To publish and divulge scientific production on subjects of relevance to Public Health.
Universidade de São Paulo. Faculdade de Saúde Pública
Hydrological disasters and health losses: an index-based analysis for Brazil
OBJECTIVE: To develop and apply composite indices to assess immediate losses caused by hydrological disasters in Brazil between 2000 and 2023, with a focus on human losses and damages to health infrastructure. METHODS: Data were obtained from the Integrated Disaster Information System, which consolidates national records of hydrological disasters. Seven indicators were selected for the Human Loss Index and four for the Health Infrastructure Loss Index. Indicators were normalized using Min-Max procedures and weighted through a combined Analytic Hierarchy Process and entropy method. The General Severity Index was calculated as the arithmetic mean of Human Loss Index and Health Infrastructure Loss Index, stratified into four levels of severity. Spatial and temporal analyses were conducted to identify critical regions and municipalities. RESULTS: The findings reveal significant heterogeneity in disaster impacts across time and space. Human losses exhibited greater variability than health infrastructure losses, with notable peaks in 2006, 2011, 2015, and 2019. Infrastructure damages were less frequent but highly disruptive, especially in 2012, 2019, and 2023. Municipalities in the Amazon region, particularly Japurá and Atalaia do Norte, registered the highest combined indices, reflecting compounded vulnerabilities from geographic isolation, fragile infrastructure, and socioeconomic inequalities. High General Severity Index scores were concentrated in the North, while human losses were more widely distributed, including along the densely populated southeastern coast. Results confirm that small and socioeconomically vulnerable municipalities are disproportionately affected, with limited institutional capacity to respond. CONCLUSIONS: Hydrological disasters in Brazil are strongly mediated by social inequalities, deficient urban planning, and weak preventive policies. Human and infrastructure losses disproportionately affect vulnerable populations, particularly in the North, where access to health services is precarious. The findings emphasize the need for territorially integrated strategies that combine climate adaptation, poverty reduction, and investments in resilient public health infrastructure.
Copyright (c) 2026 Gisele Paixão Pereira, José Firmino de Sousa Filho, Thomás Rocha Ferreira, Paulo Victor Maciel da Costa, Andrêa Jacqueline Forte Ferreira, Julia Moreira Pescarini, Joanna Miguez Nery Guimarães, Sofia Rafaela Maito Velasco, Danielson Jorge Delgado Neves, Jean Souza dos Reis, Kecia Cristina Miranda da Silva, Gervásio Ferreira dos Santos, Rita de Cássia Ribeiro Silva, Roberto Fernandes Silva Andrade, Maurício Lima Barreto https://creativecommons.org/licenses/by/4.0
Progress, challenges, and lessons for climate resilient and low carbon health systems in Latin America and the Caribbean: an exploratory mixed-methods study
OBJECTIVE: To assess progress, challenges, and enabling factors for building climate-resilient and low-carbon health systems across Latin America and the Caribbean, a region facing accelerating climate-sensitive health burdens amidst persistent health system fragilities. METHODS: We conducted an explanatory, sequential, mixed-methods study integrating quantitative analysis of the Pan American Health Organisation Climate Change and Health surveys from 2021/2022 (n = 24 countries) and 2023/2024 (n = 27 countries) with semi-structured interviews involving four countries demonstrating progress (Argentina, Chile, Jamaica, Peru). Quantitative data were analysed descriptively across three sub-regions (Caribbean, Central America, South America). Qualitative data underwent two-stage coding (deductive and inductive) with three-researcher consensus to identify barriers, enablers, and lessons learned. RESULTS: By 2023/2024, 93% of countries had designated climate-health focal points (71% in 2021/2022). However, implementation gaps persist: less than 50% of countries had integrated climate change into national health reports; 22–40% developed national climate-health strategies; and vulnerability assessments rarely informed policy. Access to international climate finance remained inequitable. Whilst 60–74% developed disaster preparedness plans, only 30–44% implemented public health communication campaigns. Training focused on environmental health personnel, with doctors, nurses, and planning staff minimally engaged. Qualitative analysis revealed interconnected barriers: climate change perceived as distant rather than urgent, competing priorities overwhelming decision-makers, institutional silos, and misalignment between available training and local needs. Key enablers included linking climate action to established health priorities, institutionalising responsibilities through formal mechanisms, multi-stakeholder engagement, and committed individuals with diplomatic skills navigating cross-sectoral dynamics. CONCLUSION: Latin America and the Caribbean countries are establishing foundations for climate-resilient and low-carbon health systems, but translating governance progress into sustained implementation requires addressing systemic barriers through institutionalisation beyond political cycles, tailored capacity building, and innovative financing mechanisms. These findings inform guidance for health systems strengthening amidst accelerating climate change.
Copyright (c) 2026 Yasna Palmeiro-Silva, Camila Llerena-Cayo, Sebastian Bauhoff, Kristie L. Ebi, Catharina Giudice, Cristian A. Herrera, Jeremy J. Hess, Zuhelen Padilla, Karen Alicia Polson, Zoila Vela-Clavo, Daniel Forsin Buss, Stella M. Hartinger https://creativecommons.org/licenses/by/4.0
Age at menarche and general and abdominal obesity in older Brazilian women: ELSI-Brazil
OBJECTIVE: To examine the association between age at menarche and general and/or abdominal obesity in Brazilian women aged ≥ 50 years. METHODS: Cross-sectional study conducted with data from the second wave of the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros — ELSI (ELSI-Brazil, 2019–2021), in a nationally representative sample of community-dwelling individuals aged ≥ 50 years. Self-reported age at menarche was categorized as ≤ 12 years, 13–15 years, and ≥ 16 years. General obesity was defined as a body mass index of ≥ 30 kg/m2, and abdominal obesity as a waist circumference of ≥ 88 cm. The variables were combined into “general or abdominal obesity” and “general and abdominal obesity”. Multinomial logistic regression adjusted for sociodemographic and lifestyle characteristics was used. RESULTS: Among the 4,229 participants, 41.1% (95% confidence interval —95%CI 37.9–44.3) reported menarche at ≤ 12 years and 9.3% (95%CI 8.0–10.9) at ≥ 16 years. The prevalence of general or abdominal obesity was 36.6% (95%CI 33.7–39.5), while the prevalence of general and abdominal obesity was 35.0% (95%CI 32.5–37.7). After adjustments, women with age at menarche of ≤ 12 and 13–15 years had, respectively, 84% (odds ratio — OR = 1.84; 95%CI 1.14–2.98) and 64% (OR = 1.64; 95%CI 1.04–2.57) greater odds of general and abdominal obesity compared with those with menarche at ≥ 16 years. There was no significant association between age at menarche and general or abdominal obesity. CONCLUSION: Menarche before age 16 is associated with a higher odds of general and abdominal obesity combined, but not in isolation, suggesting its potential as a relevant marker for the formulation of public policies aimed at preventing obesity in girls from school age onwards.
