Revista de Saúde Pública
type: channel
description: To publish and divulge scientific production on subjects of relevance to Public Health.
publisher: Universidade de São Paulo. Faculdade de Saúde Pública
language: en
publication name: Revista de Saúde Pública
issn: 0034-8910
items: Food policies, family farming, and climate justice in the Amazon towards COP30
items: Multiple sclerosis treatment coverage: an analysis based on inequality indicators
items: Guttman error graphs: a visual approach to scalability analysis
items: Prevalence of factors associated with chronic diseases in university students: PNS 2013 and 2019
items: Impact of COVID-19 pandemic on tuberculosis mortality in Brazil: a time series analysis
items: Psychometric validation of the Paykel Suicidal Behavior Scale in Mexican adolescents
items: Inequalities in time to cancer treatment initiation over a decade in Brazil
items: COVID-19 among health care workers in Brazil: prevalence and disparities based on respondent-driven sampling
items: Artificial intelligence and oral photography: an approach to the epidemiology of dental caries
items: Erratum: The protein deficit myth
items: Recrudescence of tuberculosis in the state of São Paulo post-COVID-19: trends and clusters
items: Risk of reintroduction of vaccine-preventable diseases in the state of São Paulo, Brazil
items: TVISARS-CoV-2 : a multicriteria index and urban dynamics in Minas Gerais, Brazil
items: Out-of-pocket expenditures on child health during an economic recession in Brazil
items: Dental caries and fluorosis after 40 years of community water fluoridation in São Paulo, Brazil
items: Brazil is already experiencing the brutal impacts of climate change
items: Errata: Intersectionality and mental health in university students: a jeopardy index approach
items: Reconciling advantages and difficulties: knowledge and perceptions of eventdriven PrEP among young people
items: Perceptions and practices of healthcare providers in providing HIV preexposure prophylaxis to trans adolescents and young adults and men who have sex with men
items: Factors associated with condomless anal sex among adolescent men who have sex with men and transgender women in three Brazilian state capitals: a PrEP1519 study
items: Errata: Nas intersecções: operacionalizando análise temática interseccional em prevenção ao HIV
items: Errata: Recent HIV infections and estimated HIV incidence among adolescents from key populations
items: Economic burden, mortality, and incidence of hospital admissions for cerebrovascular diseases in Brazil from 2017 to 2022: a perspective of the Brazilian Unified Health System
items: Prices paid for primary health care medicines by Brazilian municipalities
items: Barriers to implementing the WHO Safe Childbirth Checklist in maternity hospitals, Brazil
items: Spatio-temporal analysis of the double burden of malnutrition in children from the Brazilian semi-arid region
items: Purchase of food from the new staple food basket in low-income Brazilian households
items: Percepção da vizinhança e sintomas depressivos: estudo nacional ELSI-Brasil, 2015–2016
items: Yellow fever mortality in Brazil: an age-period-cohort study
items: Overall survival of neoadjuvant versus adjuvant systemic treatment for breast cancer in Brazil

Food policies, family farming, and climate justice in the Amazon towards COP30
type: item
description: 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, a…
subject: Original Articles
  topic: section
subject: Public Policy
  topic: keywords
subject: School Feeding
  topic: keywords
subject: Climate Change
  topic: keywords
subject: Social Justice
  topic: keywords
subject: Agriculture
  topic: keywords
subject: Food Supply
  topic: keywords
creator: Jaqueline Lopes Pereira
creator: Bárbara Lellis de Sá Frizo
creator: Denise Miguel Teixeira Roberto
creator: Gabriela Rigote
creator: Clara Ribeiro Camargo
creator: Fabrício Muriana
creator: Gabriela Mariano Mendonça
creator: Maurício Alcântara
creator: Roberta Moraes Curan
creator: Dirce Maria Lobo Marchioni
creator: Aline Martins de Carvalho
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-26
publication date: 2026-01-26
starting page: 2
ending page: 2
doi: 10.11606/s1518-8787.2026060007235

Multiple sclerosis treatment coverage: an analysis based on inequality indicators
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Health Equity
  topic: keywords
subject: Pharmaceutical Services
  topic: keywords
subject: Multiple Sclerosis
  topic: keywords
creator: Gabriela Bittencourt Gonzalez Mosegui
creator: Cid Manso de Mello Vianna
creator: Fernando Antoñanzas
creator: Fabiano Saldanha Gomes de Oliveira
creator: Deison Alencar Lucietto
creator: Marcus Paulo da Silva Rodrigues
rights: 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
date: 2026-01-26
publication date: 2026-01-26
starting page: 4
ending page: 4
doi: 10.11606/s1518-8787.2026060007156

Guttman error graphs: a visual approach to scalability analysis
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Psychometrics
  topic: keywords
subject: Bias
  topic: keywords
subject: Measures in Epidemiology
  topic: keywords
creator: Michael Eduardo Reichenheim
creator: Claudia Leite de Moraes
creator: João Luiz Bastos
rights: Copyright (c) 2026 Michael Eduardo Reichenheim, Claudia Leite de Moraes, João Luiz Bastos https://creativecommons.org/licenses/by/4.0
date: 2026-01-26
publication date: 2026-01-26
starting page: 1
ending page: 1
doi: 10.11606/s1518-8787.2026060007015

Prevalence of factors associated with chronic diseases in university students: PNS 2013 and 2019
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Life Style
  topic: keywords
subject: Non-communicable Disease
  topic: keywords
subject: Health Surveys
  topic: keywords
subject: Universities
  topic: keywords
creator: Maria Emília Coimbra Pereira
creator: Taciana Maia de Sousa
creator: Daniela Silva Canella
rights: Copyright (c) 2026 Maria Emília Coimbra Pereira, Taciana Maia de Sousa, Daniela Silva Canella https://creativecommons.org/licenses/by/4.0
date: 2026-01-26
publication date: 2026-01-26
starting page: 3
ending page: 3
doi: 10.11606/s1518-8787.2026060006697

