900 healthy term mother-newborn dyads in rooming-in were included. Maternal and neonatal variables associated with breastfeeding at discharge were analyzed using chi-square, Student's t-test, and multivariable logistic regression (p<0.05).
RESULTS: breastfeeding rates were higher in the pandemic period (99.3%) than in the pre-pandemic period (97.6%; p=0.031). Exclusive breastfeeding (80.2% vs. 81.6%; p=0.611) and skin-to-skin contact (56.2% vs. 58.0%; p=0.590) did not differ significantly. Exclusive breastfeeding was associated with vaginal delivery (pre-pandemic OR=3.07; 95%CI=1.83-5.13; p<0.001; pandemic OR=2.29; 95%CI=1.39-3.77; p=0.001), weight loss <10% (p<0.001), and absence of phototherapy in the pre-pandemic period (OR=3.38; 95%CI=1.96-7.12; p<0.001). No associations were found with maternal age, parity, sex, or gestational age.
CONCLUSIONS: exclusive breastfeeding rates were not negatively affected by pandemic restrictions. Maintaining Baby-Friendly practices preserved essential breastfeeding support.

Palavras-chave: Breastfeeding, COVID-19 pandemic, Newborn

OBJETIVOS: proceder a adaptação transcultural da escala The Postpartum Childcare Stress Checklist para ser utilizada no Brasil.
MÉTODOS: o processo de adaptação transcultural seguiu diretrizes definidas internacionalmente: dupla tradução, síntese e retrotradução, análise por comitê de especialistas, proposta de uma versão pré-final e pré-teste, avaliação das propriedades psicométricas e geração da versão final. A confiabilidade e validade da versão final foram analisadas por meio de estudo epidemiológico transversal envolvendo 190 mulheres em período pós-parto. Foram estimados o indicador α-Cronbach para análise da confiabilidade e análise fatorial exploratória com extração de componentes principais para análise da validade.
RESULTADOS: o indicador α-Cronbach foi de 0,894. A versão brasileira testada mostrou-se unidimensional e a análise fatorial apontou quatro fatores distribuídos de maneira muito próxima e que explicaram 57,8% da variância. Todos os itens do instrumento original foram mantidos na versão final proposta.
CONCLUSÃO: a versão brasileira proposta mostrou-se válida e confiável para aplicação em populações brasileiras.

Palavras-chave: Saúde materno-infantil, Depressão pós-parto, Escalas, Questionários

OBJECTIVES: to synthesize preventive measures against listeriosis during pregnancy as presented in the scientific literature.
METHODS: a scoping review was conducted following the PRISMA-ScR guidelines. Articles were systematically searched in the PubMed/MEDLINE, SciELO, Web of Science, LILACS, and Scopus databases. Screening and data extraction were performed manually, with the support of the Rayyan^® software.
RESULTS: of 449 articles initially identified, seven were included. The main preventive measures identified were educational interventions on risks and food safety practices, consistent with health authority recommendations. However, the literature also highlights significant challenges in effectively applying these measures, particularly in adapting them to specific social and cultural contexts.
CONCLUSIONS: health education remains the primary strategy for preventing listeriosis during pregnancy. Nevertheless, its effectiveness depends on integrated actions that address sociocultural barriers, regulatory frameworks, and systematic surveillance.

Palavras-chave: Listeriosis, Pregnancy, Prevention, Health education, Public health surveillance

OBJECTIVES: to develop and conduct a pilot test of a risk detection instrument for sexual domestic violence among schoolchildren aged 9 to 11 years, entitled the Risk Detection Instrument - Sexual Domestic Violence (IDR-VSD).
METHODS: this is a mixed method study conducted between January 2019 and December 2022, following the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. The qualitative phase included a consensus technique with nine interprofessional experts and cognitive interviews with the target population, including schoolchildren with impairment. A pilot test was conducted with 109 participants, and internal consistency, reliability, and factor structure were analyzed.
RESULTS: the initial version comprised 22 items with playful elements, distributed across four dimensions (biological, psycho-relational, social, and ecological). The intraclass correlation coefficient was 0.602 (95%CI=0.48-0.70; p<0.001). The overall Cronbach's alpha was 0.602. After correcting the item-total correlations, the overall alpha increased to 0.654 for 18 items. One item with a measure of sampling adequacy below 0.50 was removed. Exploratory factor analysis was performed with 17 items, distributed across five factors that explained 53.76% of the total cumulative variance, in accordance with the theoretical model.
CONCLUSION: the IDR-VSD demonstrates favorable measures of reliability and factor structure, despite the complexity of the studied phenomenon.