Copyright (c) 2026 Nair Tavares Milhem Ygnatios, Juliana Vaz de Melo Mambrini, Juliana Lustosa Torres, Núbia Carelli Pereira de Avelar, Ana Lúcia Danielewicz, Rosana Carolina Souza Duarte de Matos, Luciana de Souza Braga, Maria Fernanda Lima-Costa, Bruno de Souza Moreira https://creativecommons.org/licenses/by/4.0
Association between food knowledge and adherence to the Brazilian Food Guide
OBJECTIVE: To investigate the association between food knowledge according to the level of food processing and adherence to the recommendations of the Dietary Guidelines for the Brazilian Population. METHODS: This study was carried out with a subsample of the NutriNet-Brazil cohort based on quotas (n = 1,053). Adherence to the Guide was assessed using a scale of dietary practices (24 items), which generates a score ranging from 0 to 72. To assess knowledge, participants indicated on a scale of 1 to 10 how healthy they considered each item on a list of 12 foods in four categories (fruit, meat, dairy products and grains), including three groups from the Nova food classification: fresh or minimally processed (G1); processed (G3); and ultra-processed (G4). To generate the score (0 to 8), two points were assigned in each category when option G1 was evaluated as healthier than G3, and both as healthier than G4. In the analysis, sample weighting was used to bring the distribution of the sample closer to the profile of the Brazilian population. T he association between the knowledge score and adherence to the Guide was tested using linear regression with adjustment for sociodemographic, socioeconomic and behavioral variables. RESULTS: The mean score for adherence to the Guide was 43.1 (SD = 9.29) and the mean score for knowledge was 5.4 (SD = 1.2). In the crude model, for every one point increase in knowledge, adherence to the Guide increased by an average of 0.8 points (p = 0.002). The association remained significant in the adjusted model, but the coefficient was reduced to 0.6 (p = 0.020) with the inclusion of socioeconomic variables in the model. CONCLUSION: Greater knowledge to recognize ultra-processed foods as less healthy is associated with greater adherence to the dietary practices recommended by the Dietary Guidelines for the Brazilian Population, reinforcing the importance of disseminating the recommendations.
Copyright (c) 2026 Kamila Tiemann Gabe, Patricia Constante Jaime https://creativecommons.org/licenses/by/4.0
Cost of a healthy and sustainable basic food basket in Brazil between 2009 and 2024
OBJECTIVE: To evaluate the evolution of the cost of a proposed healthy and sustainable basic food basket, nationally and for metropolitan regions, between 2009 and 2024. METHODS: Food purchase data (quantities and amounts paid) from the 2008–2009 and 2017–2018 Pesquisas de Orçamentos Familiares (POF - Household Budget Surveys) were used. T he food groups that make up the baskets were based on the Eat-Lancet planetary diet and official regulatory instruments. The Broad Consumer Price Index for foods and food groups was used to update the monthly prices of the items consumed by the Brazilian population in the context of the POFs that make up the proposed basic food basket. The accumulated inflation over the period was discounted to compare monetary values over time, calculating the real value of the basic food baskets. RESULTS: The real cost of the proposed national basic food basket remained relatively stable between 2009 and 2012, showing a subsequent upward trend until early 2017, including more significant growth between 2018 and 2024. A similar pattern was observed in the basic food baskets of the metropolitan regions. The cost (adult/month) represented on average 26% of the minimum wage in force in each year of the analysis period and 19% of the national average per capita income between 2010 and 2023. The share of food groups in the cost of the proposed basket remained stable over the period. CONCLUSION: There has been an increase in the real cost of the proposed healthy and sustainable basic food basket at national and regional level, particularly since 2018. Moreover, the value of the healthy and sustainable basic food basket showed an upward trend in relation to the average per capita income of the population, especially since 2018.
Copyright (c) 2026 Eliseu Verly Junior, Dirce Maria Lobo Marchioni, Semíramis Martins Álvares Domene, Isabela de Albuquerque Ribeiro, Flávia Mori Sarti https://creativecommons.org/licenses/by/4.0
Profile of food and beverage street vendors around private schools in Brazil
OBJECTIVE: To describe the socioeconomic profile and activity of street vendors, as well as the profile of food sales, according to industrial processing, in the vicinity of private schools in Brazilian state capitals. METHODS: Cross-sectional study with street vendors in the immediate vicinity of a national probability sample of Brazilian private schools. Elementary and/or high schools participating in the Food Marketing in Brazilian Schools Study were included. A previously validated questionnaire was applied to characterize workers, infrastructure and food availability. Food was classified according to the NOVA system. Comparisons between macro-regions (North, Northeast, Central-West, Southeast, and South) and sizes of point of sale (smallest: 1–3 items; intermediate: 4–13 items; largest: ≥ 14 items) were evaluated using the Kruskal-Wallis test. RESULTS: The informal food and beverage trade in the immediate vicinity of 2,180 private schools was mapped, totaling 699 street vendors. There was a predominance of men (57.8%), black people (68.8%), those with completed secondary education (35.8%), and those who worked informally (91.4%), in carts and stalls, due to a lack of opportunity in the formal market (52.5%). T he median number of ultra-processed items was about twice that of in natura, minimally processed, or processed foods and preparations based on them (2.17; 95%CI 1.90–2.45). Larger outlets concentrated more ultra-processed foods in all regions, except in the Northeast, where this predominance already occurred in intermediate-sized outlets (3.32; 95%CI 2.88–3.75). The lowest ratio of ultra-processed foods was observed in the South (0.21; 95%CI 0.05–0.37) and the highest in the Northeast (3.32; 95%CI 2.88–3.75). CONCLUSION: Street vending around Brazilian private schools reflects structural inequalities and expands commercially in the supply of ultra-processed foods to children and adolescents. We recommend its inclusion as an inseparable component in the evaluation of the school food environment, to support policies that reconcile income generation and the promotion of healthy eating.
Copyright (c) 2026 Sabrina Gomes Ferreira Clark, Larissa Loures Mendes, Juliana Souza Oliveira, Luiza Delazari Borges, Letícia Ferreira Tavares, Paulo César Pereira de Castro Júnior, Letícia de Oliveira Cardoso, Raquel Canuto https://creativecommons.org/licenses/by/4.0
Factors associated with the cost of child and adolescent mental health crisis care in Brazil
OBJECTIVE: To identify the sociodemographic and clinical variables that influenced the daily costs of children and adolescents who stayed overnight in Type III Centro de Atenção Psicossocial Infantojuvenil (CAPSij - Child and Adolescent Psychosocial Care Center) or in hospital reference or emergency and urgent care from the perspective of society in the year 2023. METHODS: This is a retrospective cost analysis. Direct and indirect costs were collected. A mixed technique was used to measure costs, prioritizing the micro-costing approach and the bottom-up method for valuation. Factors influencing costs were evaluated using univariate statistical models. RESULTS: The study included 399 users. The average total cost was R$ 6,704.38 (US$ 1,149.99) and the average daily cost was R$ 1,097.97 (US$ 188.33). There was statistical significance in the correlation between daily cost and age, race, diagnostic subgroup, referral to the service, and reason for seeking care. The variable with the greatest positive variation in daily cost was seeking care for drug use (R$ 125.82; US$ 21.58), while the variable with the greatest negative variation in daily cost was being referred by another service (R$ 139.86; US$ 23.99). CONCLUSIONS: To make more efficient use of available resources, it is up to the child and adolescent mental health care network to invest in the early care of children and adolescents, especially those who are most vulnerable and who may have problems with drug use, and to increasingly encourage coordination between services.