Impact of COVID-19 pandemic on tuberculosis mortality in Brazil: a time series analysis
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Tuberculosis
  topic: keywords
subject: Mortality
  topic: keywords
subject: Interrupted Time Series Analysis
  topic: keywords
subject: COVID-19
  topic: keywords
creator: Bernardo Bastos Wittlin
creator: Felipe Bezerra Pimentel Araújo
creator: Antônio Augusto Moura da Silva
rights: Copyright (c) 2026 Bernardo Bastos Wittlin, Felipe Bezerra Pimentel Araújo, Antônio Augusto Moura da Silva https://creativecommons.org/licenses/by/4.0
date: 2026-02-26
publication date: 2026-02-26
starting page: e245836
ending page: e245836
doi: 10.11606/s1518-8787.2026060007226

Psychometric validation of the Paykel Suicidal Behavior Scale in Mexican adolescents
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Suicide
  topic: keywords
subject: Adolescent
  topic: keywords
subject: Education
  topic: keywords
subject: Primary and Secondary
  topic: keywords
subject: Factor Analysis
  topic: keywords
subject: Statistical
  topic: keywords
subject: Mass Screening
  topic: keywords
creator: Marina Séris-Martínez
creator: Fernando Austria-Corrales
creator: Yendy Cruz Hernández
creator: Berenice Pérez-Amezcua
creator: Alberto Jiménez Tapia
creator: Claudia Iveth Astudillo-García
creator: Leonor Rivera-Rivera
rights: 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
date: 2026-02-26
publication date: 2026-02-26
starting page: e245834
ending page: e245834
doi: 10.11606/s1518-8787.2026060007086

Inequalities in time to cancer treatment initiation over a decade in Brazil
type: item
description: 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 patien…
subject: Original Articles
  topic: section
subject: Neoplasms
  topic: keywords
subject: Uterine Cervical Neoplasms
  topic: keywords
subject: Colorectal Neoplasms
  topic: keywords
subject: Thyroid Neoplasms
  topic: keywords
subject: Central Nervous System Neoplasms
  topic: keywords
subject: Treatment Delay
  topic: keywords
subject: Sociodemographic Factors
  topic: keywords
subject: Health Inequities
  topic: keywords
subject: Health Status Disparities
  topic: keywords
creator: Matheus de Abreu
creator: Maria Emília Mota
creator: Dandara Menezes de Araujo Oliveira
creator: Yuri de Lima Medeiros
creator: Maria Stella Moreira
creator: Fábio Abreu Alves
creator: Maria Paula Curado
rights: 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
date: 2026-02-26
publication date: 2026-02-26
starting page: e245830
ending page: e245830
doi: 10.11606/s1518-8787.2026060006943

COVID-19 among health care workers in Brazil: prevalence and disparities based on respondent-driven sampling
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Health Workers
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Brazil
  topic: keywords
subject: Prevalence
  topic: keywords
subject: Disparities
  topic: keywords
subject: Respondent-Driven Sampling
  topic: keywords
creator: Ligia Kerr
creator: Marto Leal
creator: Rosa Lívia Freitas Almeida
creator: Ana Zaira da Silva
creator: Cristiane Cunha Frota
creator: Luana Nepomuceno Gondim Costa Lima
creator: Luciane Nascimento Cruz
creator: Maria de Fátima Militão de Albuquerque
creator: Mirian Cohen
creator: Ricardo Arraes de Alencar Ximenes
creator: Wayner Vieira de Souza
creator: Maria Amélia de Sousa Mascena Veras
creator: José Luis Gomes
creator: Roberto da Justa Pires Neto
creator: Marli Teresinha Gimeniz Galvão
creator: Patrícia Neyva da Costa Pinheiro
creator: Ulisses Ramos Montarroyos
creator: Cresio Romeu Pereira
creator: Demócrito de Barros Miranda-Filho
creator: Paulo Roberto Borges de Souza Junior
creator: Thália Velho Barreto de Araújo
creator: Pedro Miguel dos Santos Neto
creator: Cynthia Braga
creator: Celina Maia Turchi Martelli
creator: Carl Kendall
rights: 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
date: 2025-12-15
publication date: 2025-12-15
starting page: 51
ending page: 51
doi: 10.11606/s15188787.2025059006959

Artificial intelligence and oral photography: an approach to the epidemiology of dental caries
type: item
description: 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.
subject: Original Articles
  topic: section
subject: Dental Caries
  topic: keywords
subject: Artificial Intelligence
  topic: keywords
subject: Epidemiology
  topic: keywords
subject: Diagnosis
  topic: keywords
subject: Dental Photography
  topic: keywords
creator: Luiz Roberto Augusto Noro
creator: Maria Cristina Manzanares Céspedes
rights: Copyright (c) 2025 Luiz Roberto Augusto Noro, Maria Cristina Manzanares Céspedes https://creativecommons.org/licenses/by/4.0
date: 2025-12-15
publication date: 2025-12-15
starting page: 53
ending page: 53
doi: 10.11606/s15188787.2025059006910

Erratum: The protein deficit myth
type: item
subject: Erratum
  topic: section
creator: Ricardo Abramovay
creator: Nadine Marques Nunes Galbes
creator: Fernanda Helena Marrocos Leite
creator: Eduardo Augusto Fernandes Nilson
creator: Maria Laura da Costa Louzada
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2025-09-11
publication date: 2025-09-11
starting page: 21
ending page: 21
doi: 10.11606/s1518-8787.2025059006669err

