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A large proportion of the world's incarcerated population is concentrated in the Americas. Research has consistently shown that mental health disorders are more prevalent among incarcerated individuals compared to the general population. Despite this, mental health necessities in prisons are often neglected, and in the Americas, the treatment gap for mental disorders remains substantial. This study aimed to conduct a scoping review of the scientific literature on the prevalence of mental health problems among incarcerated populations in American countries, from a global mental health perspective. The search included databases such as SciELO, Embase, PubMed/MEDLINE, Web of Science, Scopus, PsycINFO, and CINAHL (EBSCO) and covered publications from 2013 to 2023 in Portuguese, English, and Spanish. The final sample comprised 42 articles, of which South American countries were the most studied, followed by North American countries, while Central America had the least representation. The focus of the studies were as follows: the prevalence of mental health problems among incarcerated populations in the Americas; the links between mental disorders, aggressive behavior, and criminal recidivism; mortality among incarcerated individuals; and stigma as a barrier to accessing mental health services. According to the outcomes, investing in mental health services is essential to provide adequate care to prisoners, which could help reduce incarceration rates. However, overcrowding in prisons across the continent poses a significant barrier to the provision of mental health treatments.

Considering the importance of the effective execution of the Brazilian National School Feeding Program in promoting food and nutritional security among Brazilian children, this study proposes an economic assessment of the school meal menu in a municipality in southern Brazil. The cost-effectiveness ratio was used to relate the monetary cost of meals to the nutritional benefits, which were estimated using the Meal Quality Index. The Mann-Whitney test and Spearman's correlation coefficient (p-value = 0.05) were used for the statistical analysis. The menu consisted of 191 days of meals, including 95 snacks and 96 meals. Snacks (median = 0.11 [P25 = 0.09; P75 = 0.12]) were significantly more cost-effective compared to meals (median = 0.08 [P25 = 0.06; P75 = 0.10]), which constitutes an advantage in choosing meals over snacks, using the cost and nutritional quality relationship as a strictly objective criterion. The application of the cost-effectiveness ratio as a decision-making tool for menu management in the school meal program was positive, as it enables classifying the food offered in an analysis that combines economy and health.

Alcohol consumption is an important health-related risk factor. A 10% reduction in pure alcohol consumption in liters per capita (APC) is one of the targets of the Sustainable Development Goals (SDGs). This indicator was developed using national data and published in a governmental panel (APC-Brazil). The aim of the present study was to validate the calculation method of the APC indicator using national data for monitoring SDGs. Face validation of the indicator was performed using a metadata form created through a consensus of experts. External validation was ensured by comparing the indicator to national alcohol consumption indicators and the APC used by the World Health Organization (WHO), employing time series analysis, linear correlation, and difference of means. The metadata form was validated by the experts. The analysis of indicators for external validation demonstrated a stable trend in the APC-Brazil in contrast to the downward trend in the APC-WHO; an annual upward trend of 1.4% in regular consumption and 1.2% in binge drinking and intake frequency between three to four times a week; a 4.7% reduction in the frequency of daily intake; an increase in beer (2.3%) and wine (3.5%) sales; and a positive correlation between the APC-Brazil and the mortality rate for individuals 15 years of age or older due to causes fully attributable to alcohol consumption. The APC-Brazil was validated. The comparisons of the indicators demonstrate the suitability of the APC-Brazil in reflecting national alcohol consumption patterns in the population, enabling the implementation of strategies aimed at reducing the burden of this consumption in Brazil.

This article analyzes the implementation of changes in national primary health care (PHC) policies in Brazil, and their repercussions in the Metropolitan Health Region I of Rio de Janeiro and in the Northern MacroRregion of Paraná between 2017 and 2022. This multicenter study adopts a comparative approach and mixed methods to identify similarities and differences between cases in three analytical axes: profile, institutional positioning, and conceptions about PHC; organizational decisions related to the work process; coverage and composition of teams. A total of 44 interviews were conducted with managers in 14 selected municipalities and secondary data were analyzed. Higher degrees in health, introduction to Public Health and short time in office, due to municipal elections, were common characteristics of the interviewees. There was convergence in the conceptions of PHC and the Family Health Strategy, as well as tensions and favorable positions for the Prevent Brazil Program, which encouraged organizational changes in the registration of the population and in the fulfillment of goals. A diverse set of strategies for monitoring, evaluation and maintenance of programs and actions was identified, as well as a reduction in the number of community health agents per team and an increase in the number of teams per basic health unit. Despite the predominance of family health teams, there were differences between the proportion of the registered population and the number of teams in the Family Health Support Center. The analysis suggests that the implementation of PHC guidelines and their repercussions are influenced by complex and interdependent factors, such as municipal capacities, intergovernmental relations, and state action within the regional context.