Copyright (c) 2026 Nathalia Nakano Telles, Heloísa Garcia Claro, José Carlos Marques de Carvalho, Márcia Aparecida Ferreira de Oliveira https://creativecommons.org/licenses/by/4.0
Evaluation of the implementation of an intervention aimed at expanding Covid-19 testing, case telemonitoring and surveillance actions in Primary Health Care
OBJECTIVE: To evaluate the degree of implementation of an intervention aimed at expanding testing, isolation, quarantine, and telemonitoring of Covid-19 cases (TQT-Covid-Strategy) in primary healthcare units within an administrative health region of a municipality in Northeastern Brazil. METHODS: A decision matrix was used with dimensions and criteria derived from a logical model developed based on literature review and technical guidelines of the World Health Organization, the Brazilian Ministry of Health, and the host municipality of the administrative health region. Interviews were conducted with 121 key informants. RESULTS: The degree of implementation in the 17 health units surveyed (12 Family Health Units and five Health Centers) varied according to the final classification, dimensions, and criteria. Overall, most units were considered as having the intervention partially implemented, with the highest rated dimension being “accessibility to testing,” implemented in 82.3% of the units, followed by the use of the “digital platform,” partially implemented in 15 units. The dimension with the lowest score percentage was “monitoring cases and surveillance strategies”. CONCLUSIONS: The intervention led to significant improvements in access to testing, supported by the adoption of communication strategies that enhanced the population’s adherence. Contextual, operational, technical, and acceptance factors among health professionals and users represented important challenges to implementation. To ensure sustainability and dissemination of this strategy, investments are required to strengthen Primary Health Care, including improvement in infrastructure, expansion of the health workforce, and professionals training.
Copyright (c) 2026 Gerluce Alves Pontes da Silva, Thais Regis Aranha Rossi, Sisse Figueiredo de Santana, Alcione Brasileiro Oliveira, Ana Maria Freire de Souza Lima, Trícia Silva Santos, Izabel Cristina Neves Ramos, Carolina Pedroza de Carvalho Garcia, Laio Magno, Inês Dourado, Lígia Maria Vieira da Silva https://creativecommons.org/licenses/by/4.0
Precarious work and Covid-19: repercussions on the health of primary health care workers
OBJECTIVE: To analyze how the Covid-19 pandemic influenced the working conditions and health of primary health care professionals in a health district of a capital city in Northeast Brazil. METHODS: This was a qualitative study using the theoretical framework of the health work process, part of the formative research of the project "Expansion of testing, quarantine, e-health and telemonitoring strategies in the fight against Covid-19 in Brazil" (TQT Project). Data were collected between December 2021 and March 2022 in a health district of a capital city in Northeast Brazil to support the implementation of the aforementioned project. Twenty-two interviews and three focus groups with 19 participants, all health care professionals from the health district under study, were analyzed for their content. RESULTS: The pandemic context caused repercussions on working conditions and health, with the effects of precarious working conditions and the implementation of protective measures being highlighted as key elements in the dimension of working conditions. Mental suffering, the impact of gender issues, and post-Covid-19 conditions were identified as the main elements contributing to the illness of the professionals.CONCLUSION: The evidence set gathered in this study indicates that various stressors emerge or worsen intensely and inseparably among health care professionals, clearly demonstrating the relationship between the pandemic and the health-disease process of these workers. Therefore, it is imperative to reverse the situation of illness among workers in the post-pandemic period to mitigate its effects in the medium and long term.
Copyright (c) 2026 Ticiane Teixeira de Mendonça, Sandra Garrido de Barros, Thais Regis Aranha Rossi, Ana Clara de Rebouças de Carvalho, Denise Nogueira Cruz, Laio Magno, Ines Dourado https://creativecommons.org/licenses/by/4.0
Mental health during the COVID-19 pandemic: reports from health professionals in Rio de Janeiro
OBJECTIVE: To explore the perception of Health Professionals (HP) who worked in Primary Health Care (PHC) between 2020 and 2022, in the Manguinhos neighborhood of Rio de Janeiro, regarding the risk and protective factors for their mental health during the management of the COVID-19 pandemic. METHODS: This is a qualitative study integrated into a broader investigation on testing strategies, quarantine, digital health, and telemonitoring in areas of high socioeconomic vulnerability in Brazil. Three focus groups were conducted with community health agents and ten semistructured interviews with higher education professionals. The data were collected between November 2022 and March 2023. The analysis was conducted based on the psychodynamics of work, and the procedures followed the content analysis technique. RESULTS: The study identified several factors that contributed to high levels of stress and anxiety among health professionals who worked in family health units during the COVID-19 pandemic. The main reported factor was the constant fear of death. Additionally, work overload, lack of adequate Personal Protective Equipment (PPE), feelings of decision-making incapacity, and absence of mental health support exacerbated the impact on the professionals' health. Among community health agents, the perception of exclusion concerning the HP category was particularly noted. CONCLUSION: The COVID-19 pandemic revealed the urgent need to prioritize the mental health of health professionals from the onset of any health crisis. Preparing for future emergencies requires proactive actions, such as equitable distribution of workload, adequate provision of PPE, and free and accessible access to specialized mental health treatment for health professionals.
Copyright (c) 2026 Débora Castanheira, Carla Pereira, Thiago Silva Torres, Daniele Novaes, Gessica Ferreira, Thiago Jacobino, Thais Regis Aranha, Valdilea Gonçalves Veloso https://creativecommons.org/licenses/by/4.0
Analysis of the monitoring of the expansion of Covid-19 testing and surveillance in a municipality
OBJECTIVE: To analyze the monitoring of an intervention for expanding testing, isolation, quarantine, and telemonitoring of Covid-19 (TQT-Covid-Strategy) in an administrative health region of a municipality in Northeastern Brazil. METHODS: This is an evaluative study, whose object of analysis were data produced in the monitoring of a health intervention (TQT-Covid-Strategy), for six months, in 17 health units, namely 12 Family Health Units and five Health Centers. Monitoring matrices created through field reports, workshops with professionals and managers, and permanent education activities were analyzed. Monitoring took place in the three components of the TQT-Covid-Strategy intervention: expansion of accessibility to testing, monitoring of cases and surveillance strategies, and digital platform. The actions in each component were considered adequate (A), partially adequate (P), and inadequate (I) in relation to the activities determined in the action plan and in the protocol of the TQT-Covid-Strategy. RESULTS: The component of the expansion of accessibility to testing was considered adequate, while the monitoring of cases and surveillance strategies presented partially adequate or inadequate results in many units. As for the digital platform component, there was predominantly adequate performance in relation to registration and access to test results and case reporting. However, the use of other surveillance-related resources, such as contact tracing, was inadequate. CONCLUSIONS: Boosting the institutionalization of monitoring can be an important instrument for the implementation and improvement of health interventions. The regular presence of enablers and a widely disseminated protocol, in addition to community health agents, enhanced the intervention. However, partially adequate or inadequate results reinforced the importance of qualification of the work process in primary health care regarding surveillance actions and the use of information and communication technologies.
