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Noncommunicable diseases (NCDs) are the leading causes of morbidity and mortality in Brazil. The aim of the present study was to determine whether the reduction in the occurrence of NCDs by 2030, which is one of the Sustainable Development Goals (SDGs), will be achieved through an analysis of trends in the unconditional probability of premature deaths between 1990 and 2021 in Brazil and its 27 states. A time-series study was conducted on the probability of premature death (30-69 years of age) due to NCDs (cardiovascular diseases, neoplasms, chronic respiratory diseases, and diabetes mellitus) based on data from the 2021 Global Burden of Disease Study. Joinpoint regression models were used to estimate trends and projections up to 2030 using Holt's model. Regional inequalities were assessed based on quintiles of the sociodemographic index (SDI). The probability of premature death due to NCDs reduced from 0.233 (1990) to 0.152 (2021) (average annual percent change = -1.3; p < 0.001), with a decline in all SDI quintiles. Mortality was consistently higher among men. Projections indicate that the target of a one-third reduction by 2030 will likely not be achieved, especially in the lowest SDI quintiles, with variations according to sex. Despite the downward trend, regional and social inequalities persist. Improvements in access to health care and public policies contributed to the decline, but challenges remain, such as the weakening of risk factor control policies, the influence of commercial determinants of health, and the effects of the COVID-19 pandemic.

[This corrects the article doi: 10.1590/0102-311XEN200624].

Practices developed by nurses of family health teams (FHTs) in remote rural municipalities were analyzed. A multiple case study with a qualitative approach was conducted through 52 interviews with nurses from 27 remote rural municipalities distributed across 10 states. With few specificities among the remote rural municipalities, nurses stood out for developing a broad range of skills related to management activities, individual care practices, and actions in the local community. Irrespective of the obstacles to care faced by FHTs, the work of nurses stood out in all remote rural municipalities to overcome adversities, reestablish patient flow, and minimize the lack of care as much as possible. In all remote rural municipalities, nurses sought to reestablish the communication link and enable the continuity of care for individuals who required assistance outside primary care. None of the nurses established dialogue between folk knowledge and the biomedical actions of the practices established in primary care but recognized the cultural and ethnic diversity in the local communities. In summary, nurses in the remote rural municipalities sought to overcome communication difficulties and forged - although in a limited way - practices sensitive to the needs of individuals and the community.

Losses in the tuberculosis (TB) preventive treatment cascade among people living with HIV/AIDS (PLHIV) are frequent, ranging from the identification of individuals at risk to treatment completion. This study aimed to analyze the factors associated with the completion of TB preventive treatment and the effect of the 3HP regimen on this outcome among PLHIV in Brazil between 2021 and 2023. A retrospective cohort study was conducted using secondary data from the Information System for the Notification of People Undergoing Treatment for Latent Mycobacterium tuberculosis Infection (IL-TB). PLHIV aged 18 years or older, regardless of CD4+ T-cell count, who were reported to IL-TB as new cases or re-exposure, were included. The outcome was the completion of TB preventive treatment. Poisson regression with robust variance was used to estimate the relative risk of treatment completion, with a 95% confidence interval. The average effect of the 3HP regimen on treatment completion was estimated using propensity score weighting. A total of 15,171 PLHIV were included, of whom 11,546 (76%) completed TB preventive treatment. Completion rates were higher among individuals aged ≥60 years, those with tuberculin skin test results ≥5 mm, and those who received the 3HP regimen. The 3HP regimen showed an average effect of increasing TB preventive treatment completion by 11%. These findings highlight the positive impact of the 3HP regimen compared to monotherapy with rifampin or isoniazid, suggesting its potential to enhance TB prevention strategies among PLHIV.

The resilience of a healthcare system regards the ability of health actors, institutions, and the population to maintain their essential functions in the face of adversity and reorganize based on the lessons learned. Resilient systems can achieve and maintain equity in the health and well-being of populations and respond to public health emergencies. The present scoping review involved a search of the PubMed, Virtual Health Library, Web of Science, and SciELO databases and employed the protocol of the Joanna Briggs Institute to answer the following research question: "What does the scientific evidence indicate as strategies and barriers to the attainment of a resilient healthcare system?". The results revealed that the most strongly indicated strategies were decentralization of the system, a committed, motivated workforce, good governance and leadership, multisectoral partnerships, community involvement, an adequate information system, and investments that favor the sustainability of the healthcare system. In contrast, ineffective management without leadership, inadequate monitoring, an ineffective workforce, a lack of global solidarity, and failure to learn from past experiences constitute barriers to resilience. Understanding strategies and barriers is fundamental to the creation of a resilient healthcare system capable of dealing with chronic and acute stressors.

