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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.

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.

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.

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.

Objective: To describe all stages of developing strategies and quality control in the Aging and Brain Working Study linked to the Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil - Brazilian Longitudinal Study of Adult Health), a prospective cohort of 15,105 civil servants (aged 35-74) followed up since 2008.

Methods: Based on the sample of participants alive at the beginning of the sample selection in September 2022 (n = 4,566) from ELSA-Brasil (Centro Investigação São Paulo), a representative sample of 2,165 individuals was calculated according to the following criteria and divided into two subsamples: (1) Sample of participants < 70 years old in Wave 3 (2017-2019) randomized according to cognitive trajectory from Wave 1 to 3, n = 1,670; (2) SuperAgers case-control sample, individuals aged ≥ 70 years in Wave 3, based on episodic memory in Wave 3, n = 495 participants (171 cases, 324 controls). The processes implemented to ensure quality control of information prior to data collection were selection of data collection instruments, training and certification of teams, preparation of a manual of definitions and standardized operating procedures, pilot studies, data collection logistics, harmonization of imaging protocols, and creation of an anti-noise device. Given the scope of the study, its multicenter nature, and the diversity of measures involved, this project required the implementation of effective quality assurance and control protocols, ensuring standardization, methodological consistency, and data integrity at all stages.

Results: After implementing the quality assurance and control processes, the final stages related to clinical and imaging data collection, management, and continuous monitoring of field activities were conducted, with weekly reports and statistical monitoring of the sample.

Conclusions: The adoption of systematic stages of development and quality control was fundamental to ensure the production and reliability of information from brain neuroimaging studies.

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.

Objective: To describe the mortality profile and analyze the causes of death among international migrants residing in Brazil between 2011 and 2022.

Methods: This is a cross-sectional, descriptive, and ecological study based on secondary data. The sociodemographic profile of deaths reported from 2011 to 2022 was analyzed. Absolute and relative frequencies, as well as mortality rates per 100,000 inhabitants, were calculated by country of birth, macroregion, and federative unit of residence. The underlying causes of death were also analyzed.

Results: A total of 173,807 deaths among international migrants were recorded between 2011 and 2022, with the highest number in 2021 (17,779; 10.2%). The predominant mortality profile was male (97,053; 55.8%), aged ≥ 81 years (104,308; 60.0%), White (136,835; 78.7%), and widowed (72,156; 41.5%). Most deceased migrants were born in Portugal (64,909; 37.3%), Japan (22,748; 13.1%), Italy (16,178; 9.3%), and Spain (12,835; 7.3%). The highest mortality rates were observed among migrants born in Lithuania (190,079/100,000), Serbia (146,794/100,000), and Hungary (96,395/100,000). The Southeast (137,457; 79.1%) and South (18,603; 10.7%) macroregions accounted for the majority of deaths, with the highest mortality rates observed in the states of Rio de Janeiro (25,349/100,000), São Paulo (23,574/100,000), and Mato Grosso do Sul (18,683/100,000). The covid-19 pandemic led to an increase in infectious and parasitic diseases from 2020 onward, peaking in 2021 (4,460; 25.0% of deaths that year). The most frequent underlying cause of death during the study period was unspecified acute myocardial infarction (12,141; 7.0%).

Conclusion: This study highlights the need for targeted health actions addressing international migrant profiles at higher risk of death and their specific causes of mortality. However, the general invisibility of this population in public health indicators hinders the implementation of effective strategies. Policies ensuring equitable access to healthcare services, medications, and vaccines are essential to improve long-term health outcomes of this population.

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.

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).

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.