Copyright (c) 2026 Alcione Brasileiro Oliveira, Ana Maria Freire de Souza Lima, Thais Regis Aranha Rossi, Gerluce Alves Pontes da Silva, Sisse Figueiredo de Santana, Trícia Silva Santos, Izabel Cristina Neves Ramos, Sintique Priscila Alves Lopes, Nathalia Almeida Suzart, Laio Magno, Lígia Maria Vieira da Silva https://creativecommons.org/licenses/by/4.0
Home isolation capacity after Covid-19 diagnosis in vulnerable communities of two Brazilian cities: TQT Covid-19 Study
OBJECTIVE: To investigate factors associated with self-reported capacity to comply with home isolation after Covid-19 diagnosis in vulnerable communities in two Brazilian cities. METHODS: Cross-sectional study, with data from a study on the implementation of an intervention based on strategies of testing, isolation, quarantine, and telemonitoring (TQT) of Covid-19 in Primary Health Care in vulnerable neighborhoods (TQT Covid-19 Study). Demographic, socioeconomic, and behavioral data were used to perform descriptive and logistic regression analyses, aiming to evaluate the factors associated with home isolation capacity. RESULTS: The sample consisted of 324 participants, most of them women (72.5%) and who self-reported to be Black or mixed-race (85.2%). Regarding level of education, 20.1% had up to elementary school degree; 42% had high school degree; and 37.9% had higher education or graduate degree. The density of people per room was high in 57.1% of households. In the multivariate analysis, high household density (≥ 0.5 residents/room) was significantly associated with reduced isolation capacity (ORa = 0.41; 95%CI 0.20–0.82). Other sociodemographic and behavioral variables, including age, sex, race/skin color, level of education, history of Covid-19 infection, access to health services, and preventive behaviors, did not present a statistically significant association. CONCLUSION: According to the study, housing conditions, especially high household density, can be a determinant for adherence to home isolation. Thus, innovative prevention strategies should combine educational and structural actions that consider the household context of vulnerable families.
Copyright (c) 2026 Audêncio Victor, Fabiane Soares, Diana Zeballos, Thais Aranha Rossi, Joilson Nascimento Paim, Thiago Silva Torres, Debora Castanheira, Valdiléia Gonçalves Veloso, Inês Dourado, Laio Magno https://creativecommons.org/licenses/by/4.0
Demand creation for testing and Covid-19 surveillance indicators in the Covid-19 Testing, Isolation, Quarantine, and Telemonitoring Study
OBJECTIVE: To analyze the demand creation strategies for Covid-19 testing and to describe surveillance indicators for testing, quarantine, contact tracing, and telemonitoring in primary health care services. METHODS: This cross-sectional study used data from the Covid-19 Testing, Isolation, Quarantine, and Telemonitoring (TQT Covid-19) study, conducted from July 2022 to July 2023. Primary healthcare service units in Rio de Janeiro and Salvador were selected to apply an intervention to develop demand creation strategies for testing uptake. Demand creation strategies were grouped into online strategies, traditional means, primary health care service units, community, and active search. Logistic regression was performed to determine the characteristics of the population reached by each strategy. The following Covid-19 surveillance indicators were estimated for testing and prevention (testing rate, positivity rate, monthly incidence, and full vaccination rate); for telemonitoring (monitoring rate, severity, referrals, and mortality); for quarantine (quarantine conditions); and for contact tracing (proportion of contacts traced and refusals of testing). RESULTS: The intervention reached 12,401 individuals, and 11,843 tests were performed. Demand creation strategies that reached more individuals for testing were primary health care service units (37.0%) and active search (25.9%). The positivity rate during the study period was 27.2% in Salvador and 11.5% in Rio de Janeiro. A total of 14.1% of cases were monitored, and most were asymptomatic (42.5%) or mild (52.3%). No deaths were reported among monitored cases. The proportion of fully vaccinated individuals was 91.8%. Contact tracing identified 25.1% of reported contacts, and 41.5% declined testing. CONCLUSIONS: The intervention facilitated expanded testing. Primary health care service units and active search were the strategies that reached more individuals for testing. Telemonitoring and contact tracing were the most challenging components to implement in primary health care services units and, given their importance, should be strengthened for future pandemics. These findings underscore the relevance of surveillance for assessing public health measures, identifying gaps, and supporting data-driven decision-making to improve epidemic management.
Copyright (c) 2026 Diana Zeballos, Fabiane Soares, Laio Magno, Thais Aranha Rossi, Gabriel Alves de Sampaio Morais, Carina Carvalho dos Santos, Joice Neves Reis, Guilherme Barreto Campos, Lucas Miranda Marques, Alexandre Grangeiro, Debora Castanheira, Thiago Silva Torres, Valdilea Gonçalves Veloso, Ines Dourado https://creativecommons.org/licenses/by/4.0
Covid-19 testing in primary health care: professionals’ perceptions
OBJECTIVE: To analyze the perceptions of primary health care (PHC) professionals regarding Covid-19 testing in basic health units (BHUs). METHODS: This qualitative study, part of a formative research project, involved 22 semi-structured interviews and 4 focus groups with professionals working in PHC in a Brazilian capital city. Among other criteria, the professional most directly involved in pandemic response measures in each BHU was selected. Content analysis was performed using a deductive analytical approach, in which the findings were organized into categories defined based on the components of the health system (population; infrastructure; organization of services; service delivery or care model; and management). RESULTS: Reports commonly referred, in the population component, to the challenges arising from the limitations of PHC coverage; in the infrastructure component, the insufficiency of human resources and physical infrastructure was highlighted, which in turn required changes in the organization and provision of services, with repercussions on the care model. The contributions also revealed that at some points during the pandemic there was a disruption of the work process, especially in family health teams. In the management component, weaknesses in communication flows between the health secretariat and the BHU were identified, although this was less frequently mentioned. CONCLUSION: The perception that expanding and decentralizing testing in BHUs was necessary was confirmed. The findings point to the importance of coordinating the pandemic response and effectively decentralizing the actions adopted, of preparedness plans and strengthening PHC and its professionals, as well as investments in infrastructure and team training, and advances in actions aimed at occupational health. The pandemic revealed the importance of advancing the health economic-industrial complex and, fundamentally, strengthening and defending the Brazilian Unified Health System.
