Sao Paulo Medical Journal最新文献

{"title":"Multilevel auditory and cognitive processing in post-stroke aphasia: associations with language performance using ABR, LLR, and P300: a cross-sectional observational study.","authors":"Agit Şimşek, Nihal Sümeyye Ulutaş, Feyza Deniz Saman","doi":"10.1590/1516-3180.2026.3635.08042026","DOIUrl":"10.1590/1516-3180.2026.3635.08042026","url":null,"abstract":"<p><strong>Background: </strong>Aphasia following stroke is primarily characterized by language impairment; however, accumulating evidence suggests that deficits in auditory and cognitive processing may also contribute to impaired language function. Auditory evoked potentials provide objective markers of neural processing across subcortical, cortical, and cognitive levels and may help clarify the neurophysiological mechanisms underlying post-stroke aphasia.</p><p><strong>Objectives: </strong>To investigate multilevel auditory processing and its relationship with language performance in individuals with post-stroke aphasia using Auditory Brainstem Responses (ABR), Late Latency Responses (LLR), and P300 potentials.</p><p><strong>Design and setting: </strong>Cross-sectional observational study conducted at a university hospital in Türkiye.</p><p><strong>Methods: </strong>Twenty-nine individuals with post-stroke aphasia and 33 age-matched healthy controls were included. Language performance was assessed using the Aphasia Language Assessment Test and a standardized naming task. Auditory processing was evaluated using ABR, LLR (P1, N1, P2, N2), and P300 potentials recorded according to standard electrophysiological protocols. Group comparisons were performed for latency and amplitude measures, and correlation analyses were conducted to examine associations between electrophysiological parameters and language performance.</p><p><strong>Results: </strong>Compared with healthy controls, individuals with aphasia demonstrated significantly prolonged latencies in ABR waves and interpeak intervals, as well as in all LLR and P300 components (p < 0.05). No significant group differences were observed in amplitude measures. Naming performance was significantly lower in the aphasia group. Although correlations between language performance and electrophysiological measures did not reach statistical significance, moderate negative trends were observed between naming scores and N2 and P300 latencies.</p><p><strong>Conclusion: </strong>Post-stroke aphasia is associated with delayed auditory processing across subcortical, cortical, and cognitive levels, reflecting generalized slowing rather than reduced neural recruitment. Latency-based auditory evoked potential measures may complement behavioral language assessments and support a multilevel auditory-cognitive framework for aphasia evaluation and rehabilitation.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20263635"},"PeriodicalIF":1.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of melasma in pregnant women and its relationship with body perception: a cross-sectional study in Türkiye.","authors":"Demet Toktaş, Rabia Atilla","doi":"10.1590/1516-3180.2026.3641.27032026","DOIUrl":"10.1590/1516-3180.2026.3641.27032026","url":null,"abstract":"<p><strong>Background: </strong>Melasma is one of the most common physiological hyperpigmentation disorders observed during pregnancy, and its clinical characteristics and risk factors have been extensively investigated. However, evidence regarding the relationship between pregnancy-related melasma and body perception remains limited.</p><p><strong>Objective: </strong>This descriptive cross-sectional study aimed to determine the prevalence of melasma among pregnant women and to examine its association with body perception.</p><p><strong>Methods: </strong>This study included 450 pregnant women in the central city center of the Central Anatolia Region of Türkiye who met the inclusion criteria. Data were collected using the Introductory Information Form, the Melasma and Skin Type Characteristics Assessment Form, and the Body Perception Scale (BPS) and analyzed using descriptive statistics, comparative analyses, and logistic regression.</p><p><strong>Results: </strong>Melasma was identified in 37.8% of the participants, and the centrofacial pattern was the most common presentation (56.5%). A statistically significant association was found between pregnancy-related melasma and total BPS scores (p < 0.05). Pregnant women without melasma had significantly higher mean BPS scores than those with melasma (150.83 ± 17.18 vs. 146.15 ± 15.16; p = 0.004). Logistic regression analysis demonstrated that low educational and income levels, a personal or family history of melasma, and Fitzpatrick skin type IV were significant predictors of pregnancy-related melasma (p < 0.05), accounting for 61% of the variance.