Recrudescence of tuberculosis in the state of São Paulo post-COVID-19: trends and clusters
type: item
description: OBJECTIVE: To analyze the recrudescence of tuberculosis in the state of São Paulo after the COVID-19 pandemic, identifying temporal trends and spatial clusters of the disease. METHODS: An ecological study of tuberculosis cases reported on TBWeb in all São Paulo municipalities between January 2015 and December 2023. Time decomposition techniques, interrupted time series analysis by month and spatial analysis by municipality (global Moran index and Getis-Ord Gi*) were applied to identify trends, abrupt changes associated with the pandemic and clusters of high incidence, mortality, and treatment outcomes. The pre-pandemic (01/2015 to 01/2020), pandemic (02/2020 to 04/2022), and post-pandemic (05/2022 to 12/2023) periods were analyzed separately. RESULTS: There was an upsurge in tuberculosis in the post-pandemic period, with a 21.2% increase in the number of municipalities with an incidence > 110 cases per 100,000 inhabitants. T here was a progressive increase in the mortality trend of 0.0026 (95%CI: 0.0016 to 0.0035) deaths per 100,000 inhabitants per month after the pandemic. There was a gradual drop of 0.67% (95%CI: -1.099 to -0.246) per month in the proportion of people cured after the pandemic. High incidence clusters persisted in the Presidente Prudente region in all periods, and new clusters in Marília and Registro after the pandemic. Areas with high mortality rates persisted in the regions of Taubaté, Baixada Santista, Grande São Paulo, Registro, Sorocaba and Campinas in all periods. CONCLUSION: The recrudescence of tuberculosis in São Paulo in the post-pandemic context highlights the need for targeted strategies for early diagnosis, strengthening treatment and intensive monitoring in regions identified as clusters, especially those with vulnerable populations and structural challenges in health services.
subject: Original Articles
  topic: section
subject: Tuberculosis
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Recrudescence
  topic: keywords
subject: Trends
  topic: keywords
subject: Public Health
  topic: keywords
creator: Reginaldo Bazon Vaz Tavares
creator: Nathalia Zini
creator: Yan Mathias Alves
creator: André Luiz Teixeira Vinci
creator: Natacha Martins Ribeiro
creator: Ariela Fehr Tártaro
creator: Valter Chicalo António Caripa
creator: Maria Eduarda Pagano Pelodan
creator: Clara Ferreira de Souza
creator: Aline Aparecida Monroe
creator: Jaqueline Garcia de Almeida Ballestero
creator: Ione Carvalho Pinto
creator: Pedro Fredemir Palha
creator: Ricardo Alexandre Arcêncio
rights: Copyright (c) 2025 Reginaldo Bazon Vaz Tavares, Nathalia Zini, Yan Mathias Alves, André Luiz Teixeira Vinci, Natacha Martins Ribeiro, Ariela Fehr Tártaro, Valter Chicalo António Caripa, Maria Eduarda Pagano Pelodan, Clara Ferreira de Souza, Aline Aparecida Monroe, Jaqueline Garcia de Almeida Ballestero, Ione Carvalho Pinto, Pedro Fredemir Palha, Ricardo Alexandre Arcêncio https://creativecommons.org/licenses/by/4.0
date: 2025-12-04
publication date: 2025-12-04
starting page: 50
ending page: 50
doi: 10.11606/s15188787.2025059006987

Risk of reintroduction of vaccine-preventable diseases in the state of São Paulo, Brazil
type: item
description: OBJECTIVE: To analyze the risk classification of transmission of vaccine-preventable diseases in the municipalities of the state of São Paulo (SP) and to assess the influence of population size on the risk of transmission of vaccine-preventable diseases (RTDI) before and after the implementation of Microplanning for High-Quality Vaccination Activities. METHODS: This is an epidemiological study with an ecological design, conducted using secondary data on vaccination coverage for nine immunobiologicals recommended in the immunization schedule for children under two years of age. It also examines dropout rates for multi-dose vaccines within the same age group in the state of São Paulo, covering the years 2022 and 2023. Following the calculation of all indicators, municipalities were classified according to their risk of transmission for vaccine-preventable diseases. RESULTS: Analyses of vaccination coverage indicators, dropout rates, homogeneity of vaccination coverage among vaccines for children under two years of age, and the RTDI indicator for children aged one year or younger revealed that, in 2022, the human rotavirus vaccine had the highest proportion of municipalities reaching the coverage target (46%), followed by the meningococcal vaccine (39%). In 2023, the human rotavirus vaccine maintained the highest proportion of municipalities reaching the target (68%), followed by the pneumococcal vaccine (57%). Regarding the RTDI, in large municipalities, high risk fell from 100% to 91.2%, while in medium-sized municipalities there was a reduction from 90.8% to 66.7%, and in small municipalities, from 68.3% to 56%. CONCLUSION: Challenges remain within the state regarding the RTDI classification for vaccination, particularly in medium-sized and large municipalities. The use of immunization indicators at the municipal level can be highly effective for proposing health interventions aimed at increasing vaccination coverage.
subject: Original Articles
  topic: section
subject: Vaccination Coverage
  topic: keywords
subject: Risk Management
  topic: keywords
subject: Environmental Monitoring
  topic: keywords
subject: Disaster Surveillance
  topic: keywords
creator: José Elisomar Silva de Santana
creator: Maria Lígia Bacciotte Ramos Nerger
creator: Tatiana Lang D’ Agostini
creator: Joyce Ribeiro da Conceição Santos
creator: Sheila Aparecida Ferreira Lachtim
creator: Camilla Stephane Oliveira Silva
creator: Thales Philipe Rodrigues da Silva
creator: Fernanda Penido Matozinhos
rights: Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
date: 2026-01-30
publication date: 2026-01-30
starting page: e244780
ending page: e244780
doi: 10.11606/s1518-8787.2026060007062

TVISARS-CoV-2 : a multicriteria index and urban dynamics in Minas Gerais, Brazil
type: item
description: OBJECTIVE: To develop a municipal-level vulnerability index to COVID-19 transmission that integrates socioeconomic factors, urban infrastructure, mobility, and composite indicators of social vulnerability and leisure for Minas Gerais. This study found factors associated with the spatial distribution of COVID-19 and classified the 853 municipalities in the state by vulnerability levels. METHODS: Data on COVID-19 cases from February 2022 were combined with nine variables in three domains: (i) socioeconomic factors (trade, service, construction, and manufacturing jobs); (ii) urban infrastructure and mobility (urban area, road connectivity, and vehicle density); and (iii) composite indicators (index of social vulnerability and access to culture, sports, and leisure). A multicriteria analysis model with Pearson’s correlations was elaborated and validated by cross-validation. RESULTS: The vulnerability index ranged from 1 to 8. The municipality of Belo Horizonte showed the highest value (8), followed by Uberlândia (6) and other medium to large municipalities with high urban dynamism. Urban area (22.92%), road connectivity (17.54%), and vehicle density (12.86%) constituted the most influential variables in the model. Spatial distribution indicated greater vulnerability in metropolitan regions and regional hubs. CONCLUSIONS: The proposed index highlighted the role of structural and occupational characteristics in territorial vulnerability to COVID-19. Limitations such as the time lag of some variables, source heterogeneity, and case underreporting—especially in municipalities with lower testing capacity—may have influenced the results. Incorporating emerging technologies and sustainable practices can mitigate the risks of future pandemics and improve quality of life. The index offered a useful tool for health planning (which may be adapted to other communicable diseases).
subject: Original Articles
  topic: section
subject: Demography
  topic: keywords
subject: Epidemiology
  topic: keywords
subject: Healthcare Disparities
  topic: keywords
subject: Socioeconomic Factors
  topic: keywords
creator: Matheus Luiz Jorge Cortez
creator: Úrsula Ruchkys de Azevedo
creator: Sónia Maria Carvalho Ribeiro
creator: Anacleto Marito Diogo
creator: Danilo Cirino Muniz do Nascimento
rights: Copyright (c) 2025 Matheus Luiz Jorge Cortez, Úrsula Ruchkys de Azevedo, Sónia Maria Carvalho Ribeiro, Anacleto Marito Diogo, Danilo Cirino Muniz do Nascimento https://creativecommons.org/licenses/by/4.0
date: 2025-12-04
publication date: 2025-12-04
starting page: 49
ending page: 49
doi: 10.11606/s15188787.2025059006877