The aim of the present study was to analyze access to healthcare among deaf individuals who communicate through Brazilian Sign Language (Libras, acronym in Portuguese) 18 years of age or older residing in the Metropolitan Region of Campinas, São Paulo State, Brazil, comparing public and private healthcare systems. A descriptive cross-sectional epidemiological study was conducted. The data collection instrument was an online form accessible in sign language. Statistical analysis involved contingency and frequency tables, georeferencing, and logistic regression. Among the 316 participants, most considered communication with health professionals to be poor in both the public (64.3%) and private (67.6%) systems. The likelihood of effective communication was only 40.47% in the best-case scenario (patients in public healthcare with a positive self-assessment of their health status). Hearing impaired individuals who use Libras and only use the public healthcare system were 22% more likely to have effective communication with health professionals compared to those who use the private healthcare system. Both public and private health services lack linguistic and communication accessibility, mainly due to a lack of knowledge of Libras on the part of health professionals.

This study analyzes the conceptions and communication practices of government agents on HIV prevention and their symbolic and programmatic implications based on the criticism regarding the end of the paradigm of exceptionality in AIDS responses in Brazil. This reflection is part of broader research with users, professionals and managers of five municipal HIV/AIDS programs carried out in the Metropolitan Area of Rio de Janeiro, Brazil, and run by the Federal Government. Based on contributions of the social sciences to the understanding of social representations and practices in health, the investigation involved an analysis of interviews with managers (federal and local) and health professionals about the communication strategies of combined prevention (CP), HIV pre-exposure (PrEP) and post-exposure (PEP) prophylaxis and an analysis of 24 pieces of communication on CP, PrEP and PEP. Government agents reported strategies for disseminating PrEP and PEP to health professionals via consultation material and workshops, considering the turnover of this group and moral and ethical-political resistance. However, the public disclosure of prophylaxis is discreet or carried out digitally. The exploration of the meanings of the communication pieces indicates an emphasis on the clinical dimension of prophylaxis in government materials; in pieces created by nongovernmental organizations a greater contextualization of CP strategies for sexual scenes, practices, and identities was found. A shift from communication strategies to a grammar informed by the availability of biotechnologies and their dispersed enunciation was observed. The weakening of government communication in the era of CP compromises the effectiveness of the right to prevention.

Post-traumatic stress disorder represents a substantial global mental health burden, particularly in the face of cumulative violence, forced migration, and structural inequities. Narrative Exposure Therapy (NET) configures a brief trauma-focused intervention that supports the reconstruction of autobiographical memory by the chronological narration of life events. By integrating fragmented traumatic experiences into a coherent narrative, NET facilitates emotional processing and restores continuity to disrupted life stories. This regional case series examines the integration of NET into the mental health systems in Brazil, the Democratic Republic of Congo, Germany, Switzerland, Japan, Mexico, the United Kingdom, and Scandinavia. Drawing on diverse implementation experiences, the study identifies both enabling conditions and persistent challenges. Results highlight that NET is feasible and adaptable across different sociocultural and resource settings, especially when supported by sustained supervision, task-shifting strategies, and intersectoral collaboration. Embedding NET into existing service structures expanded access to evidence-based trauma care for populations often excluded from specialized treatment. These findings underscore the critical role of trauma-informed public policies in responding to the mental health consequences of violence on a global scale.

In 2008, the World Health Organization launched the Mental Health Gap Action Program (mhGAP) to scale up mental health care in non-specialized health care settings. Studies have demonstrated the benefits of mhGAP implementation while highlighting the need for better contextual adaptation and ongoing support. The challenge of integrating mental health into primary care is particularly noticeable in fragile and conflict-affected settings, where the need for such services is greater and health systems are often disrupted. A literature search was conducted on PubMed, PsycINFO, Scopus, and Web of Science to identify relevant peer-reviewed studies addressing the effectiveness of mhGAP in fragile and conflict-affected settings. Information was collected on study characteristics and design, impact of mhGAP, and main operational challenges. After full-text review, 10 articles met the inclusion criteria, reporting the impact of mhGAP on primary care personnel, on service user outcomes and in health systems. Studies reported post-training improvements in knowledge, mainly on epilepsy and psychosis. However, gaps remained in skills related to conducting mental state examinations, assessing suicide risk, and strengthening psychosocial support. The evidence was inconclusive regarding the impact of mhGAP on improving access to mental health care at the primary level. Several implementation challenges were identified, including an overemphasis on short-term knowledge transfer and the lack of structured supervision following mhGAP training.