</p><p><strong>Conclusion: </strong>The findings indicate the need for a holistic assessment of physiological skin changes and body perception during pregnancy, as well as the integration of counseling, education, and nursing care interventions targeting risk factors into routine prenatal care.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20263641"},"PeriodicalIF":1.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of balance, sleep quality, and depression in relation to attention in Parkinson's disease: A cross-sectional P300 study.","authors":"Gulfem Ezgi Ozaltin, Agit Simsek, Busra Candiri, Fatma Ebru Algul, Mehmet Tecellioglu, Burcu Talu","doi":"10.1590/1516-3180.2026.3465.10032026","DOIUrl":"10.1590/1516-3180.2026.3465.10032026","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by motor and non-motor symptoms. Attention deficits are common in patients with PD, and balance can be affected by sleep quality and depression. The auditory event-related potential (ERP) P300 tool is associated with attention and discrimination processes and is a sensitive indicator of attention.</p><p><strong>Objectives: </strong>This study aimed to investigate the effects of balance, sleep quality, and depression on attention in individuals with PD using P300 latency.</p><p><strong>Design and setting: </strong>In this cross-sectional study, 28 individuals with PD and 27 healthy controls were assessed.</p><p><strong>Methods: </strong>Attention was measured using the auditory ERP P300, balance with the Berg Balance Scale (BBS), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and depression with the Beck Depression Inventory (BDI). Multiple linear regression analysis was used to examine the effects of these variables on P300 latency.</p><p><strong>Results: </strong>Significant differences were found between the groups in terms of attention, balance, sleep quality, and depression (all P < 0.001). Regression analysis indicated that balance (B = -4.909, P = 0.001) and sleep quality (B = 12.704, P = 0.007) were significantly associated with P300 latency, whereas depression (B = 3.472, P = 0.084) was not.</p><p><strong>Conclusion: </strong>PD is associated with impaired attention, balance deficits, poor sleep quality, and increased depressive symptoms. The significant association between balance performance and sleep quality with attentional processing highlights their potential relevance in clinical assessment and management.</p><p><strong>Clinical trial registration: </strong>The study was registered with Clinical Trials (NCT04687371 - https://clinicaltrials.gov/study/NCT04687371).</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253465"},"PeriodicalIF":1.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation, cultural adaptation, and evidence of content and face validity of a questionnaire to assess REDs knowledge in Brazil: a cross-cultural validation study.","authors":"Uyara Pereira de Maria, Claudia Ridel Juzwiak","doi":"10.1590/1516-3180.2025.3135.08042026","DOIUrl":"10.1590/1516-3180.2025.3135.08042026","url":null,"abstract":"<p><strong>Background: </strong>Relative energy deficiency in sport (REDs) is a syndrome that impairs physiological function because of low energy availability. Awareness and knowledge of REDs among athletes and health professionals are essential for early identification and prevention.</p><p><strong>Objective: </strong>To translate into Brazilian Portuguese and culturally adapt a questionnaire that assesses knowledge of the signs, symptoms, and consequences of REDs, originally created by Pai et al., and to obtain evidence of content and face validity.</p><p><strong>Design and setting: </strong>Translation, cultural adaptation, and validation study conducted remotely using online tools and digital data collection.</p><p><strong>Methods: </strong>The translation and cultural adaptation consisted of the following steps: two independent translations, synthesis of the translations by a committee of health professionals, two back-translations, and review by a committee of experts to determine the best version for testing. For content validity, the content validity coefficient (CVC) was calculated based on the evaluation of the experts committee on the practical pertinence, theoretical relevance, and linguistic clarity of the items of the pretest version. For face validity, the pretest version was applied to 30 individuals who assessed the items for linguistic clarity, adequacy, and comprehensibility.</p><p><strong>Results: </strong>The CVC for the scale was 0.97. The CVC values for clarity, pertinence, and relevance were 0.97, 1 and 0.99, respectively. All items had a CVC > 0.8, confirming acceptable content validity. The pretest version was tested on 12 female runners, eight coaches, and 10 dietitians. Items were clear and comprehensible to 93% and adequate to 96% of respondents. No changes were needed, and the pretest version was defined as the Brazilian version of the questionnaire to assess REDs knowledge (QC-REDs).