Copyright (c) 2026 Denise Nogueira Cruz, Sandra Garrido de Barros, Ana Clara de Rebouças Carvalho, Thais Regis Aranha Rossi, Laio M agno, Inês Dourado https://creativecommons.org/licenses/by/4.0
Acceptability of Covid-19 self-testing among Primary Health Care users
OBJECTIVE: To identify factors associated with the acceptability of Covid-19 self-testing among socioeconomically vulnerable populations. METHODS: Cross-sectional study using data from the “TQT Covid-19” project, which involved users from 19 primary health care (PHC) units located in socioeconomically vulnerable areas in Salvador (BA) and Rio de Janeiro (RJ), Brazil. Data were collected between July 2022 and July 2023. Descriptive analysis of Covid-19 self-test acceptability was performed, and logistic regression models were used to estimate factors associated with acceptability, with respective 95% confidence intervals (95%CI). RESULTS: Among 7,939 study participants, 45.8% (95%CI 44.75–46.95) reported willingness to use a Covid-19 self-test. In the analysis of associated factors, regarding sociodemographic profile, non-Black individuals (ORa = 1.17; 95%CI 1.02–1.34), cisgender men (ORa = 1.23; 95%CI 1.12–1.37), and participants with higher educational levels (ORa = 1.60; 95%CI 1.43–1.79) were more likely to accept the self-test. Those with prior knowledge of the self-test (ORa = 2.33; 95%CI 2.11–2.58) and those previously diagnosed with Covid-19 (ORa = 1.17; 95%CI 1.05–1.28) also reported higher acceptance. CONCLUSIONS: Provision of Covid-19 self-testing should be considered as a complement to testing within the public health system, especially due to its acceptance among vulnerable populations and the difficulties in accessing testing in many Brazilian regions. During periods of increased Covid-19 incidence, self-testing may serve as an important strategy for mass case detection, provided that access and knowledge are expanded so communities can play an active role in SARS-CoV-2 epidemiological surveillance.
Copyright (c) 2026 Fabiane Soares, Laio Magno, Thaís Regis Aranha Rossi, Suelen Seixas, Thiago Silva Torres, Débora Castanheira, Helena Lima, Ana Paula Prates, Valdiléa Gonçalves Veloso, Inês Dourado https://creativecommons.org/licenses/by/4.0
Use of chloroquine, hydroxychloroquine or ivermectin for Covid-19 prevention in vulnerable Brazilian populations
OBJECTIVE: To explore factors associated with the use of chloroquine, hydroxychloroquine, and ivermectin for Covid-19 prevention in socioeconomically vulnerable populations in Brazil. METHODS: A cross-sectional study was conducted using data from the project "Expansion of testing, quarantine, digital health, and telemonitoring strategies to tackle the Covid-19 pandemic in Brazil." Participants were users of 19 primary healthcare units in Salvador (Bahia, BA) and Rio de Janeiro (Rio de Janeiro, RJ) from July 2022 to July 2023. Data were collected via a socioeconomic questionnaire and analyzed using logistic regression to assess factors associated with the use of chloroquine, hydroxychloroquine, or ivermectin for Covid-19 prevention. Multicollinearity was assessed using the generalized variance inflation factor (GVIF), with GVIF^(1/(2*df)) > 5 indicating potential collinearity. Sensitivity analyses were performed using the same backward selection procedure as the main model: excluding “sometimes” responses and stratifying analyses by city (Rio de Janeiro and Salvador). RESULTS: Among 7,505 participants, 11.7% reported using chloroquine, hydroxychloroquine, or ivermectin for Covid-19 prevention. Use was more frequent among people who identified themselves as Brown (ORa = 1.38; 95%CI 1.10–1.75), aged 35–44 (ORa = 1.34; 95%CI 1.03–1.75) or 44–59 (ORa = 1.36; 95%CI 1.06–1.77), evangelical (ORa = 1.32; 95%CI 1.14–1.53), and with comorbidities (ORa = 1.25; 95%CI 1.07–1.47). Having up to two doses of Covid-19 vaccine (ORa = 1.30; 95%CI 1.06–1.59) and being unvaccinated while living with someone with comorbidities (ORa = 10.34; 95%CI 2.27–53.48) also increased the odds of use. GVIF values were low except for city (8.79), due to its interaction with income; the variable was retained for conceptual reasons. Sensitivity analyses yielded results consistent with the main model. CONCLUSION: The use of ineffective medications for Covid-19 prevention was higher among specific demographic groups, reflecting inequalities in access to information and the influence of religious factors. Scientific communication and community engagement strategies remain essential to combat misinformation.
Copyright (c) 2026 Débora Castanheira, Thiago Silva Torres, Thais Regis Aranha, Fabiane Soares, Ines Dourado, Valdilea Gonçalves Veloso https://creativecommons.org/licenses/by/4.0
Covid-19 and chronic conditions: lessons to strengthen care in primary health care
OBJECTIVE: To analyze the work process of Primary Health Care professionals regarding care practices aimed at users with hypertension and diabetes during the Covid-19 pandemic in a capital in Northeastern Brazil. METHODS: 35 semi-structured interviews were conducted with professionals who provided care and followed up this subpopulation in Primary Health Care, in addition to analyzing municipal documents and news reports from the Municipal Department of Health about Covid-19 and Primary Health Care. The study criteria were Primary Health Care workers who acted in the Covid-19 pandemic in the same Primary Health Care unit. Data were analyzed according to the health work process reference of Mendes-Gonçalves. RESULTS: The pandemic has imposed significant changes in Primary Health Care practices. We observed priority of spontaneous demand, weaknesses in continuous monitoring of users, emphasis on prescriptions renewal, and work in vast territories, with unattended areas, by the Family Health Strategy. CONCLUSIONS: Health practices aimed at users with chronic conditions, such as hypertension and diabetes, remain fragmented and should be resumed, but based on equity, with planning, monitoring, and knowledge of their territory in such a way to provide comprehensive and problem-solving access to the population that remains “isolated,” even with the end of the pandemic.