Palavras-chave: Domestic violence, Sexual violence, Instrument development, Risk assessment, Child

OBJECTIVES: this study aimed to explore, from a maternal perspective, the experiences of Brazilian women regarding prenatal care, childbirth, and immediate postpartum period, including the associated feelings and emotions.
METHODS: a qualitative phenomenological study was conducted with six women, aged 18 years or older, who were in the third trimester of pregnancy during the first part of the study, regardless of parity, and who received care in both public and private healthcare institutions. Semi-structured online interviews were conducted during pregnancy and after birth (30-45 days). Data were analyzed using Interpretative Phenomenological Analysis (IPA).
RESULTS: the findings strongly indicate that perceptions and emotions regarding pregnancy and childbirth varied widely across participants. Common anticipatory feelings included fear, curiosity, and anxiety. Participants who reported negative maternity care experiences expressed feelings of apprehension and stress, whereas positive experiences fostered confidence and peace of mind regarding childbirth.
CONCLUSION: the findings highlight the diverse range of perceptions and emotions during pregnancy, childbirth and immediate postpartum among women in Brazil. The study

Palavras-chave: Pregnancy, Childbirth, Maternal mental health, Experience, Phenomenology

OBJECTIVE: to estimate the prevalence of HIV and syphilis, and their association with gestational complications and newborn outcomes in women admitted for delivery at a mother and child center in the South of Brazil.
METHODS: cross-sectional study based on the review of electronic medical records of parturients (March/2016 to June/2018). Sociodemographic and clinical data were analyzed. HIV and syphilis were considered outcomes, then exposures to assess associations with pregnancy and neonatal variables. Prevalence Ratio (PR) were calculated using Poisson Regression with robust variance and 95% Confidence Interval (CI).
RESULTS: data from 6,527 women were evaluated. HIV prevalence was 0.6% and syphilis 1.5%. Women assisted by the public health system [PR=2.28 95%CI=1.07-4.82 for syphilis; PR=3.52 95%CI=1.06-11.72 for HIV] and drug users [PR=5.47 95%CI=2.49-12.04 for syphilis; PR=4.76 95%CI=1.12-20.19 for HIV] were more affected. Syphilis was more prevalent among younger and non-white women (p=0.001). Adequate prenatal care reduced syphilis by 38% (PR= 0.62 95%CI=0.39-0.97; p=0.006). Neonatal complications occurred in 32.3% of syphilis cases and 17.1% of HIV cases. Of the 98 syphilis cases, 29.6% led to congenital syphilis.
CONCLUSION: women in socially vulnerable conditions, such as drug users, were more affected. Congenital syphilis exceeded the national average, reinforcing the need for timely and comprehensive prenatal care.

Palavras-chave: Syphilis, HIV seropositive, Congenital syphilis, Sexually transmitted diseases, High-risk pregnancy

OBJECTIVES: the objective this study was evaluating the prevalence of maternal colonization by Group B beta-hemolytic Streptococcus (GBS) in pregnant women who delivered preterm and its relationship with adverse maternal/perinatal outcomes.
METHODS: we carried out a retrospective cohort study with singleton pregnancies with or without a culture for GBS (vaginal-rectum) who delivered spontaneously <37 weeks of gestation.
RESULTS: the study included 190 pregnant women, 53.1% (101/190) did not undergo culture for GBS and 46.8% (89/101) have done. Among the patients who had a culture, 13.5% (12/89) had positive culture for GBS and 86.5% (77/89) had a negative culture. Pregnant women without GBS culture had higher prevalence of preterm birth (74.3 vs. 59.6%, p=0.031) and lower prevalence of antibiotic prophylaxis (27.7 vs. 56.2%, p<0.001) than pregnant women with GBS culture. Higher prevalence of crystalline penicillin G use was observed in pregnant women with positive culture compared to pregnant women with negative culture for GBS (100 vs. 39%, p<0.0001). There was no significant association between pregnant women with or without a culture for GBS or positive and negative GBS cultures and adverse maternal/perinatal outcomes.
CONCLUSION: No significant association was found between GBS culture or not, GBS positive or negative culture, adequate or inadequate GBS prophylaxis, and the prevalence of adverse maternal/perinatal outcomes.

Palavras-chave: Group B beta-hemolytic Streptococcus, Screening, Preterm delivery, Antibiotic prophylaxis, Adverse maternal/perinatal outcomes

Hypertensive disorders in pregnancy, particularly preeclampsia, represent a global public health issue and are the leading cause of maternal mortality in Brazil, accounting for 20% of maternal deaths. Despite advancements in prevention, disparities persist, especially in low- and middle-income countries, where calcium intake is often below recommended levels. This article reviews the evidence supporting calcium supplementation as an effective strategy for preventing preeclampsia, with benefits extending beyond blood pressure control. Systematic review data from the Cochrane Library highlight a reduction in preeclampsia, maternal morbidity, and preterm birth among women who supplement and have low calcium intake. However, recent debates have questioned the universality of this recommendation, suggesting supplementation only for high-risk pregnancies. These controversies arise from methodological limitations in sensitivity analyses and misinterpretations. Nevertheless, the World Health Organization guidelines advocate calcium supplementation of 1.5-2 g/day for pregnant women in regions with low calcium intake. This recommendation aligns with findings demonstrating improved maternal and neonatal outcomes, emphasizing the need for widespread implementation. Urgent national policies in Brazil are required to ensure equitable access to calcium, particularly given the high prevalence of preeclampsia and maternal mortality.