</p><p><strong>Conclusion: </strong>The QC-REDs obtained strong content and face validity. It provides a rigorously adapted tool for Brazil, supported by positive feedback from the target population, demonstrating its applicability and usability. This instrument fills a crucial gap and offers a valuable resource for researchers and professionals working with athletes at risk of REDs. Future research should focus on psychometric validation to further solidify its effectiveness in the Brazilian context.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253135"},"PeriodicalIF":1.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of the Positive Aspects of Caregiving Scale for unpaid caregivers of people living with dementia in the Brazilian context: a validation study.","authors":"Sofia Cristina Iost Pavarini, Aline Cristina Martins Gratão, Camila Rafael Ferreira Campos, Diana Quirino Monteiro, Elizabeth Joan Barham, Fabiana de Souza Orlandi, Gabriela Martins, Gustavo Carrijo Barbosa, Keila Cristianne Trindade da Cruz, Larissa Corrêa, Luana Aparecida Rocha, Ludmyla Caroline de Souza Alves, Ana Carolina Ottaviani","doi":"10.1590/1516-3180.2025.3184.06042026","DOIUrl":"10.1590/1516-3180.2025.3184.06042026","url":null,"abstract":"<p><strong>Background: </strong>The Positive Aspects of Caregiving Scale (PAC) assesses the satisfaction and psychosocial benefits perceived by caregivers in the caregiving experience.</p><p><strong>Objective: </strong>To analyze the psychometric properties of the PAC among unpaid caregivers of people living with dementia in the Brazilian context.</p><p><strong>Design and setting: </strong>Validation study of the instrument conducted online with caregivers from different regions of Brazil.</p><p><strong>Methods: </strong>The sample comprised 100 unpaid caregivers of people living with dementia. Sociodemographic characteristics, positive aspects of caregiving, burden, depressive symptoms, anxiety symptoms, and quality of life were assessed using an online form. Evidence of validity based on internal structure was examined using confirmatory factor analysis, reliability testing, and criterion validity analysis.</p><p><strong>Results: </strong>Most participants were women (95%), daughters of the care recipient (85%), with an average age of 54.5 years, a high educational level, and residence in the Southeast region of Brazil. Depressive symptoms (70%), anxiety (65%), moderate to severe burden (42%), and low quality of life (62%) were prevalent. Factor analysis indicated satisfactory fit for the PAC, and the high correlation between factors supported consideration of a one-dimensional scoring structure. The scale showed high internal consistency (α = 0.89) and significant correlations with burden, anxiety symptoms, depressive symptoms, and quality of life.</p><p><strong>Conclusion: </strong>The PAC showed good psychometric properties in the Brazilian context, supporting its validity and reliability for assessing positive aspects of caregiving among unpaid caregivers of people living with dementia.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253184"},"PeriodicalIF":1.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family functionality and social support in Brazilian older people with chronic kidney disease in hemodialysis: a cross-sectional study.","authors":"Ana Beatriz Murari Thomazini, Diana Gabriela Mendes Dos Santos, Yngrid Larisse Teodoro de Souza, Daiane Baldo Apolinário, Ana Luiza Barbosa, Marisa Silvana Zazzetta, Fabiana de Souza Orlandi","doi":"10.1590/1516-3180.2025.3529.18032026","DOIUrl":"10.1590/1516-3180.2025.3529.18032026","url":null,"abstract":"<p><strong>Background: </strong>End-stage chronic kidney disease (CKD) requires hemodialysis, which carries significant biopsychosocial impact.</p><p><strong>Objectives: </strong>This study aimed to investigate the relationship between family functionality and social support among older individuals undergoing hemodialysis.</p><p><strong>Design and setting: </strong>This cross-sectional and correlational study was conducted at a renal replacement therapy unit located in São Paulo State.</p><p><strong>Methods: </strong>A total of 118 participants aged ≥ 60 years undergoing hemodialysis were interviewed individually using the Family adaptability, partnership, growth, affection, and resolve (APGAR), and the Medical Outcomes Study Social Support Scale. All ethical principles were duly respected.