Copyright (c) 2026 Marina Souza Vieira, Thais Regis Aranha Rossi, Carla Maria Lima Santos, Laio Magno, Ines Dourado https://creativecommons.org/licenses/by/4.0
COVID-19, primary care, and community surveillance in vulnerable areas: lessons learned from the results of the TQT-COVID-19 Study
Copyright (c) 2026 Alexandre Dias Porto Chiavegatto Filho, Bruno Pereira Nunes https://creativecommons.org/licenses/by/4.0
Adoption of Covid-19 Preventive Behaviors in the Community: Salvador and Rio de Janeiro
OBJECTIVE: To describe the prevalence of adoption of Covid-19 preventive behaviors and to evaluate associated factors among users of health units in Salvador and Rio de Janeiro. METHODS: Cross-sectional study conducted between July 2022 and July 2023. Adoption of preventive behaviors was assessed based on eight behaviors, grouped into the following outcomes: social distancing; respiratory etiquette; mask use; hand hygiene; sociodemographic, housing, structural characteristics, and individual perceptions. All analyses were stratified by study site. Bivariate and multivariate analyses were performed using Poisson regression with robust variance. RESULTS: A total of 5,476 participants from Salvador and 1,940 from Rio de Janeiro were evaluated. The most prevalent preventive behaviors were respiratory etiquette (82.7 and 84.3%) and hand hygiene (84.9 and 79.1%), respectively. In Salvador, age remained associated with all behaviors assessed. In Rio de Janeiro, adoption of preventive behaviors increased among those who received a Covid-19 vaccine booster. In both cities, individuals aged 40–59 years, ≥ 60 years, and those not employed showed higher adherence to social distancing. Respiratory etiquette was more prevalent among women, individuals with complete high school education, and those who received a Covid-19 booster. Mask use and hand hygiene were associated with female sex, older age, and vaccine booster in both locations. Mask use was also more frequent among those vaccinated against influenza, while hand hygiene was associated with higher education. CONCLUSIONS: These findings reinforce the importance of public policies that promote maintenance of preventive behaviors and awareness of epidemic prevention, particularly among men, younger individuals, those with lower education, and those who do not receive recommended vaccines or booster doses.
Copyright (c) 2026 Gabriele Amorim, Danielle Souto de Medeiros, Fabiane Soares, Laio Magno, Thaís Regis Aranha Rossi, Thiago Silva Torres, Valdiléa Gonçalves Veloso, Débora Castanheira, Inês Dourado https://creativecommons.org/licenses/by/4.0
TQT-Covid-19 Study: coping strategies and lessons learned for the future
Copyright (c) 2026 Laio Magno, Thais Regis Aranha Rossi, Inês Dourado https://creativecommons.org/licenses/by/4.0
Impact of structural and interpersonal racism on oral health and dental services
OBJECTIVE: To analyze the role of racism in oral health and access to dental services, considering two impact pathways: structural racism and interpersonal racism. METHODS: A cross-sectional study with 686 undergraduate students, which analyzed two categories of outcomes: those related to oral health (self-perception, oral health impairment, and tooth loss) and those related to access to/perception of the quality of dental services (access to services, recent use, and evaluation of care). Exposures were race/color, racial discrimination, and characterization of the neighborhood environment. Prevalence ratios were estimated using Poisson regression with robust variance, with adjustments guided by directed acyclic diagrams. RESULTS: Black and brown people had a higher prevalence of negative self-perception (black: PR = 1.56; 95%CI 1.14–2.13; brown: PR = 1.53; 95%CI 1.14–2.05), tooth loss (black: PR = 1.99; 95%CI 1.33–2.97), lack of access to dental services (black: PR = 3.08; 95%CI 1.06–8.95; brown: PR = 3.78; 95%CI 1.49–9.59), and negative evaluation of care (black: PR = 1.63; 95%CI 1.08–2.45; brown: PR = 1.64; 95%CI 1.12–2.39). Racial discrimination was associated with lack of access (PR = 4.34; 95%CI 1.45–12.95), recent non-use of services (PR = 1.74; 95%CI 1.31–2.31) and negative evaluation of care (PR = 1.51; 95%CI 1.01–2.25). And living in neighborhoods with fewer physical and social problems was associated with a lower prevalence of negative self-perception (PR = 0.70; 95%CI 0.54–0.90), compromised oral health (PR = 0.87; 95%CI 0.76–0.99), lack of access (PR = 0.42; 95%CI 0.18–0.98), and negative evaluation of care (PR = 0.56; 95%CI 0.40–0.79). CONCLUSIONS: The findings show that racism impacts oral health through structural and interpersonal channels and highlight the urgency of broad and effective strategies to reduce the inequities affecting racialized groups.
Copyright (c) 2026 Rafaela de Oliveira Cunha, Isabel Cristina Gonçalves Leite, Mário Círio Nogueira https://creativecommons.org/licenses/by/4.0
Food policies, family farming, and climate justice in the Amazon towards COP30
OBJECTIVE: To analyze the sustainability of the food system in the Belém Metropolitan Region, based on the interface between public institutional purchasing policies (National School Feeding Program and Food Acquisition Program), considering local production, the profile of spending, the appreciation of family farming, and the principles of climate justice. METHODS: The analysis of the National School Feeding Program was based on data from the School Census (profile of schools and students) and invoices from the Accountability Management System (amounts and types of food from family farming), both from 2022. The food was classified into 12 groups. The characterization of family farming and the data from the Food Acquisition Program were based on reports on urban and peri-urban agriculture and the mapping of settlements. RESULTS: The Belém Metropolitan Region has 929 public schools and 390,552 students. In 2022, the municipalities allocated 31 million reais to the National School Feeding Program, of which 43.5% came from family farming, exceeding the legal target. Fruit accounted for the largest amounts invested, followed by vegetables and spices. In the Food Acquisition Program, the Abril Vermelho (Red April) settlement sold 28 tons of food, especially fruit, vegetables, and tubers, with pumpkin and cassava root being the foods with the highest volume, and spring onions and pepper the ones with the highest financial value. Production prioritized permanent crops, agro-ecological practices and culturally significant foods. CONCLUSIONS: The results show the potential of the National School Feeding Program and the Food Acquisition Program in the Belém Metropolitan Region to strengthen family farming, promote healthy and sustainable eating, value regional products, and contribute to environmental recovery. These policies represent strategic instruments for integrating food security and climate justice, by promoting low-impact local production, recognizing inequalities, and increasing the resilience of food systems, in line with the COP30 objectives.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
Multiple sclerosis treatment coverage: an analysis based on inequality indicators
OBJECTIVE: To assess territorial inequalities in the coverage of first-line pharmacological treatment for relapsing-remitting multiple sclerosis in the Brazilian Unified Health System (SUS) in 2024, analyzing the regional distribution of coverage, consumption, and spending, and quantifying socioeconomic inequalities using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) indicators. METHODS: An observational study based on administrative data from the SUS, integrating information from Outpatient Procedure Authorizations and epidemiological estimates to calculate consumption in defined daily doses and per capita expenditure on disease-modifying drugs. The state Human Development Index was used as a socioeconomic proxy to calculate the SII and RII indicators, which quantify absolute and relative inequalities. RESULTS: In 2024, only 35.3% of eligible patients received treatment, with coverage varying between regions (50.9% in the Central-West and 34.3% in the Northeast). The SII (0.2082) and RII (2.58) for PT/PATSUS indicated strong socioeconomic inequality in coverage. For per capita spending, there was no consistent socioeconomic gradient (SII = -99.18; RII = 0.96). Consumption in defined daily doses showed significant inequality (SII = 61.65; RII = 2.50), reflecting greater therapeutic intensity in states with a higher Human Development Index. CONCLUSIONS: The study shows important limitations in the coverage and equity of treatment for relapsing-remitting multiple sclerosis in the SUS, with structural inequalities associated with regional socioeconomic position. The integrated use of administrative indicators and inequality metrics (SII and RII) provides subsidies for policy interventions focused on distributive justice and sustainability of the public health system.