Out-of-pocket expenditures on child health during an economic recession in Brazil
type: item
description: OBJECTIVE: To investigate the association between the 2014–2016 economic recession in Brazil and households’ direct expenditures on child health across the distribution of such expenditures. METHODS: Using longitudinal datasets that followed children born in Pelotas, in the state of Rio Grande do Sul, in 2004 and 2015, estimates were obtained using a Double–Hurdle model, which provides one outcome for the probability of incurring any expenditure and another for the expected value of those expenses when they occur. RESULTS: The findings showed that the economic recession during this period reduced the likelihood of incurring any health-related expenditure, excluding health insurance, by 34% among 12-month-old children and by 29% among 24-month-old children. Regarding health insurance expenditures, the recession reduced the likelihood of occurrence by 37% among 12-month-olds and by a substantial 68% among 24-month-olds. As for the amount spent, given that some expenditure occurred, the economic recession was associated with an expected 15% higher total spending excluding health insurance, and a 9% lower expected spending on health insurance for 12-month-old children. CONCLUSIONS: Thus, total health expenditures, excluding health insurance, were less likely to occur during the economic recession; however, when such expenditures occurred, their expected value was higher. In contrast, spending on health insurance was lower in both analyses, reinforcing its preventive nature.
subject: Original Articles
  topic: section
subject: Health Expenditures
  topic: keywords
subject: Children
  topic: keywords
subject: Economic Recession
  topic: keywords
subject: Health Economics
  topic: keywords
creator: Marcelo Torres da Silva
creator: Cesar Augusto Oviedo Tejada
creator: Anderson Moreira Aristides
creator: Alicia Matijasevich
creator: Iná S. Santos
creator: Andréa Dâmaso Bertoldi
rights: Copyright (c) 2025 Marcelo Torres da Silva, Cesar Augusto Oviedo Tejada, Anderson Moreira Aristides, Alicia Matijasevich, Iná S. Santos, Andréa Dâmaso Bertoldi https://creativecommons.org/licenses/by/4.0
date: 2025-12-04
publication date: 2025-12-04
starting page: 48
ending page: 48
doi: 10.11606/s15188787.2025059006388

Dental caries and fluorosis after 40 years of community water fluoridation in São Paulo, Brazil
type: item
description: OBJECTIVE: To analyze the non-exclusive impact of community water fluoridation on the prevalence of caries and dental fluorosis in schoolchildren in the municipality of São Paulo between 1986 and 2023. METHODS: Secondary data were used for the index age of 12 years, provided by the Ministry of Health, covering caries and dental fluorosis in different years, from 1986 to 2023. The degree of caries polarization was calculated using the Gini index. Two recognized risk factors for caries—low maternal schooling and per capita income—were obtained from the municipal human development index for 1991, 2000, and 2010, the years for which they are available. Exposure to community fluoridated water was verified by analyzing 49,515 water samples obtained between 1990 and 2021. RESULTS: Caries prevalence was 94.9% (95%CI: 92.7–97.1) in 1986; 68.1% (95%CI: 60.9–75.3) in 1996; 60.2% (95%CI: 54.2–66.3) in 2003; 47.6% (95%CI: 41.2–54.1) in 2010; and 46.3% (95%CI: 38.3–54.3) in 2023. The mean DMFT decreased from 6.47 (95%CI: 6.05–6.89) in 1986 to 2.37 (95%CI: 1.96–2.78) in 1996; 1.75 (95%CI: 1.48–2.02) in 2003; 1.40 (95%CI: 1.13–1.67) in 2010 and 1.51 (95%CI: 1.03–1.99) in 2023. The proportion of decayed teeth (“D” component of DMFT) was 58.5% in 1986; 33.3% in 1996; 32.3% in 2003; 51.2% in 2010, and 56.0% in 2023. Fluoride concentrations in the public water supply were adequate during the period in question, with values predominantly (98.0%) between 0.545 mgF/L and 0.944 mgF/L of water. The mean concentration was 0.663 mgF/L and the standard deviation was 0.167. CONCLUSION: The significant decline in the mean value of the DMFT index, in the order of 76.7% from 1986 to 2023, indicates the effectiveness of fluoridation, corroborating the scientific evidence related to its effectiveness and the continuity of this measure, especially considering the persistent difficulties in accessing dental care in the city of São Paulo.
subject: Original Articles
  topic: section
subject: Dental Caries
  topic: keywords
subject: DMFT Index
  topic: keywords
subject: Fluoridation
  topic: keywords
subject: Dental Fluorosis
  topic: keywords
subject: Evidence-Based Public Health
  topic: keywords
creator: Paulo Capel Narvai
creator: Carlos Cesar da Silva Soares
creator: Antonio Carlos Frias
creator: José Leopoldo Ferreira Antunes
rights: Copyright (c) 2025 Paulo Capel Narvai, Carlos Cesar da Silva Soares, Antonio Carlos Frias, José Leopoldo Ferreira Antunes https://creativecommons.org/licenses/by/4.0
date: 2025-12-04
publication date: 2025-12-04
starting page: 47
ending page: 47
doi: 10.11606/s15188787.2025059007126