</p><p><strong>Results: </strong>Majority of participants were male (69.5%), aged between 60-69 years (50.8%), white ethnicity (63.6%), with a stable partner (54.2%), and had an income of one to three times the minimum wage (55.9%). Regarding the domains of social support, affective support (AS) had the highest mean score (93.44 ± 12.97), whereas informational support (IS) had the lowest (81.69 ± 24.60). Overall, 83.9% reported good family functioning, 9.3% moderate family dysfunction, and 6.8% severe dysfunction. A statistically significant positive correlation with a moderate magnitude was confirmed between APGAR with all support domains. Material support (MS, r = 0.327), AS (r = 0.425), emotional support (ES, r = 0.518), positive social interaction support (PSIS, r = 0.466), and IS (r = 0.421).</p><p><strong>Conclusion: </strong>Social support was positively associated with family functioning, indicating that patients with CKD undergoing hemodialysis who reported better family functioning also perceived higher levels of social support.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253529"},"PeriodicalIF":1.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety in the transport of substances of human origin: a critical challenge for the quality of transplants.","authors":"Bartira de Aguiar Roza, Andre Ibrahim David, Flavio Pola Dos Reis, Paulo Manuel Pêgo-Fernandes","doi":"10.1590/1516-3180.2026.1443.23022026","DOIUrl":"10.1590/1516-3180.2026.1443.23022026","url":null,"abstract":"","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20261443"},"PeriodicalIF":1.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of physical activity associated with bariatric surgery on systemic arterial hypertension control: a systematic review.","authors":"Julia Barros Brito, Ana Gabriela Terencio de Sousa, Lélia Lessa Teixeira Pinto, Eric Simas Bomfim, João Henrique Cerqueira Barros, Josias Melo Leite, Luiz Alberto Bastos de Almeida, Lucas Antônio Jesus de Souza, Milton Rocha Moraes, Clarcson Plácido Conceição Dos Santos","doi":"10.1590/1516-3180.2025.3540.23022026","DOIUrl":"10.1590/1516-3180.2025.3540.23022026","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a highly prevalent condition frequently associated with systemic arterial hypertension (SAH). Bariatric surgery (BS) is an effective strategy for weight loss and has been shown to improve blood pressure (BP) control, whereas physical activity (PA) is recognized as an important adjuvant therapy for treatment of SAH. Nevertheless, evidence regarding the combined impact of BS and PA on BP reduction remains inconsistent.</p><p><strong>Objectives: </strong>This review aimed to evaluate whether BS combined with PA contributes to additional BP reduction in individuals with obesity.</p><p><strong>Methods: </strong>The review followed PRISMA guidelines and was registered in PROSPERO (CRD42024628299). Eligible studies included randomized controlled trials, cohort and cross-sectional studies involving adults who underwent BS, with or without PA. Searches were performed in CENTRAL, PubMed, LILACS, and BVS. Methodological quality was assessed using the RoB2 and JBI tools, and the certainty of evidence was graded according to GRADE.</p><p><strong>Results: </strong>Of the 406 records screened, nine studies were included (n = 504 participants). BS alone was associated with significant reductions in BP. When PA was combined with BS, additional reductions were reported; however, the findings were heterogeneous and supported by low to very low certainty of evidence. The follow-up duration across studies ranged from 4 months to 5 years.</p><p><strong>Conclusion: </strong>The combination of BS and PA provides modest but clinically relevant benefits in BP reduction. However, the limited number of studies and short follow-up periods preclude definitive conclusions. High-quality, long-term randomized clinical trials are warranted to clarify the role of PA in optimizing BP control after BS.</p><p><strong>Clinical trial or systematic review registration: </strong>The review followed PRISMA guidelines and was registered in PROSPERO (CRD42024628299).</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253540"},"PeriodicalIF":1.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-surgical facial harmonization for gender affirmation and psychosocial well-being in transmasculine persons: an exploratory mixed-methods study.","authors":"Liliane Lins-Kusterer, Victor Augusto Bastos E Silva, João Gabriel Macedo Briglia, José Valber Lima Meneses, Larissa do Nascimento Sampaio Celestino, Iza Maura Alves Travenzoli, Rodrigo Fernandes Weyll Pimentel","doi":"10.1590/1516-3180.2025.3274.25022026","DOIUrl":"10.1590/1516-3180.2025.3274.25022026","url":null,"abstract":"<p><strong>Background: </strong>Facial appearance plays a central role in gender recognition and identity congruence, particularly among transmasculine individuals. Although the demand for gender-affirming care has increased, evidence regarding the psychosocial implications of nonsurgical facial masculinization using hyaluronic acid remains limited, especially within public health systems.