Copyright (c) 2026 Gabriela Bittencourt Gonzalez Mosegui, Cid Manso de Mello Vianna, Fernando Antoñanzas, Fabiano Saldanha Gomes de Oliveira, Deison Alencar Lucietto, Marcus Paulo da Silva Rodrigues https://creativecommons.org/licenses/by/4.0
Guttman error graphs: a visual approach to scalability analysis
OBJECTIVE: To develop an innovative graphical tool to represent Guttman errors and facilitate scalability analysis of measurement instruments in epidemiology. METHODS: Implemented in R (RStudio), the guttemap function was developed to fill this gap. It provides an intuitive visual representation of Guttman errors, with color gradients that facilitate the assessment of measurement instruments, revealing internal patterns of inconsistency. The rationale underlying the proposed Guttman error map is presented, along with an annotated summary of the routine for its implementation. RESULTS: Seven synthetic examples show the potential of graphical representation in identifying problem areas and how this helps to inform adjustments and develop more robust instruments. CONCLUSIONS: With guttemap, Guttman error analysis becomes more accessible and interpretable, contributing to the improvement of measurement instruments and the advancement of epidemiological research.
Copyright (c) 2026 Michael Eduardo Reichenheim, Claudia Leite de Moraes, João Luiz Bastos https://creativecommons.org/licenses/by/4.0
Prevalence of factors associated with chronic diseases in university students: PNS 2013 and 2019
OBJECTIVE: To assess the prevalence of risk and protective factors for non-communicable diseases among Brazilian university students. METHODS: Data from the 2013 and 2019 National Health Survey were used to assess undergraduate students (≥ 18 years). Risk factors included consumption of unhealthy foods, sedentary behavior, insufficient physical activity, alcohol and tobacco consumption, overweight, and obesity, while protective factors involved consumption of healthy foods and leisure-time physical activity. Prevalences and confidence intervals were described for each year, stratified by sex, professional occupation, race/skin color, and age group. RESULTS: The prevalence of regular consumption of soft drinks (men: 27.9% to 12.5%; women: 22.8% to 10.7%), sweets (men: 27.1% to 17.6%; women: 33.2% to 20.4%), and insufficient physical activity (men: 37.6% to 22.7%; women: 57.7% to 37.3%) decreased, while the prevalence of regular fruit and vegetable consumption (men: 16.1% to 27.2%; women: 22.6% to 34%) and leisure-time physical activity (women: 28.3% to 37.3%) increased. Regular consumption of beans (65.1% to 55.8%) and leisure-time physical activity (32.4% to 42.9%) increased among students with jobs. Leisure-time physical activity (37.2% to 46.4%) increased and sweet consumption (33.7% to 17.5%) decreased among white/Asian students, while regular consumption of beans decreased among Black/indigenous students (69.9% to 57.1%). CONCLUSION: The prevalence of most risk factors decreased. The prevalence of fruit and vegetable consumption and physical activity remained low but increased.
Copyright (c) 2026 Maria Emília Coimbra Pereira, Taciana Maia de Sousa, Daniela Silva Canella https://creativecommons.org/licenses/by/4.0
Impact of COVID-19 pandemic on tuberculosis mortality in Brazil: a time series analysis
OBJECTIVE: To evaluate changes in the trend of tuberculosis mortality in Brazil over recent decades and assess the impact of the COVID-19 pandemic on this indicator. METHODS: We analyzed the national and regional time series of tuberculosis mortality from 2000 to 2023 using joinpoint regression. To assess the pandemic’s impact, we applied two Interrupted time series (ITS) approaches: segmented linear regression and the AutoRegressive Integrated Moving Average with eXogenous variables (ARIMAX) model). We also used Autoregressive Integrated Moving Average (ARIMA) modeling to estimate excess tuberculosis deaths linked to the pandemic and to forecast mortality trends through 2030. RESULTS: An increase in tuberculosis mortality was observed starting in 2021, reaching 2.4 deaths per 100 thousand people in both 2022 and 2023 — similar to rates observed in 2011. This represents a reversal in the declining trend seen throughout the 2000s and 2010s, affecting all macroregions. The annual percentage change from 2019 to 2023 was +6.5% (95% confidence interval — 95%CI 4.42–9.98), contrasting with an average decline of -1.93% (95%CI -2.19 to -1.69) over the full period. Both ITS models consistently demonstrated a detrimental long-term reversal of the mortality trend after the pandemic. While a precise level change was not apparent using traditional segmented regression, the ARIMAX-based analysis successfully isolated a significant acute and lagged effect (β = +0.211; p = 0.0029). We estimated 6,540 excess tuberculosis deaths in Brazil between 2020 and 2023 (95%CI 3,950–9,130). The forecasting model with the pandemic effect projected higher mortality rates from 2024 to 2030, while the counterfactual scenario showed a continued decline. CONCLUSIONS: The COVID-19 pandemic had a substantial negative impact on tuberculosis mortality in Brazil, representing a setback in achieving national and global elimination targets.
Copyright (c) 2026 Bernardo Bastos Wittlin, Felipe Bezerra Pimentel Araújo, Antônio Augusto Moura da Silva https://creativecommons.org/licenses/by/4.0
Psychometric validation of the Paykel Suicidal Behavior Scale in Mexican adolescents
OBJECTIVE: To psychometrically validate the Spanish version of the Paykel Suicidal Behavior Scale in the Mexican adolescent population, and to establish an optimal cut-off point to identify risk of suicidal behavior in school contexts. METHODS: A cross-sectional study was conducted in 2022 with a non-probabilistic sample of 1,407 students from eight public high schools in the state of Morelos, Mexico. The mean age was 17 years, 58.7% were female and 41.3% were male. The students completed an online questionnaire that included the Paykel Suicidal Behavior Scale, the Center for Epidemiological Studies Depression Scale, and the Depression Anxiety and Stress Scale. A confirmatory factor analysis, item response theory, factorial invariance analysis (by sex, gender identity, and school grade), divergent validity analysis, and ROC curves were applied in this study. RESULTS: The confirmatory factor analysis was found to be acceptable. The factor loadings ranged from 0.799 to 0.938. Item discrimination parameters were elevated (2.33 to 6.63), with difficulties ranging from 0.17 to 1.11. Factor invariance was confirmed in all subgroups. The divergent validity of the Paykel Suicidal Behavior Scale was satisfactory, as evidenced by its moderate correlations with the Epidemiological Studies Depression Scale (r = 0.507), depression (r = 0.644), anxiety (r = 0.570), and stress (r = 0.541). ROC analysis identified an optimal cutoff point of ≥ 1.0, with sensitivity of 75.93% and specificity of 76.54%. CONCLUSION: The Mexican version of the Paykel Suicidal Behavior Scale demonstrates robust psychometric properties, including validity, reliability, and factorial invariance in the adolescent school population. The scale's brevity, clarity, and ease of application make it an effective tool for school screening, allowing for timely detection and referral to mental health services. Its use is recommended in adolescent suicide prevention programs in educational contexts in Mexico.