Brazil is already experiencing the brutal impacts of climate change
type: item
description: Brazil is increasingly experiencing severe climate events, including extreme droughts, wildfires, floods, and heatwaves, driven by both excessive rainfall and prolonged dry periods. These disasters have resulted in significant environmental, economic, and social losses, deepening inequality and fuelling public health crises. Climate change is disproportionately affecting vulnerable populations and contributing to the rise of disease outbreaks such as dengue and Oropouche fever. Brazil’s vulnerability stems from its diverse ecosystems, heavy reliance on agriculture and hydropower, and its critical role in global climate dynamics due to widespread deforestation. This paper examines the country’s future challenges and outlines strategies to address extreme weather events, including the development of climate adaptation policies, enhanced deforestation monitoring, and strengthened disaster preparedness. To improve resilience, Brazil must invest in comprehensive risk assessments, the integration of disaster risk indicators, and the establishment of a national climate-disaster reporting system to better anticipate, mitigate, and manage the impacts of extreme climate events.
subject: Commentary
  topic: section
subject: Climate Change
  topic: keywords
subject: Disasters
  topic: keywords
subject: Disaster Mitigation
  topic: keywords
creator: Thais Araújo Cavendish
creator: Thiago Salomão de Azevedo
creator: Michelle Bell
creator: Adelaide Nardocci
creator: Thiago Nogueira
creator: Camila Lorenz
creator: Maria de Fátima Andrade
rights: Copyright (c) 2026 Thais Araújo Cavendish, Thiago Salomão de Azevedo, Michelle Bell, Adelaide Nardocci, Thiago Nogueira, Camila Lorenz, Maria de Fátima Andrade https://creativecommons.org/licenses/by/4.0
date: 2026-01-15
publication date: 2026-01-15
starting page: e219420
ending page: e219420
doi: 10.11606/s1518-8787.2026060007009

Errata: Intersectionality and mental health in university students: a jeopardy index approach
type: item
subject: Erratum
  topic: section
creator: Andrea Camaz Deslandes
creator: Felipe Barreto Schuch
creator: Thiago Sousa Matias
creator: Renato Sobra Monteiro Junior
creator: Nicole Leite Galvão Coelho
creator: Helena Ferreira Moura
creator: Fabianna Resende de Jesus Moraleida
creator: Danilo Rodrigues Pereira da Silva
creator: Daniel Alves Pires
creator: Aline Josiane Waclawovsky
creator: Letícia Dalcero Abend
creator: Beatriz Andrade
creator: Jessica Plácido
creator: Juliana Dias de Lima
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-12
publication date: 2026-01-12
doi: 10.11606/1518-8787.2025059006197err

Reconciling advantages and difficulties: knowledge and perceptions of eventdriven PrEP among young people
type: item
subject: Erratum
  topic: section
creator: Inês Dourado
creator: Marcia Thereza Couto
creator: Ramiro Fernandez Unsain
creator: Eliana Miura Zucchi
creator: Luiz Fabio Alves de Deus
creator: Dulce Ferraz
creator: Lorruan Alves dos Santos
creator: Alexandre Grangeiro
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-12
publication date: 2026-01-12
doi: 10.11606/s1518-8787.2025059005729err

Perceptions and practices of healthcare providers in providing HIV preexposure prophylaxis to trans adolescents and young adults and men who have sex with men
type: item
subject: Erratum
  topic: section
creator: Ayra Zaine Rodrigues Urbano
creator: Dulce Ferraz
creator: Yzabelle de Lima Raymundo
creator: Eliana Miura Zucchi
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-12
publication date: 2026-01-12
doi: 10.11606/s1518-8787.2025059005589err

Factors associated with condomless anal sex among adolescent men who have sex with men and transgender women in three Brazilian state capitals: a PrEP1519 study
type: item
subject: Erratum
  topic: section
creator: Rijone Rosário
creator: Inês Dourado
creator: Marcos Pereira
creator: Lorenza Dezanet
creator: Dirceu Greco
creator: Alexandre Grangeiro
creator: Laio Magno
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-12
publication date: 2026-01-12
doi: 10.11606/s1518-8787.2025059005462err

Errata: Nas intersecções: operacionalizando análise temática interseccional em prevenção ao HIV
type: item
subject: Erratum
  topic: section
creator: Marcia Thereza Couto
creator: Cristiane Spadacio
creator: Lorruan Alves dos Santos
creator: Ramiro Andres Fernandez Unsain
creator: Isa da Silva Sorrentino
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-09
publication date: 2026-01-09
doi: 10.11606/s1518-8787.2025059005728err

Errata: Recent HIV infections and estimated HIV incidence among adolescents from key populations
type: item
subject: Erratum
  topic: section
creator: Diana Zeballos
creator: Fabiane Soares
creator: Laio Magno
creator: Celia Landmann Szwarcwald
creator: Orlando Ferreira
creator: Mateus Westin
creator: Dirceu Greco
creator: Alexandre Grangeiro
creator: Inês Dourado
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
date: 2026-01-09
publication date: 2026-01-09
doi: 10.11606/s1518-8787.2025059005997err

Economic burden, mortality, and incidence of hospital admissions for cerebrovascular diseases in Brazil from 2017 to 2022: a perspective of the Brazilian Unified Health System
type: item
description: OBJECTIVE: To analyze hospitalizations, mortality, and costs related to cerebrovascular diseases in Brazil from 2017 to 2022 and to evaluate the impact of the COVID-19 pandemic on these numbers. METHODS: Data were collected from the Brazilian Unified Health System Information Technology Department via the Hospital and Mortality Information Systems. The 2010 censuses and the inter-census projections (2017 to 2022) of the Brazilian Institute of Geography and Statistics were searched for population data. The mortality rates and incidence of hospital admissions for cerebrovascular diseases were calculated by dividing the number of deaths and the number of hospital admissions due to cerebrovascular diseases by the total population at risk, multiplied by 100,000 inhabitants, respectively. The results were stratified by age groups, regions of Brazil, sex, and calendar years. Rates were standardized by age, following the direct method from the World Health Organization. RESULTS: Data on mortality from cerebrovascular diseases showed a significant reduction throughout Brazil in general and by sex. The Brazilian Northeast showed a decrease in overall mortality, especially in women, whereas its South showed stationary numbers. Hospitalization rates remain stable, with notable increases in the age groups for younger (from zero to four years of age) and female (from five to nine years of age). Hospitalization costs increased significantly throughout Brazil, with the highest increase in its Northeast, North, Southeast, and Midwest. CONCLUSION: Mortality rates from cerebrovascular diseases decreased in Brazil, showing regional and age group variations and a worrying increase in young men. Despite stable hospitalizations, hospital costs significantly increased, indicating greater complexity of cases and reinforcing the need for more effective prevention and control strategies.
subject: Original Articles
  topic: section
subject: Cerebrovascular Disorders
  topic: keywords
subject: Stroke
  topic: keywords
subject: Hospitalization
  topic: keywords
subject: Public Expenditures on Health
  topic: keywords
subject: COVID-19
  topic: keywords
subject: Mortality
  topic: keywords
subject: Epidemiology
  topic: keywords
creator: Gabriel Medeiros Correia da Silva
creator: Luana Kitagawa Cunha Soares
creator: Ana Clara Ramon Giannelli
creator: Fernando Rocha Oliveira
creator: Luiz Vinicius de Alcantara Sousa
creator: Laércio da Silva Paiva
rights: Copyright (c) 2025 Laércio da Silva Paiva, Gabriel Medeiros Correia da Silva, Luana Kitagawa Cunha Soares, Ana Clara Ramon Giannelli, Fernando Rocha Oliveira, Luiz Vinicius de Alcantara Sousa https://creativecommons.org/licenses/by/4.0
date: 2025-11-25
publication date: 2025-11-25
starting page: 44
ending page: 44
doi: 10.11606/s15188787.2025059006781