Palavras-chave: High-risk pregnancy, Calcium, Preeclampsia, Maternal mortality, Public health

OBJETIVOS: analisar a distribuição geográfica dos serviços de saúde da linha de cuidado do câncer de mama em Pernambuco, Nordeste do Brasil.
MÉTODOS: estudo descritivo transversal com análise da distribuição geográfica dos serviços da linha de cuidado do câncer de mama, que utilizou o Cadastro Nacional de Estabelecimentos de Saúde, Plano Estadual de Oncologia e Sistemas de Informações Ambulatoriais e Hospitalares, no ano de 2022. As ferramentas empregadas na análise foram o Excel 2021, o TabWin DataSUS e o Geoclip versão Dubded.
RESULTADOS: a distribuição geográfica e os fluxos assistenciais revelaram disparidades regionais, especialmente nas Macrorregiões II, III e IV. A Macrorregião I é a mais equipada, concentrando a maioria dos mamógrafos (64,4%), além de possuir a maioria dos equipamentos de ultrassonografia (64,5%) e serviços de tratamento de câncer (65,1%). Observou-se a ausência de serviços para biópsia de mama no SUS no Cadastro Nacional de Estabelecimentos de Saúde. Das sete unidades indicadas no plano de oncologia, três não realizaram biópsias nos últimos cinco anos, e duas iniciaram em 2022.
CONCLUSÃO: os resultados evidenciaram a necessidade de (re)organizar a rede de atenção ao câncer de mama e a distribuição dos serviços de saúde, considerando necessidades locais, através da implementação da linha de cuidado com fluxos adequados, proporcionando atendimento oportuno e equitativo.

Palavras-chave: Oncologia, Câncer de mama, Acesso aos serviços de saúde, Equidade, Integralidade

OBJECTIVES: to evaluate pregnant women's knowledge on oral health and its association with sociodemographic characteristics.
METHODS: this exploratory cross-sectional study included a convenience sample of 69 women attended at a prenatal referral outpatient clinic in a Brazilian city. Data were collected using an oral health questionnaire adapted from Bianco (2010); higher scores indicated better knowledge. The outcome "knowledge on oral health " was dichotomized at the sample mean (less/more). Sociodemographic and oral health-related variables were obtained from the questionnaire, and associations were tested using Pearson's chi-square/Fisher's exact tests (α=0.05).
RESULTS: most participants who were unemployed, had completed secondary education, and had low family income; 50.7% had less knowledge on oral health. Lower scores involved primary and permanent dentition, tooth eruption and exfoliation, and causes of dental caries, halitosis, and oral cancer. In bivariate analyses, women with lower family income and lower schooling were more frequently classified as having lower knowledge on oral health, whereas employed women were more frequently classified as having higher knowledge.
CONCLUSION: pregnant women showed limited knowledge on oral health, especially among those in socioeconomically more vulnerable groups. Given the cross-sectional design and the use of an unvalidated instrument for pregnant women, findings should be interpreted cautiously and may inform educational strategies in similar services.

Palavras-chave: Oral health, Pregnant women, Knowledge, Cross-sectional study, Observational study

OBJECTIVES: to develop and validate an educational booklet for pregnant women experiencing pelvic girdle pain.
METHODS: this was a methodological development study conducted at the Federal University of São Carlos, Brazil. The educational booklet was developed following a comprehensive literature review and subsequently validated by healthcare professionals and pregnant women. Content and appearance were assessed using the Content Validity Index (threshold: 0.8 or higher) and the percentage of absolute agreement among participants (threshold: 75% or higher).
RESULTS: in the first stage, healthcare professionals rated the material with a mean global content validity of 0.93. In the second stage, pregnant women indicated an 89.2% agreement regarding its clarity, relevance, and usability. The final version, titled "What You Need to Know About Gestational Pelvic Pain", includes an introduction, the definition and location of pain, its relationship with pregnancy, and practical guidance for prevention and self-management.
CONCLUSION: the educational booklet met the acceptability standards established for validation and may contribute to improving prenatal care and self-management of pelvic girdle pain.

Palavras-chave: Pregnancy, Health education, Pelvic girdle pain, Physical therapy, Validation study