</p><p><strong>Objectives: </strong>To describe the subjective and psychosocial experiences related to nonsurgical facial harmonization with hyaluronic acid among transmasculine individuals receiving care in public health settings.</p><p><strong>Design and setting: </strong>A mixed-methods exploratory study with a qualitative core component was conducted in a public, gender-affirming outpatient clinic in Salvador.</p><p><strong>Methods: </strong>Six transmasculine patients participated in semi-structured interviews. The FACE-Q Satisfaction with Facial Appearance Overall Scale (SFAOS) and Beck Anxiety Inventory (BAI) were administered before and 30 days after the procedure as complementary quantitative measures. Qualitative data were analyzed using thematic content analysis based on Bardin's framework, with sampling guided by theoretical saturation.</p><p><strong>Results: </strong>Participants reported perceived reductions in facial dysphoria, improvements in self-perception, and greater social confidence after the procedure. Complementary quantitative measures indicated consistent short-term increases in facial satisfaction scores and a trend toward reduced anxiety.</p><p><strong>Conclusions: </strong>In this exploratory study, nonsurgical facial harmonization with hyaluronic acid was associated with short-term improvements in self-perceived facial satisfaction and psychosocial comfort among transmasculine participants. Given the small sample size and short follow-up period, these findings should be interpreted as preliminary. Larger studies with longer follow-up periods and comparative designs are warranted to evaluate the durability and generalizability of our findings.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 2","pages":"e20253274"},"PeriodicalIF":1.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connecting care-telemedicine breaks barriers for low-income Brazilians battling breast cancer: a prospective cohort study.","authors":"Gabriel Salum D'Alessandro, Yedda Nunes Reis, Mila Trementosa Garcia, Daniela Zaros Guimarães, Roberta Amparado Miziara, Flavia Colsomagno Silveira Berlofa, Mayara de Cássia Benedito Andrade, Emily Rie Yoshizato, Jonathan Yugo Maesaka","doi":"10.1590/1516-3180.2025.3116.09032026","DOIUrl":"10.1590/1516-3180.2025.3116.09032026","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine may help advance healthcare equity, particularly in low-income communities, by reducing economic burdens and mitigating geographic barriers to specialized care, including transportation costs, time away from work, and long travel distances to referral centers.</p><p><strong>Objectives: </strong>This study aims to evaluate the impact of a remote consultation protocol on healthcare access among predominantly low-income patients with breast cancer in Brazil.</p><p><strong>Design and setting: </strong>This prospective cohort study was conducted at a tertiary public cancer center and included 946 women with breast cancer.</p><p><strong>Methods: </strong>Sociodemographic characteristics, teleconsultation-related data, and patient satisfaction measured using a validated Likert-based questionnaire were collected. The study was approved by the local ethics committee, and all participants provided informed consent.</p><p><strong>Results: </strong>The mean age was 57.3 years. Overall, 51.6% of participants identified as white, and 64.4% reported a family income below two Brazilian minimum wages. Over one-third (34.3%) had not completed elementary school. Despite this socioeconomic vulnerability, 93.5% reported internet access, 90.3% owned a mobile phone, and 52.7% had an email address. During the study period, 946 appointments were scheduled and screened for teleconsultation eligibility. Among these, 229 patients met predefined eligibility criteria and were offered teleconsultation, and 117 completed the remote visit, corresponding to an uptake of 51.1% among eligible patients. Regarding hospital visits, 57% relied on public transportation, with a mean cost of $ 4 per visit, representing a substantial financial burden. Travel time exceeded 90 minutes for 19.4% of patients. Satisfaction with teleconsultation was high, with a mean Likert score of 4.65/5 and a Net Promoter Score of 79.8.</p><p><strong>Conclusion: </strong>Among patients eligible for telemedicine, more than half completed teleconsultation, indicating that implementation is feasible even in socially vulnerable populations with limited digital literacy. The remote care protocol improved access, reduced financial burden, and achieved high patient satisfaction, supporting telemedicine as a strategy to promote equity in breast cancer care in Brazil.</p>","PeriodicalId":49574,"journal":{"name":"Sao Paulo Medical Journal","volume":"144 3","pages":"e20253116"},"PeriodicalIF":1.2,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}