Prices paid for primary health care medicines by Brazilian municipalities
type: item
description: OBJECTIVE: The study analyzes the prices paid by Brazilian municipalities for medicines in 2016, 2018, and 2020, comparing municipal human development index, size, region, and purchase modality. METHODS: Economic Ratio indicator, adapted from that proposed for international analyses by the World Health Organization, was used and analyses were performed using data provided by municipalities to the National Database of Pharmaceutical Assistance Actions and Services. RESULTS: The study reveals that the most socially and economically vulnerable municipalities pay more for these medicines, especially in the North and Northeast regions, which can compromise access to and the efficiency of the Unified Health System. Moreover, the article shows that municipalities that purchased in association tend to pay lower prices, suggesting that consortia may be a strategy to mitigate price inequalities. CONCLUSIONS: Based on the results obtained, we propose the adoption of regulatory, economic, and negotiation strategies to reduce these differences and ensure a more equitable distribution of medicines in Brazil.
subject: Original Articles
  topic: section
subject: Pharmaceutical Services
  topic: keywords
subject: Primary Health Care
  topic: keywords
subject: Medicines Costs
  topic: keywords
subject: Equity in Resource Allocation
  topic: keywords
subject: National Pharmaceutical Policy
  topic: keywords
creator: Wendell Rodrigues Oliveira da Silva
creator: Ivanessa Thaiane do Nascimento Cavalcanti
creator: José Roberto Peters
creator: Luis Eduardo Maciel dos Santos Ferreira
creator: Rafael Santos Santana
creator: Silvana Nair Leite
rights: Copyright (c) 2025 Silvana Nair Leite, Wendell Rodrigues Oliveira da Silva, Ivanessa Thaiane do Nascimento Cavalcanti , José Roberto Peters, Luis Eduardo Maciel dos Santos Ferreira , Rafael Santos Santana https://creativecommons.org/licenses/by/4.0
date: 2025-11-25
publication date: 2025-11-25
starting page: 45
ending page: 45
doi: 10.11606/s15188787.2025059006964

Barriers to implementing the WHO Safe Childbirth Checklist in maternity hospitals, Brazil
type: item
description: OBJECTIVE: To identify barriers to the implementation of the World Health Organization Safe Childbirth Checklist in two reference maternity hospitals—one for high-risk and one for routine-risk childbirths—and to develop a causal model applicable to these contexts. METHODS: This qualitative, exploratory study was conducted in two public maternity hospitals that had been using the checklist, since its implementation in 2014. Data were collected through focus groups interviews and brainstorming sessions conducted in 2022 and 2023. Participants included healthcare professionals involved in childbirth care and members of the patient safety center. Content analysis categorized findings based on the five domains of the Consolidated Framework for Implementation Research (CFIR). A causal model was developed using a fishbone diagram to organize results by category. RESULTS: The identified barriers were classified into four of the five CFIR domains. In the Innovation domain, the checklist itself posed challenges due to its design, complexity, and adaptability to existing workflows. In the Inner Setting, barriers included a weak patient safety culture and infrastructure limitations. The Implementation Process domain revealed deficiencies such as inadequate planning, lack of stakeholder involvement, and absence of feedback and assessment mechanisms. Unlike the high-risk maternity hospital, the Outer Setting barrier —lack of policies supporting continuing education—was identified in the routine-risk facility. CONCLUSIONS: Implementation of the checklist in the studied maternity hospitals is hindered by structural, cultural, and adaptation challenges. Limited investment in training represents a significant obstacle, highlighting the need for professional development programs. High staff turnover and the absence of specific protocols further compromise consistent use. Addressing these barriers requires comprehensive strategies to enhance adherence to and integration of the checklis…
subject: Original Articles
  topic: section
subject: Checklist
  topic: keywords
subject: Maternal Health
  topic: keywords
subject: Health Care Quality
  topic: keywords
subject: Patient Safety
  topic: keywords
subject: Implementation Science
  topic: keywords
creator: Ewerton William Gomes Brito
creator: Tatyana Maria Silva de Souza Rosendo
creator: Fernanda Pereira Marinho Amaro
creator: Wilton Rodrigues Medeiros
creator: Flôrismeiire de Souza Silva
creator: Marise Reis de Freitas
creator: Rafhael Brito de Almeida Santos
creator: Rose L. Molina
creator: Katherine E. A. Semrau
creator: Lauren Bobanski
creator: Danielle E. Tuller
creator: Zenewton André da Silva Gama
rights: Copyright (c) 2025 Zenewton André da Silva Gama, Ewerton William Gomes Brito, Tatyana Maria Silva de Souza Rosendo, Fernanda Pereira Marinho Amaro, Wilton Rodrigues Medeiros, Flôrismeiire de Souza Silva, Marise Reis de Freitas, Rafhael Brito de Almeida Santos, Rose L. Molina, Katherine E. A. Semrau, Lauren Bobanski, Danielle E. Tuller https://creativecommons.org/licenses/by/4.0
date: 2024-11-25
publication date: 2024-11-25
starting page: 41
ending page: 41
doi: 10.11606/s1518-8787.2025059006897