Copyright (c) 2026 Marina Séris-Martínez, Fernando Austria-Corrales, Yendy Cruz Hernández, Berenice Pérez-Amezcua, Alberto Jiménez Tapia, Claudia Iveth Astudillo-García, Leonor Rivera-Rivera https://creativecommons.org/licenses/by/4.0
Inequalities in time to cancer treatment initiation over a decade in Brazil
OBJECTIVE: To evaluate access to treatment for cervical (CVC), colorectal (CRC), thyroid (CT), and central nervous system (CCNS) cancers that differ in incidence, prognosis, early detection program, and in their requirements for high-complexity and technologically advanced treatments METHODS: Data from IntegradorRHC INCA (2013–2022) were extracted. Sociodemographic and clinic characteristics and time diagnosis-to-treatment were analyzed using multinomial logistic regression and cumulative incidence function. RESULTS: 395,225 cases of cancers were identified, CC = 168,951, CVC = 141,189, CT = 57,755 and CCNS = 27,330. Patients with CNS and CRC had higher cumulative probability (CPob) of treatment initiation within 60 days compared to CVC/CT. The North region was less likely to receive treatment within 30 days for all cancers (odds ratio — OR: CNS = 0.34; CVC = 0.30; CT = 0.17; CRC = 0.49). Radiotherapy showed a lower chance of earlier treatment for all cancers (94% lower CNS; CVC = 48%; CRC = 81%). There was a greater chance of treatment initiation within 30 days for patients with higher education for CVC (OR = 1.42); CT (OR = 2.09). White individuals demonstrated a consistently higher CPob of treatment initiation at 60 days for all cancers compared to Black (CNS: 60 versus 49%; CVC: 37 versus 29%; CT: 32 versus 21%; CRC: 52 versus 45%). For CT, males had a higher CPob of treatment 37% in males compared to 30% in females at 60 days). For CRC, CPob of treatment initiation at 60 days was higher among individuals at younger (60% compared to 46% for those aged > 69 years) and clinical stage IV (56% compared to stage 1 — 45%). CONCLUSION: In Brazil, patients requiring multimodal treatments or therapies demanding technology, such as radiotherapy or chemotherapy, faced longer delays. Regional and sociodemographic disparities persist, with timely access to cancer treatment limited in socioeconomically disadvantaged regions, such as the North and Northeast, among Black patients and individuals with lower education.
Copyright (c) 2026 Matheus de Abreu, Maria Emília Mota, Dandara Menezes de Araujo Oliveira, Yuri de Lima Medeiros, Maria Stella Moreira, Fábio Abreu Alves, Maria Paula Curado https://creativecommons.org/licenses/by/4.0
COVID-19 among health care workers in Brazil: prevalence and disparities based on respondent-driven sampling
OBJECTIVE: To determine the prevalence and disparities of COVID-19 among health care workers in Brazil. METHODS: A survey was conducted among health care workers in five Brazilian cities. Disparities in the prevalence of COVID-19 were analyzed by professional category and region (North/Northeast versus South/Southeast). RESULTS: The sample was composed of 2,499 health care workers: 601 (24.1%) nursing technicians, 1,095 (43.8%) registered nurses, and 803 (32.1%) physicians. Recruitment and data collection were conducted online from May 21, 2020, to February 10, 2021, using respondent-driven sampling. The overall COVID-19 prevalence was 48.1% (95%CI: 43.4–52.9). The highest COVID-19 prevalence was identified among nursing technicians (52.8%; 95%CI: 44.4–61.0). Nursing technicians reported undergoing fewer PCR and COVID-19 tests compared to physicians. Nursing technicians and registered nurses in the North/Northeast regions who reported COVID-19 symptoms spent much of the first year of the pandemic without access to confirmatory testing. Furthermore, the risk of laboratory-confirmed COVID-19 was significantly lower for all occupational categories in the North and Northeast regions. CONCLUSIONS: COVID-19 rates among health care workers were exceptionally high and non-uniformly distributed. This mirrors the vast socioeconomic, cultural, and political differences and the difficulty in coordinating pandemic control actions in Brazil.
Copyright (c) 2025 Ligia Kerr, Marto Leal, Rosa Lívia Freitas Almeida, Ana Zaira da Silva, Cristiane Cunha Frota, Luana Nepomuceno Gondim Costa Lima, Luciane Nascimento Cruz, Maria de Fátima Militão de Albuquerque, Mirian Cohen, Ricardo Arraes de Alencar Ximenes, Wayner Vieira de Souza, Maria Amélia de Sousa Mascena Veras, José Luis Gomes, Roberto da Justa Pires Neto, Marli Teresinha Gimeniz Galvão, Patrícia Neyva da Costa Pinheiro, Ulisses Ramos Montarroyos, Cresio Romeu Pereira, Demócrito de Barros Miranda-Filho, Paulo Roberto Borges de Souza Junior, Thália Velho Barreto de Araújo, Pedro Miguel dos Santos Neto, Cynthia Braga, Celina Maia Turchi Martelli, Carl Kendall https://creativecommons.org/licenses/by/4.0
Artificial intelligence and oral photography: an approach to the epidemiology of dental caries
OBJECTIVE: Dental caries is an important public health issue due to its high prevalence around the world, its impact on people’s quality of life, and the existence of effective methods to control and prevent it. This study aims to find the state of the art regarding the diagnosis of caries with the use of artificial intelligence in the scientific literature, which could represent future advances in its use in oral health epidemiology. METHODS: A scoping review was carried out based on a search strategy on the main health databases that found 1,439 articles by descriptors or keywords related to caries, diagnosis, and artificial intelligence. RESULTS: After analysis, 17 scientific articles composed the final sample. Of these, 94.1% are quite recent, published from 2020 onward. Although the articles were based on a clinical perspective, their objectives, results, and conclusions signal the possible effectiveness of artificial intelligence as a strategic tool for epidemiology. Frontal, lateral, and occlusal photographs served to diagnose caries on all sides of the teeth. CONCLUSION: It is essential to invest in alternatives related to artificial intelligence and oral photography to replace traditional epidemiological surveys, which would enable the full development of oral health surveillance.
Copyright (c) 2025 Luiz Roberto Augusto Noro, Maria Cristina Manzanares Céspedes https://creativecommons.org/licenses/by/4.0