Temporal trends in cesarean section (C-sections) rates were analyzed in Brazil and its regions using the Robson classification system. An ecological time-series study was conducted with data from the Brazilian Ministry of Health about C-section rates from 2014 to 2022. Joinpoint models were used to estimate percentage changes in C-section rate trends in the units of analysis. C-section rate in the study period was 56.4%. Robson groups with low expected C-section values (R1 to R4) represented 46% of the total rate of C-sections, with higher rates in the R2 and R4 groups. In these groups, rates increased significantly in Brazil and all its regions during the study period. However, a significant decrease in rates was observed in the R1 and R3 groups, from 2014 to 2016 in Brazil and in the North, Northeast, and Southeast regions. Despite its larger relative size among groups and greater contributions to the total C-section rate, the R5 group had a small but significant increase in rates in the Central-West Region only. Groups with higher expected values for C-sections (R6 to R10) showed a general upward trend, except for R9. The results indicate an excess of C-sections in Brazil and its regions, especially in low obstetric risk groups. Therefore, efforts to reduce unnecessary C-sections should be based on interventions to improve labor management in nulliparous women and promote vaginal birth after the procedure.

[This corrects the article doi: 10.1590/0102-311XPT175024].

Different perspectives with regards to illness may be influenced by distinct cultures. The aim of the present study was to explore illness representations of the part of Brazilians with Alzheimer's disease (AD). A qualitative study was conducted involving 12 participants with mild and moderate AD using a semi-structured interview guide. Interpretative Phenomenological Analysis was used to guide the analysis of the participants' accounts, resulting in themes that formed five categories. The biological category (six participants) emerged from a group that acknowledged their memory deficits. Two participants from this group mentioned memory deficits and labeled their condition as a disease without the use of diagnostic labels. Three participants from this category recognized memory deficits and related their difficulties to the aging process. The psychosocial category resulted from the accounts of two participants who acknowledged memory deficits and attributed such deficits to the erosion of memory function as well as troubles with day-to-day stress. A mixed category (one participant) included biological, psychosocial, and cultural aspects. The participant labeled the disease as "Zazá", which was considered a cultural euphemism. Two additional categories were identified: one with two participants uncertain of how to make sense of their condition and the last one included one participant who was unaware of her condition. The present results show that illness representations of individuals with AD are influenced by emotional, social, and cultural contexts, and are also deeply embedded in individual coping mechanisms.

Given the centrality of comprehensive care and network organization as key outcomes of matrix support, this study aims to examine changes in the operation of the community mental health network in Itatiba, São Paulo State, Brazil, after the implementation of matrix support, focusing on three main components: (i) users' profile; (ii) identification of available therapeutic interventions; and (iii) analysis of the clinical care received by participants across the studied services. This is a repeated cross-sectional, document-based descriptive study with two measurement points (T0 and T1). Data for T0 were collected between May and July 2019, and for T1 between November and December 2021. A total of 1,958 records were analyzed at T0 and 1,431 at T1, using descriptive statistical analysis to estimate absolute and relative frequencies for each variable. The findings indicate substantial changes in referral patterns following matrix support implementation, with a decrease in spontaneous demand and a greater role of primary care in coordinating access to specialized mental health services. Improvements were also observed in clinical care, with increased attention to vital signs measurement, anamnesis, physical exams, and documentation of smoking, alcohol, and psychoactive substance use. These results suggest that matrix support contributed to a more structured and effective mental health network, enhancing integration between care levels and promoting more comprehensive and accessible care.

The Brazilian National Oral Health Policy has increased access to dental services for the Brazilian population. However, it is not clear whether there has been a reduction in oral health inequalities in the country. The aim of the study was to investigate the evolution of socioeconomic inequalities in oral health, the use of oral hygiene products, and the use of dental services in the adult population of Brazil between 2013 and 2019. Data from the Brazilian National Health Survey conducted in 2013 (n = 60,202) and 2019 (n = 88,531) were used to calculate the slope index of inequality (SII) and relative index of inequality (RII) in terms of schooling and family income per capita. The dependent variables were the use of a toothbrush, toothpaste, and dental floss, functional dentition, use of dental services at least once in life, use of dental services in the previous year, and use of dental services for preventive care. Inequalities in the use of oral hygiene products and the use of dental services reduced between 2013 to 2019. However, functional dentition maintained the same levels of inequality in terms of schooling (RII = 1.6) and income (RII = 1.3). Schooling inequalities in the use of preventive dental care increased (SII = 33.3 in 2013, SII = 38.9 in 2019). This study underscores the need to reorient the Brazilian National Oral Health Policy in order to reduce tooth loss and improve the use of dental services for preventive care in the most vulnerable groups. Despite improvements in the use of dental services and oral hygiene products, socioeconomic inequalities in oral health persist in Brazil.