Spatio-temporal analysis of the double burden of malnutrition in children from the Brazilian semi-arid region
type: item
description: OBJECTIVE: To analyze the temporal trend of the double burden of malnutrition in the Brazilian semi-arid and non-semi-arid regions, and to assess its spatial distribution in the Brazilian semi-arid region among children aged 5 to 9 years, between 2008 and 2022. METHODS: Ecological time-series study based on public reports, using macrodata of body mass index-for-age and height-for-age from the Sistema de Vigilância Alimentar e Nutricional (SISVAN – Brazilian Food and Nutritional Surveillance System). For temporal analysis of the prevalence of wasting, overweight, stunting, undernutrition, and the double burden of malnutrition in the semi-arid and non-semi-arid regions, Prais-Winsten regression models were used to estimate the annual percentage change (APC%) between 2008 and 2022. To evaluate spatial distribution in the Brazilian semi-arid region, maps showing the temporal evolution of the prevalence of overweight, undernutrition, and the double burden of malnutrition were constructed. RESULTS: Between 2008 and 2022, 48.7 million children aged 5 to 9 years were registered in SISVAN-Web for body mass index-for-age and height-for-age indices. Approximately 28.1% of these lived in the Brazilian semi-arid region. The prevalence of the double burden of malnutrition in the semi-arid region exceeded 20%, with an increasing trend among children aged 7 to 9 years (APC = 0.61%; p < 0.05). Overweight showed a rising trend, while undernutrition decreased across all strata except among the Indigenous population, which remained stable (APC = −1.12%; p > 0.05). APCs in the semi-arid region were higher than in the non-semi-arid region. CONCLUSION: The study highlights a high prevalence of the double burden of malnutrition in the Brazilian semi-arid region, especially among children aged 7 to 9 years. Therefore, it is crucial to promote health actions and malnutrition prevention, strengthening existing policies and prioritizing the most vulnerable populations.
subject: Original Articles
  topic: section
subject: Nutritional Status
  topic: keywords
subject: Child Nutrition
  topic: keywords
subject: Primary Health Care
  topic: keywords
subject: Secondary Data Analysis
  topic: keywords
subject: Prevalence
  topic: keywords
subject: Geographic Mapping
  topic: keywords
creator: Maisa Póvoa de Oliveira
creator: Cíntia Pereira Donateli
creator: Daniela Mayumi Usuda Prado Rocha
creator: Helen Hermana Miranda Hermsdorff
rights: Copyright (c) 2025 Helen Hermana Miranda Hermsdorff, Maisa Póvoa de Oliveira, Cíntia Pereira Donateli , Daniela Mayumi Usuda Prado Rocha https://creativecommons.org/licenses/by/4.0
date: 2025-11-25
publication date: 2025-11-25
starting page: 40
ending page: 40
doi: 10.11606/s15188787.2025059006605

Purchase of food from the new staple food basket in low-income Brazilian households
type: item
description: OBJECTIVE: To describe the purchase of foods included in the new staple food basket by low-income households in Brazil, from 2017 to 2018. METHODS: Data on household food purchases were obtained from the 2017–2018 Household Budget Survey, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Data from 13,706 low-income households (< ½ minimum wage per capita) were analyzed. Foods were identified based on an ordinance issued by the Ministry of Social Development and Fight Against Hunger, which specifies the composition of the new staple food basket. Estimates were expressed as a percentage of caloric intake. RESULTS: Foods introduced into the new staple food basket accounted for 84.1% of the total calories purchased by low-income households in Brazil, from 2017 to 2018, with significant participation in rural areas (88.0%) and in the North (88.2%) and Northeast (85.9%) regions. Among food groups, cereals (33.5%), sugars and oils/fats (21.3%), and meats and eggs (11.6%) presented the highest contributions. Rice, corn, and other grains contributed 19.7%, whereas beans accounted for 4.7% of calories. Poultry meat and beef were the most purchased foods in the meat and egg group, representing 5.0% and 4.0% of calories, respectively. Fruits contributed 1.9% and vegetables 0.7% of calories. We observed no major differences in food purchase regarding the race/skin color of the head of the household. CONCLUSION: Analysis shows that in the 2017–2018 period, the foods included in the new staple food basket became the basis of low-income households’ diet, reinforcing the cultural viability of its implementation.
subject: Original Articles
  topic: section
subject: Staple Food Basket
  topic: keywords
subject: Healthy Eating
  topic: keywords
subject: Food Purchase
  topic: keywords
subject: Bolsa Família
  topic: keywords
subject: Low Income
  topic: keywords
creator: Marcos Anderson Lucas da Silva
creator: Lucas Braga Rodrigues
creator: Samuel Almeida Brito
creator: Luisa Gazola Lage
creator: Maria Laura da Costa Louzada
rights: Copyright (c) 2025 Marcos Anderson Lucas da Silva, Lucas Braga Rodrigues, Samuel Almeida Brito, Luisa Gazola Lage, Maria Laura da Costa Louzada https://creativecommons.org/licenses/by/4.0
date: 2025-11-24
publication date: 2025-11-24
starting page: 43
ending page: 43
doi: 10.11606/s15188787.2025059006780

Percepção da vizinhança e sintomas depressivos: estudo nacional ELSI-Brasil, 2015–2016
type: item
description: OBJECTIVE: To investigate the association between depressive symptoms and neighborhood perception among older adults living in urban areas. METHODS: This cross-sectional study included 7,115 individuals (≥ 50 years) from the baseline (2015–2016) of the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil – Brazilian Longitudinal Study of Aging) who lived in urban areas and had self-reported responses (no proxy respondents), with complete data on the outcome. The outcome was assessed using the 8-item Center for Epidemiologic Studies–Depression Scale (CES-D-8) (cutoff ≥ 4), and the exposure variable was neighborhood perception related to participants’ area of residence. Univariable and multivariable Poisson regression analyses were performed, with each exposure variable adjusted for sociodemographic characteristics and health conditions. RESULTS: The prevalence of depressive symptoms was 34.9%, being 43.8% among women and 24.5% among men. In the multivariable analysis, urban mobility issues, noise pollution, physical disorder, violence, lack of neighborhood pleasantness, low social cohesion, and perceived insecurity were significantly associated with a higher prevalence of depressive symptoms in the overall sample and among women. Among men, all variables except perceived insecurity were also significantly associated with higher prevalence of depressive symptoms. CONCLUSION: The findings highlight the importance of intersectoral action across health, urban mobility, public safety, and urban planning policies to promote mental health among older adults living in urban areas.
subject: Original Articles
  topic: section
subject: Depressive Symptoms
  topic: keywords
subject: Neighborhood Environment
  topic: keywords
subject: Neighborhood Effects
  topic: keywords
subject: Perception
  topic: keywords
subject: Middle-Aged Person
  topic: keywords
subject: Older adult
  topic: keywords
creator: Pablo Cardozo Roccon
creator: Amanda Cristina de Souza Andrade
creator: Débora Moraes Coelho
creator: Bruno de Souza Moreira
creator: Luciana de Souza Braga
creator: Maria Fernanda Lima-Costa
creator: Waleska Teixeira Caiaffa
rights: Copyright (c) 2025 Pablo Cardozo Roccon, Amanda Cristina de Souza Andrade, Débora Moraes Coelho, Bruno de Souza Moreira , Luciana de Souza Braga, Maria Fernanda Lima-Costa, Waleska Teixeira Caiaffa https://creativecommons.org/licenses/by/4.0
date: 2025-11-24
publication date: 2025-11-24
starting page: 42
ending page: 42
doi: 10.11606/s15188787.2025059006948

Yellow fever mortality in Brazil: an age-period-cohort study
type: item
description: OBJECTIVE: To analyze yellow fever mortality trends in Brazil, focusing on sexes differences and using an age-period-cohort model. METHODS: This ecological study analyzed yellow fever mortality data in Brazil from 1980 to 2019 sourced from Datasus. Population estimates were retrieved from the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality data, including age, year of death, and cause (ICD-9: 060; ICD-10: A95), were analyzed using an age period cohort model. A Poisson distribution was assumed for mortality counts, and analyses were conducted using Holford’s method and its adaptations on R. RESULTS: The results show that the incidence rate peaked at younger ages, such as 30 years (0.010/100,000 individuals, 95%CI: 0.008/100,000 to 0.013/100,000), followed by a gradual declining trend with increasing age, reaching 0.007/100,000 individuals (95%CI: 0.005/100,000 to 0.010/100,000) at 50 years onward. Regarding period, a substantial increase in the adjusted hazard ratio occurred over time, especially in 2015 (13.923 [95%CI: 11.095 to 17.471]), suggesting a significant elevation when compared with previous periods. Cohort analysis showed a trend of increasing risk until 1960 (RR = 1.000), followed by a marked reduction for more recent cohorts, such as 2010: RR = 0.056 (95%CI: 0.028 to 0.112). Vaccination analysis showed alternating periods of significant increases and decreases in vaccination rates. CONCLUSIONS: Younger individuals showed higher mortality rates, with a gradual decline with advancing age. Period effects highlighted a pronounced resurgence in recent years, particularly during the 2015 epidemic, underscoring the influence of temporal factors such as outbreaks and vaccination campaigns. Cohort analysis showed a progressive decline in mortality risk among more recent birth cohorts, likely reflecting the impact of expanded immunization programs and improved public health measures. The proposed yellow …
subject: Original Articles
  topic: section
subject: Yellow Fever
  topic: keywords
subject: Mortality
  topic: keywords
subject: Brazil
  topic: keywords
creator: Lucas Casagrande Passoni Lopes
rights: Copyright (c) 2025 Lucas Casagrande Passoni Lopes https://creativecommons.org/licenses/by/4.0
date: 2025-11-17
publication date: 2025-11-17
starting page: 31
ending page: 31
doi: 10.11606/s15188787.2025059006721

Overall survival of neoadjuvant versus adjuvant systemic treatment for breast cancer in Brazil
type: item
description: OBJECTIVE: Compare the overall survival of women with non-metastatic breast cancer who received neoadjuvant systemic therapy followed by surgery versus those who underwent surgery followed by adjuvant systemic therapy. METHODS: A nationwide retrospective cohort study was conducted using real-world data from 2008 to 2015 available on the Brazilian Unified Health System (SUS). Women aged ≥ 18 years with breast cancer undergoing surgery or neoadjuvant systemic therapy as their first treatment between 2008 and 2010 were included. Cohorts were matched using propensity score matching in a 1:1 ratio and assessed 5-year overall survival using Kaplan-Meier, compared by log-rank test and hazard ratios (HR) using Cox proportional HR model. RESULTS: A total of 23,331 women began treatment for breast cancer in SUS with neoadjuvant systemic therapy (n = 6,040) and surgery (n = 17,291). In the matched cohorts (n = 6,040 in both groups), more deaths occurred among those who received neoadjuvant systemic therapy compared with surgery as first treatment (37.3% and 19.6%, respectively; p < 0.001). Overall survival after five years was 0.641 in neoadjuvant systemic therapy and 0.816 in the surgery group (p < 0.001). For both groups, older patients (≥ 70 years) living in northern and midwestern Brazil, in municipalities with low and medium HDI, and self-declared as Black presented the lowest overall survival probabilities. Use of hormone therapy after surgery and conservative surgery instead of mastectomy were associated with higher survival. HR was 5.13 (95%CI: 2.95–8.88) in stage I, 1.57 (95%CI: 1.27–1.95) in stage II, and 1.38 (95%CI: 1.26–1.50) in stage III. CONCLUSION: Women who underwent surgery as first treatment had a significantly higher 5-year overall survival compared with those who received neoadjuvant systemic therapy. Socioeconomic and demographic factors influenced survival outcomes.
subject: Original Articles
  topic: section
subject: Breast Neoplasms
  topic: keywords
subject: Surgical Oncology
  topic: keywords
subject: Neoadjuvant Therapy
  topic: keywords
subject: Survival Rate
  topic: keywords
creator: Carolina Zampirolli Dias
creator: Carolina Campos Vieira de Sousa
creator: Thais Piazza
creator: Ilka Afonso Reis
creator: Augusto Afonso Guerra Junior
creator: Mariangela Leal Cherchiglia
rights: Copyright (c) 2025 Carolina Zampirolli Dias, Carolina Campos Vieira de Sousa, Thais Piazza, Ilka Afonso Reis, Augusto Afonso Guerra Junior, Mariangela Leal Cherchiglia https://creativecommons.org/licenses/by/4.0
date: 2025-11-17
publication date: 2025-11-17
starting page: 38
ending page: 38
doi: 10.11606/s15188787.2025059006671